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Clinical pathology selected abstracts

February 2024—Patients receiving a pathology report may have many outstanding questions that can cause anxiety and confusion. The 21st Century Cures Act has increased patients’ access to pathology reports via delivery to patient portals. However, reports sent without further explanation can exacerbate the anxiety and confusion. Many health care institutions are creating new communication methods to help patients interpret these reports and develop a better understanding of their health status. One such approach is the pathology explanation clinic (PEC), which is an interactive visit between patients and pathologists to discuss the pathology report and review the patient’s slides.

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Anatomic pathology selected abstracts

February 2024—The gold standard for prostate cancer diagnosis is the pathological examination of prostate biopsy tissue by light microscopy. The application of artificial intelligence (AI) to digitized whole slide images (WSIs) can aid pathologists in cancer diagnosis, but robust, diverse evidence in a simulated clinical setting is lacking. The authors conducted a study to compare the diagnostic accuracy of pathologists who read WSIs of prostatic biopsy specimens with and without AI assistance. Eighteen pathologists, two of whom were genitourinary subspecialists, evaluated 610 prostate needle core biopsy WSIs prepared at 218 institutions, with the option for deferral. Two evaluations were performed sequentially for each WSI: the first without assistance and the second, conducted immediately thereafter, aided by Paige Prostate (Paige, New York City).

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Molecular pathology selected abstracts

February 2024—Precision cancer medicine relies heavily on understanding the genomic landscape of tumors. Prior comparisons between African and European ancestry, though based on limited data, have indicated distinct differences in the landscape of cancer driver alterations between these populations. Whether these discrepancies are mediated by genetic variants or environmental influences is still unclear. Accurately characterizing ancestry-associated genomic alterations is essential to not only improving genomic diagnostic testing but also to developing targeted therapies, biomarkers, and personalized cancer care for diverse populations. The authors conducted a study that leveraged two large genomic cohorts to investigate the relationship between genomic alterations and African ancestry in six common cancers: prostate, pancreas, ovary, nonsmall cell lung cancer (NSCLC), colorectal, and breast.

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Clinical pathology selected abstracts

January 2024—People respond differently to SARS-CoV-2 infection, with some having a very severe clinical course and sequelae while others recover quickly. Several research studies have used laboratory data to identify patient populations most at risk for severe outcome from COVID-19. However, many of these studies were conducted in China and did not represent the demographics of the U.S. population. Among the drawbacks of these studies were that most analyzed variance between two patient groups, yet statistical differences don’t always correlate with clinically useful predictions. Furthermore, these studies used data from throughout patients’ disease course, and clinicians would like to identify patients at risk during their initial interaction.

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Anatomic pathology selected abstracts

January 2024—Diffuse parenchymal lung disease is a well-recognized complication of systemic connective tissue disease but rarely arises in patients with psoriasis or psoriatic arthritis, which are poorly understood. Therefore, the authors conducted a study to characterize diffuse parenchymal lung disease (DPLD) associated with psoriasis or psoriatic arthritis, with or without prior immunomodulation. Their pathology consultation files were searched for patients having psoriasis or psoriatic arthritis and DPLD. After excluding cases with active infection or smoking-related DPLD only, 44 patients (22 of whom were women; median age, 60 years; range, 23–81 years) were enrolled in the study. Clinical history and pathology slides were reviewed.

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Anatomic pathology selected abstracts

December 2023—Cytomegalovirus hepatitis in allograft livers is a significant infectious complication for which the histology historically has been described as overlapping that of acute cellular rejection, a diagnosis that compels a different treatment regimen. The authors conducted a study to update the clinicopathologic features of cytomegalovirus (CMV) hepatitis and explore its clinical and histologic relationship with acute cellular rejection (ACR). They performed a retrospective analysis of 26 patients, across four institutions, who were diagnosed with CMV hepatitis, assessing clinical, histologic, and IHC features. Patients were predominantly CMV donor positive/recipient negative (D+/R-; n=9 of 15) and received a diagnosis of CMV hepatitis at a mean age of 52 years (standard deviation [SD], 17 years) and at a mean interval of 184 days (SD, 165 days) from transplantation. Mean CMV viral load at diagnosis was 241,000 IU/mL (SD, 516 000 IU/mL), and liver biochemical enzymes were elevated (mean alanine aminotransferase, 212 U/L [SD, 180 U/L]; mean aspartate aminotransferase, 188 U/L [SD, 151 U/L]; and mean alkaline phosphatase, 222 U/L [SD, 153 U/L]).

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Clinical pathology selected abstracts

December 2023—Efforts to develop biomarkers that help predict risk factors for preeclampsia/eclampsia and to better understand the trends and implications related to new-onset hypertensive disorders in pregnancy have grown. New-onset hypertension arising during pregnancy (gestational hypertension and preeclampsia/eclampsia) is associated with coronary heart disease, heart failure, stroke, and other cardiovascular-related mortality. Hypertensive disorders of pregnancy have grown into major public health problems that contribute to maternal morbidity, mortality, and future risk of cardiovascular disease. The authors conducted a study to describe contemporary trends in new-onset hypertensive disorders of pregnancy in the United States. They conducted a serial cross-sectional analysis of 51,685,525 live births to women aged 15 to 44 years, from 2007 to 2019, using the Centers for Disease Control and Prevention’s natality database.

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Molecular pathology selected abstracts

December 2023—Immune checkpoint blockade therapy has dramatically altered treatment options for a variety of cancers. A high tumor mutation burden (TMB) is considered one of the strongest predictors of immune checkpoint blockade response. DNA mismatch repair deficiency (MMRd) is associated with a high TMB, and many tumors associated with MMRd have shown excellent response to immunotherapy. However, most MMRd tumors do not show durable response to treatment with immune checkpoint blockade (ICB). Intratumor heterogeneity may further mediate response to ICB therapy.

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Clinical pathology selected abstracts

November 2023—Among the many reasons unnecessary laboratory tests are ordered in a hospital are preselected orders on order sets, clinician habits, and trainee concerns. Laboratory tests are among the highest volume procedures performed in inpatient hospital care. Excessive use of these tests can lead to patient discomfort as a result of unnecessary phlebotomy and contribute to iatrogenic anemia and increased risk of bloodstream infections. It can also contribute to the rising cost of medical care. Many laboratory stewardship programs have been developed to improve how clinicians order and use lab tests.

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Anatomic pathology selected abstracts

November 2023—Claudin-4 is a sensitive and specific marker for carcinoma in effusion cytology. The authors examined the diagnostic use of claudin-4 versus MOC-31 and Ber-EP4 by comparing their sensitivity, specificity, positive predictive value, and negative predictive value in differentiating carcinoma from mesothelioma and benign/mesothelial hyperplasia in effusion specimens. They conducted a retrospective study on a cohort of 229 cytology specimens, including 211 effusion fluid and 18 fine-needle aspiration specimens. The cytologic categories included 134 carcinoma, 28 mesothelioma, 46 indefinite (suspicious and atypical), and 21 benign.

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Molecular pathology selected abstracts

November 2023—Dilated cardiomyopathy is characterized by dilation and weakening of one or both ventricles combined with impaired contractility. Although several external etiologies are associated with dilated cardiomyopathy (DCM), a familial form (comprising about half the known cases of DCM) has symptoms that tend to arise in mid-adulthood. Despite the genetic nature of the familial form, little is known about the genetic profile of the disease. Black patients have an increased familial risk of DCM and often have a worse prognosis. The authors conducted a study in which they used genomic ancestry to compare the rare variant genetic architecture of DCM within a diverse patient population.

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Clinical pathology selected abstracts

October 2023—Several large randomized controlled trials have shown the safety of tolerating hemoglobin levels as low as 7 g/dL in critically ill hemodynamically stable children. These trials have led to recent guidelines advocating for restrictive transfusion therapy, which is significantly changing practices in pediatric critical care.

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Anatomic pathology selected abstracts

October 2023—Special AT-rich sequence-binding protein 2, or SATB2, induces local chromatin loops to facilitate transcription. SATB2 immunostaining is commonly used as a marker for colorectal adenocarcinoma and osteosarcoma. The authors conducted a study to better understand the prevalence and diagnostic value of SATB2 expression in cancer by analyzing a comprehensive set of human tumors. SATB2 expression was analyzed in 15,012 tissue samples from 120 tumor types and subtypes and 608 samples from 76 nonneoplastic tissue types using IHC in a tissue microarray format. SATB2 positivity was found in 89 of the 120 (74 percent) tumor types—59 of the 120 (49 percent) had at least one moderately positive tumor and 38 of the 120 (32 percent) had at least one strongly positive tumor.

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Molecular pathology selected abstracts

October 2023—Ovarian cancer is the eighth most common cancer in women. There are several histological types of ovarian neoplasms, and all rank among the deadliest gynecological cancers. However, those with homologous recombination deficiency (HRD) may benefit from a recently discovered category of drugs, called poly ADP-ribose polymerase inhibitors (PARPi). The homologous recombination repair pathway, which is responsible for repairing double-strand DNA damage, involves several genes, including BRCA1, BRCA2, and ATM. People with germline or somatic deleterious alterations of these genes are at higher risk of certain malignancies, such as ovarian, breast, prostate, and pancreatic cancers.

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Clinical pathology selected abstracts

September 2023—Approximately 30 percent of U.S. employees report that they have been bullied in the workplace, and these numbers are even higher for remote workers. Bullying is defined as any act or situation in which someone is subjected to recurrent, systematic, serious negative or hostile behavior and long-lasting acts designed to oppress or abuse another person. This behavior may include belittling, humiliating, personally attacking, verbally criticizing, or intentionally excluding a coworker. Bullying can harm both the target of the attack and the organization that employs the bully and the targeted person. The potential negative effects on an organization can be high staff turnover, a decrease in employee performance and productivity, and an increase in errors and medical mistakes.

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Anatomic pathology selected abstracts

September 2023—Understanding of the pathologic and molecular features of endometrial cancer has advanced measurably since the FIGO (International Federation of Gynecology and Obstetrics) staging system was updated in 2009. New treatments, results of clinical trials, and prognostic survival data that correlate with pathologic and surgical findings have been reported. Therefore, the FIGO Committee on Women’s Cancer determined that changes to the FIGO system were necessary. The goals of the revised staging system are to further clarify the diverse biologic nature of endometrial carcinomas with differing prognostic outcomes, better define the prognostic groups, and create substages that yield more appropriate surgical, radiation, and systemic therapies. The cancer committee developed a subcommittee on endometrial cancer staging in October 2021, of which the authors are members.

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Molecular pathology selected abstracts

September 2023—Neurodegenerative diseases are a broad group of disorders characterized by progressive loss of nerve cells in the central or peripheral nervous system. These diseases are often chronic and incurable, with symptoms ranging from cognitive decline to motor or sensory dysfunction. There are many types of neurodegenerative diseases, with various underlying etiologies. One group of diseases, the synucleinopathies, are associated with the misfolding and aggregation of the protein α-synuclein. This group includes disease entities such as Parkinson disease, dementia with Lewy bodies, and multiple-system atrophy.

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Clinical pathology selected abstracts

August 2023—Burnout has been reported to affect as many as 44 percent of physicians. It is listed in the International Classification of Diseases 11th Revision (ICD-11) and has been attributed to chronic workplace stress, emotional exhaustion, depersonalization, and a low sense of personal accomplishment. A social psychologist created the Maslach Burnout Inventory (MBI) tool to measure degrees of burnout. The 2018 Canadian Medical Association Physician Health Survey of 3,000 members found an overall burnout rate of 30 percent, and 28 percent of pathologists who responded to that survey indicated they were burned out. Physician burnout can have a significant negative impact on patient care, including on the amount of medical errors. It has been estimated that physician burnout costs the Canadian health care system CAD $185 million due to early retirement and CAD $27.9 million due to reduced professional work effort.

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Anatomic pathology selected abstracts

August 2023—Gastric foveolar-type adenoma is a rare benign neoplasm that occurs sporadically or presents in patients with familial adenomatous polyposis. The molecular features of foveolar-type adenoma (FA) and the relationship between sporadic and syndromic lesions remain unclear. The authors conducted a study in which they performed clinicopathological, immunohistochemical, and genetic analyses of 18 sporadic and 30 familial adenomatous polyposis (FAP)-associated FAs. The majority of sporadic and FAP-associated FAs were located in the upper or middle third of the stomach on a background of fundic gland mucosa. Most lesions were low grade, but three had a high-grade component.

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Molecular pathology selected abstracts

Augstus 2023—Atypical hemolytic uremic syndrome is a rare, potentially life-threatening thrombotic microangiopathy. The disorder causes tiny blood clots to form in blood vessels and results in organ damage. Clinical findings in atypical hemolytic uremic syndrome (aHUS) include hemolytic anemia, low platelet count, and acute kidney failure. In many cases, HUS is caused by Shiga toxin-producing E. coli, other infections, or certain medications, or it can result from other health conditions. The label “atypical” is used to delineate hemolytic uremic syndrome that is not due to any of these common causes.

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Clinical pathology selected abstracts

July 2023—Hemolytic disease of the fetus and newborn is caused by maternal immunoglobulin G crossing the placenta and binding to fetal RBC antigens. In severe cases, it results in fetal or neonatal anemia, edema, hepatosplenomegaly, and death. In China, antibodies to the ABO blood group system are the most common cause of hemolytic disease of the fetus and newborn (HDFN) and account for 85.3 percent of cases. This is followed by antibodies to the Rh blood group system, which account for 14.6 percent of HDFN cases. Other blood group systems, including Duffy, Kidd, and MNS, may also cause HDFN.

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Anatomic pathology selected abstracts

July 2023—High-grade appendiceal mucinous neoplasm is a relatively recent term that describes a rare epithelial neoplasm of the appendix that demonstrates pushing-type invasion but high-grade cytologic atypia. Because it has been understudied, the authors conducted a multi-institutional retrospective study to describe the clinicopathologic features of high-grade appendiceal mucinous neoplasm (HAMN). They reviewed the clinical and histologic features of 35 HAMNs and the molecular features of eight of the cases. Patients were an average of 57 years old and most commonly presented with abdominal or pelvic pain. Histologically, 57 percent of the tumors showed widespread high-grade features.

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Molecular pathology selected abstracts

July 2023—Non-muscle-invasive bladder cancer accounts for the majority of bladder tumors and is typically treated with transurethral resection of the bladder tumor followed by adjuvant intravesical Bacillus Calmette-Guérin instillations. However, the long-term effectiveness of Bacillus Calmette-Guérin (BCG) is limited, and patients with recurrent or progressive disease have lower survival rates. Understanding the genetic makeup of tumors and identifying molecular subtypes associated with BCG response could provide valuable insights that aid in developing personalized treatments. The authors conducted a study in which they performed whole-transcriptome sequencing of non-muscle-invasive bladder cancers (NMIBCs) from 132 patients who had never received BCG treatment and 44 patients whose cancer recurred after BCG treatment. Based on these patients’ results, the authors identified three unique molecular subtypes among the tumors—BRS1, 2, and 3. Patients with BRS3 showed increased epithelial-to-mesenchymal transition pathway activity and their tumors were enriched for mutations associated with the extracellular matrix when compared with the other two subtypes.

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Clinical pathology selected abstracts

June 2023—Studies that address whether the incidence of dementia in the U.S. population is declining are inconsistent. They cannot establish conclusive trends in disease rates. Most studies are hard to interpret due to small sample sizes or use of hospital-based autopsies. Understanding trends in dementia is necessary from a public health perspective and for planning interventions. Therefore, the authors conducted a study to characterize trends in pathways underlying dementia using two U.S. cohorts focused on aging and dementia.  

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Anatomic pathology selected abstracts

June 2023—The authors conducted a study to examine whether quantitative digital pathology can derive valuable information from readily available and inexpensive H&E slides and thereby augment routine pathologic reporting of colorectal carcinoma. They applied a quantitative segmentation algorithm (QuantCRC) to 6,468 digitized H&E slides of colorectal carcinoma (CRC). Fifteen parameters from each image were recorded and tested for associations with clinicopathologic features and molecular alterations. A prognostic model was developed to predict recurrence-free survival using data from the internal cohort (n=1,928) and validated on an internal test (n=483) and external cohort (n=938). There were significant differences in QuantCRC according to stage, histologic subtype, grade, venous/lymphatic/perineural invasion, tumor budding, CD8 IHC, mismatch repair status, KRAS mutation, BRAF mutation, and CpG methylation.    

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Molecular pathology selected abstracts

June 2023—Endometriosis is defined by the presence of endometrial-like tissue outside of the uterus and can cause debilitating pelvic pain and often infertility. It has also been associated with a range of reproductive, metabolic, inflammatory, and chronic pain conditions. While it is fairly common, affecting five to 10 percent of women of reproductive age, treatment options are limited, and the precise causes of endometriosis, as well as its relationship with other conditions that cause chronic pain, remain unclear. Studies estimate that endometriosis has a heritability of approximately 50 percent. Nine genomewide association studies (GWAS) of endometriosis involving women of European and East Asian ancestry were reported prior to this study.  

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Clinical pathology selected abstracts

May 2023—Several studies have evaluated the brain protective role of the Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet. The studies have shown that the MIND diet can slow cognitive decline, reduce rates of cognitive impairment, and reduce Alzheimer’s and Parkinson’s disease. Because obesity is a global epidemic, there is an interest in determining if the MIND diet may also have a beneficial effect on cardiovascular disease mortality, central or general obesity, metabolic syndrome and its components, and cardiac remodeling. The authors conducted a cross-sectional study to examine the relationship between the MIND diet and other metabolic risk factors, including lipids, glycemic indicators, and mental health, in obese people. The study included 339 obese people (body mass index of 30 kg/m2 or more) who were between 20 and 50 years old and lived in Tabria or Tehran, Iran.  

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Anatomic pathology selected abstracts

May 2023—Although criteria for malignancy have been established for glomus tumors of soft tissue, no accepted criteria exist for gastroesophageal glomus tumors, which are considered to behave unpredictably. Benign and aggressive gastroesophageal glomus tumors have been shown to harbor CARMN::NOTCH2 fusions, but genetic features that predict clinical behavior have not been identified. The authors conducted a study in which they evaluated 26 gastroesophageal glomus tumors to investigate histologic and genetic features that may predict malignancy. Seventeen of the 26 (65 percent) patients were male. The median age at presentation was 54.5 years (range, 16–81 years).  

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Molecular pathology selected abstracts

May 2023—One in four children worldwide have unregistered births according to 2019 data from UNICEF. While efforts are underway to mitigate this staggering statistic by prioritizing documentation of birth, millions of people still cannot prove their date of birth. Age-assessment methods, most commonly used in forensics, have relied on bone radiography. However, more recently, chronologic age-prediction models have been developed based on knowledge of how epigenetics change with age. Epigenetics is the modification of gene expression without changing the underlying genetic code.

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Pathology informatics selected abstracts

May 2023—Computational pathology is a subspecialty of pathology that exploits computational analysis to analyze patient specimens and that often uses multiple sources of related data. Artificial intelligence systems are typically used in this subspecialty. The field of pathology is rapidly being transformed by the development of AI algorithms trained to perform diagnostic, prognostic, and predictive tasks. However, routine use of artificial intelligence in anatomic pathology remains limited, making it difficult to measure the long-term clinical impact of AI. With this issue in mind, the authors surveyed 24 subject matter experts worldwide regarding the anticipated role of AI in pathology by the year 2030.

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Clinical pathology selected abstracts

April 2023—Cancer is the second leading cause of death globally. While great progress is being made in personalized cancer treatments, early detection and diagnosis is critical to reduce mortality and improve the effectiveness of treatment. Guidelines for preventative screening are available but require a large public health intervention strategy. Having “one-stop-shop” screening for multiple cancers at one time would reduce the barriers to participating in cancer screening programs and may lead to greater numbers of screening participants. An integrated cancer prevention center (ICPC) was developed in 2006 at the Tel Aviv Medical Center, in Israel, to screen for all cancers that the U.S. Preventive Services Task Force recommends be screened, including breast, colon, cervical, lung, skin, ovarian, uterine, thyroid, testicular, oropharyngeal, and prostate cancer.  

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Anatomic pathology selected abstracts

April 2023—Kaposi sarcoma can pose diagnostic challenges in biopsy specimens. Multiple histologic variants of cutaneous Kaposi sarcoma (KS) have been described. However, the histomorphologic spectrum of gastrointestinal KS has not been systematically studied. The authors presented a large multi-institutional case series that comprehensively evaluated 46 cases of KS involving the GI tract and identified seven histomorphologic variants, some of which had not previously been described. Five of the variants—lymphangioma/lymphangiectatic like (n=17), mucosal hemorrhage/telangiectatic like (n=17), mucosal inflammation like (n=15), granulation tissue like (n=13), and mucosal prolapse like (n=4)—were inconspicuous but had unique morphologic patterns. These variants easily can be misdiagnosed or misinterpreted on routine examination if KS is not considered and if the IHC stain for human herpesvirus-8 is not utilized.  

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Molecular pathology selected abstracts

April 2023—Clonal hematopoiesis of indeterminate potential refers to the clonal expansion of hematopoietic stem cells that harbor a somatic mutation in people who do not exhibit hematological symptoms. This phenomenon is common in the elderly and associated with an increased risk of hematological malignancies, cardiovascular disease, infection, and all-cause mortality. Several somatic alterations are frequently detected in clonal hematopoiesis of indeterminate potential (CHIP), but the medical community’s understanding of the underlying genetic predisposition to CHIP is limited. The authors conducted a large-scale exome-sequencing study involving more than 600,000 people to characterize CHIP status and discover rare somatic variants and possible predisposing germline alterations. The prevalence of CHIP was 15 percent by 75 years of age, and the affected individuals were more likely to be heavy smokers, in agreement with previous studies.  

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Clinical pathology selected abstracts

March 2023—Coagulation screening prior to surgery for patients without a history of a bleeding disorder is controversial. Studies have recommended routine screening of prothrombin time/International Normalized Ratio (PT/INR) and activated partial thromboplastin time (aPTT) to reduce the risk of perioperative and postoperative hemorrhage. Other studies have questioned the value of coagulation screening tests, such as INR, aPTT, and platelet count, because it is rare to detect an abnormal value in patients undergoing elective surgeries. Many professional society guidelines, such as those of the American Society of Anesthesiologists and British Committee for Standards in Hematology, advise against routine perioperative coagulation screening prior to surgery for patients who do not have a clinical history of abnormal bleeding, medical history of comorbidity, or bleeding disorders. The authors conducted a study in which they examined the association between abnormal coagulation profile and risk of transfusion following common elective surgery in patients who did not have bleeding disorders. They used the National Surgical Quality Improvement Program (NSQIP) database for their retrospective cohort study, which focused on adult patients across multiple disciplines who underwent common surgical procedures between 2004 and 2018.  

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Anatomic pathology selected abstracts

March 2023—Prognostic stratification of patients with surgically resected invasive pulmonary adenocarcinoma must be improved. The authors conducted a study to evaluate the prognostic value of complex glandular patterns (CGPs) in patients with resected stage I through IV lung adenocarcinoma. The presence of CGPs as a minor to predominant component was tested for association with overall survival (n=676) and relapse-free survival (n=463) after surgery. CGPs were observed in 284 (42 percent) tumors. Cribriform and fused gland were the predominant patterns in 35 and 37 cases, respectively. The presence of a cribriform pattern was associated with worse relapse-free but not overall survival.  

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Molecular pathology selected abstracts

March 2023—The Association for Molecular Pathology, American Society of Clinical Oncology, and College of American Pathologists published a formalized somatic variant classification system in 2017. The tiered system stratifies variants based on clinical importance, taking into account how variants affect cancer diagnosis, prognosis, or treatment strategies. Somatic variants with strong clinical significance, including those that are associated with FDA-approved therapies or included in professional guidelines, are tier one; variants with potential clinical significance are tier two; variants of unknown significance are tier three; and benign variants are tier four. The authors, members of the AMP Variant Interpretation Across Testing Laboratories Working Group, assessed how laboratories are using the AMP/ASCO/CAP guidelines and whether there is good concordance among laboratories in applying the guidelines to variant interpretation. A somatic variant interpretation challenge was sent to participating laboratories.  

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Pathology informatics selected abstracts

March 2023—Whole slide imaging is increasingly being adopted by pathology laboratories worldwide. In 2013, the College of American Pathologists published guidelines on validating whole slide imaging (WSI) for diagnostic purposes. The CAP updated the recommendations in 2021. The guidelines include three strong recommendations and nine good-practice statements. The purpose of the validation guidelines is to ensure that a WSI system performs as intended in a particular clinical environment before it is used in patient care. In other words, the process is intended to make sure pathologists can render accurate diagnoses with WSI that are at least comparable to those provided via traditional light microscopy and that there are no interfering artifacts or technological risks to patient safety.  

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Clinical pathology selected abstracts

February 2023—Fetal and neonatal alloimmune thrombocytopenia is the most common cause of intracranial hemorrhage in term infants with thrombocytopenia. It often presents as severe thrombocytopenia in the newborn or a spontaneous intracranial hemorrhage in a fetus in an uncomplicated pregnancy. Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal antibodies against paternal platelet antigens, which cross the placenta and destroy fetal platelets. Studies have shown that FNAIT is underdiagnosed in pregnancies. However, primigravida screening for FNAIT is not performed in the United States.

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Anatomic pathology selected abstracts

February 2023—Atypical mitosis is considered a feature of malignancy, but its significance in breast cancer remains elusive. The authors conducted a study to assess the clinical value of atypical mitoses in breast cancer and explore their underlying molecular features. They quantified and correlated atypical and typical mitotic figures with clinicopathological variables in a large cohort of primary breast cancer tissue sections (n=846) using digitalized H&E whole slide images. They also used RNA sequencing data from The Cancer Genome Atlas (TCGA) breast cancer data set (n=1,032) to link atypical mitoses to the underlying genetic alterations and pathways.

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Molecular pathology selected abstracts

February 2023—Systemic lupus erythematosus is an autoimmune disease that affects multiple organ systems and is most prevalent in women of Asian, Hispanic, and African ancestries. People with the heterogeneous disease experience major organ damage, which primarily affects the kidneys, skin, heart, and joints. Transcriptomic studies of systemic lupus erythematosus (SLE) have implicated increased type 1 interferon signaling, dysregulated lymphocyte activation, and failure of apoptotic clearance as hallmarks of the disease. Many genes are near the approximately 100 loci associated with SLE. Despite the use of flow cytometry and transcriptome profiling to characterize the role of circulating immune cells in SLE, there is not a complete census of circulating immune cells in the disease, and characterizing the genetic associations has been challenging.

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Anatomic pathology selected abstracts

January 2023—Radioembolization therapy uses yttrium-90-impregnated resin or glass microspheres to selectively target hepatic lesions via transarterial radioembolization. Occasional cases of gastrointestinal (GI) tract injury secondary to nontargeted delivery of microspheres have been reported, but large descriptive pathology series are lacking.

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Molecular pathology selected abstracts

January 2023—An international group of scientists and clinicians identified the molecular cause of a rare neurodevelopmental syndrome affecting children worldwide. This discovery was made possible through such publicly available online databases as MyGene2, GeneMatcher, and Matchmaker Exchange, which match genotypic profiles with phenotypic profiles of rare diseases.

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Clinical pathology selected abstracts

November 2022—Exposure to lead may cause severe illness in children, including neurological damage, organ failure, and even death. The Centers for Disease Control and Prevention and other agencies recommend routine testing for blood lead levels (BLL) as part of a well-child examination to identify elevated levels and, subsequently, eliminate exposure to lead and initiate therapeutic interventions.

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Molecular pathology selected abstracts

November 2022—Spontaneous coronary artery dissection is an uncommon cause of acute heart attack. It is not associated with high cholesterol or atherosclerosis but, instead, occurs when a small tear or separation in the wall of the coronary artery leads to blood entering a false lumen, occluding blood flow and impairing oxygenation of the heart muscle.

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Pathology informatics selected abstracts

November 2022—Lab test result formats are not standardized, potentially causing confusion when the same test results are displayed differently—for example, when a positive pregnancy test appears as +, P, or positive, or an indeterminate test result appears as DNR, which could be interpreted to mean did not report, did not react, or even do not resuscitate. Because of this issue, the authors trialed standard laboratory result formats across the 130 facilities that are part of the Veterans Health Administration, each of which has one or more CLIA-certified laboratories. The authors selected the most common laboratory tests from each facility, which composed at least 95 percent of a facility’s monthly laboratory test volume between 2000 and 2015. They then specified the standard result formats for these tests based on the facilities’ feedback. Personalized emails were sent weekly, over a 15-week period in 2016, to the facilities’ lab information systems managers, lab managers, and laboratory directors.

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Clinical pathology selected abstracts

October 2022—Cardiovascular health is often linked to dementia, and compelling evidence indicates that there are modifiable risk factors for dementia, knowledge of which may also benefit vascular health. In previous studies, hypercholesterolemia and cardiovascular pathology were associated with the apolipoprotein E (APOE) ε4 genotype and cognitive function.

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Clinical pathology selected abstracts

September 2022—Clinical laboratory workforce shortages are an issue, in large part because it is difficult to find qualified testing personnel. Pathology residents present a solution to this problem because MD and DO residents who have current training certificates or medical licenses and who are trainees in pathology or other specialties can qualify to perform high-complexity testing.

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Pathology informatics selected abstracts

September 2022—Artificial intelligence in pathology has progressed recently, with at least four machine-learning algorithms classified for clinical use in the United States. While many challenges of implementing AI in pathology labs are well documented, one area that has not received much study is how an AI algorithm designed to augment pathologist performance will impact pathologists’ clinical decisions.

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Molecular pathology selected abstracts

September 2022—The widespread availability of next-generation sequencing-based somatic mutation analysis of solid tumors has led to the routine identification of patients eligible for FDA-approved targeted therapies, including immunotherapies. However, validated targeted therapies are available for only a small number of mutations, thereby preventing many patients from realizing the benefits of these life-extending modalities. With a focus on reducing the gap in eligibility for targeted therapy, the authors conducted a large-scale retrospective analysis of interactions between mutations, drug responses, and long-term cancer survival outcomes. They performed the analysis using the nationwide U.S.-based Flatiron Health–Foundation Medicine clinicogenomic database. The authors analyzed data on more than 40,000 patients from approximately 280 cancer clinics.

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Clinical pathology selected abstracts

July 2022—A complete blood count with a white blood cell differential (CBCD) is often ordered when a CBC alone would suffice. Even though a CBCD can be performed with automated technology, it requires more reagents than a CBC. Furthermore, if an automated CBCD is flagged, a laboratory will perform a manual WBC differential, adding to labor and material costs.

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Molecular pathology selected abstracts

July 2022—Although offspring share similar DNA, their physical and behavioral differences are multifactorial. One of those factors is epigenetics, the chemical and structural modifications of DNA by proteins and enzymes. Whereas the DNA sequence is relatively stable, epigenetic modifications are dynamic, as they are critical to controlling gene expression in response to cellular development and environment. Reproductive cells, or gametes, carry half the normal set of chromosomal DNA. Advances in molecular technologies demonstrate that this DNA is epigenetically modified to influence traits of future offspring, referred to as transgenerational epigenetic inheritance.

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Molecular pathology selected abstracts

May 2022—The most common cause of death related to gynecological malignancies is epithelial ovarian cancer. One of the biggest challenges to treating this disease is the lack of reliable biomarkers for identifying its underlying precancerous and early stages. The study of epigenetic changes in epithelial cells shows some promise for detecting early ovarian cancer. In previous studies, DNA methylation performed on blood samples demonstrated important epigenetic changes associated with ovarian cancer but did not yield realistic screening parameters due to the heterogeneity of blood samples. To identify ovarian cancer risk earlier, the authors conducted a molecular epigenetic analysis of cervical epithelial cells derived from the Mullerian duct and collected using the ThinPrep system to establish a methylation model index called the Women’s Risk Identification for Ovarian Cancer [WID-OC] index.

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Anatomic pathology selected abstracts

March 2022—Invasive gallbladder carcinoma is preceded by two main types of precursor lesions—intracholecystic papillary-tubular neoplasms and biliary intraepithelial neoplasias. Invasive gallbladder carcinomas with an intracholecystic papillary-tubular neoplasm (ICPN) component have more favorable prognoses than those without an ICPN component.

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Pathology informatics selected abstracts

March 2022—Over the past decade, the field of pathology has increasingly been using Twitter for educational purposes, due in part to the ease with which one can share images for review on the social media platform. However, not all pathologists use Twitter, and only a portion of those who do use it employ the platform for educational purposes. To identify the challenges of using Twitter to create educational posts, the authors created a short multiple-choice Likert scale survey using Google Forms and distributed it through Twitter. The survey was divided into the categories of user demographics—work setting, job role, and history of posting educational content on Twitter; the biggest obstacle to creating educational content; and further exploration of the challenges faced when posting content to Twitter. One hundred and seventy-four medical professionals responded to the survey, of which pathology residents and fellows (n = 68; 39.1 percent) and practicing pathologists (n = 60; 34.5 percent) composed the largest groups.

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Anatomic pathology selected abstracts

• Use of subtyping to predict behavior of papillary thyroid microcarcinomas • Gastrointestinal pathology in samples from COVID-19–positive patients • Assessment of an artificial intelligence system for prostate cancer detection • Expression patterns for Bcl-2, EMA, β-catenin, E-cadherin, PAX8, and MIB-1 in thymomas • Analysis of intraoperative frozen section biopsy of uterine smooth muscle tumors

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Pathology informatics selected abstracts

November 2021—When the COVID-19 pandemic struck, many pathology training programs scrambled to formulate a plan to teach their pathology residents in a physically distanced learning environment. Using double- or multi-headed optical light microscopes, even with plexiglass barriers, is not ideal because they do not permit physical distancing. Many training programs leveraged digital imaging technology to continue teaching microscopy during the pandemic. Pathology departments that could not afford whole slide imaging for this purpose sometimes employed the less expensive option of dynamic virtual microscopy (DVM). A DVM platform includes a digital camera mounted to a light microscope and videoconferencing software so an educator can stream a slide image to one or more remote learners.

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Anatomic pathology selected abstracts

October 2021—Squamous cell carcinoma is the most common malignancy of the anal canal and is strongly associated with human papillomavirus (HPV) infection. Characteristic genomic alterations have been identified in anal squamous cell carcinoma (SqCC), but their clinical significance and correlation with HPV status, pathologic features, and immunohistochemical markers are not well established.

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Clinical pathology selected abstracts

September 2021—Colorectal cancer is the third leading cause of cancer death for men and women, with approximately 52,980 deaths projected this year. Although colorectal cancer is most frequently diagnosed in adults between the ages of 65 and 74 years, about 10.5 percent of new colorectal cancer cases will occur in those younger than 50 years of age.

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Anatomic pathology selected abstracts

August 2021—Pseudocarcinomatous squamous hyperplasia within the bone is uncommon and closely mimics well-differentiated squamous cell carcinoma. It arises from cutaneous or mucosal surfaces and grows directly into the bone. The authors conducted a study in which they analyzed a series of 31 pseudocarcinomatous squamous hyperplasia (PSH) cases and discussed the clinicopathologic features that distinguished PSH from squamous cell carcinoma (SCC).

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Clinical pathology selected abstracts

August 2021—The primary target organ of the SARS-CoV-2 virus is the lung. The virus invades endothelial cells through angiotensin-converting enzyme 2 receptors, which are found throughout the body. There are multiple markers of abnormal coagulation and hemostasis activation in patients with COVID-19 that signal a risk of thromboembolic complications.

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Clinical pathology selected abstracts

July 2021—Pathologists play a key role in molecular and genomics testing, so pathologists-in-training should demonstrate an understanding of genetics concepts and the utility of molecular and genomic testing in patient care. A list of published competencies for training includes determining sample adequacy, ensuring that appropriate molecular tests are ordered, and effectively communicating genomic testing results through pathology reports and interdisciplinary teams.

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Pathology informatics selected abstracts

July 2021—Despite growing awareness of whole slide imaging, few pathology laboratories have implemented and validated such a digital pathology system for primary diagnosis. Among the barriers to adopting whole slide imaging (WSI) for routine clinical work is the difficulty of justifying the expense, time and effort, and change management involved in deploying this disruptive technology.

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Molecular pathology selected abstracts

July 2021—The accurate diagnosis of malignant pleural mesothelioma is important because of its association with asbestos inhalation and because it is an aggressive tumor with poor outcome despite multimodal treatment. Unfortunately, however, diagnosing malignant pleural mesothelioma is not straightforward. Initial diagnosis often occurs on small biopsies, and the disease has morphologic overlap not only with other neoplasms that affect the lungs and pleura, such as solitary fibrous tumor or synovial sarcoma, but also with reactive conditions, such as reactive mesothelial hyperplasia or sclerosing fibrous pleuritis. While immunohistochemical markers can provide ancillary information, many of them are nonspecific and can lead to diagnostic dilemmas. Sequencing of cancer genes can help in some situations but cannot provide a definitive diagnosis.

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Clinical pathology selected abstracts

June 2021—Adverse events reported following administration of the ChAdOx1 nCoV-19 AstraZeneca vaccine were similar to those reported for the Johnson & Johnson/Janssen COVID-19 vaccine. The latter was paused in the United States in April due to concerns about thrombocytopenia, cerebral venous thrombosis, and a heparin-induced thrombocytopenia (HIT)-like syndrome that was a rare occurrence post-vaccination in women under the age of 60.

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Molecular pathology selected abstracts

June 2021—In myeloid malignancies, identification of genetic abnormalities informs diagnostic classification, aids risk stratification, and often predicts response to clinical therapy. Multiple methodologies generally are necessary to detect these abnormalities given the diversity of genetic occurrences, which can range from single-nucleotide variants to chromosomal translocations.

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Molecular pathology selected abstracts

May 2021—Autoinflammatory and rheumatologic disorders in adults often present with overlapping clinical features and are challenging to treat. A genotype-first approach has been helpful to guide proper clinical management in other analogous disease settings. The authors conducted a study in which they analyzed the exome/genome sequencing data of peripheral blood cells from two large cohorts: 1,477 people who had undiagnosed recurrent fevers or systemic inflammation, or both, and 1,083 people affected by atypical, unclassified disorders who were identified through the National Institutes of Health Undiagnosed Diseases Program. Recurrent novel missense mutations affecting the methionine-41 codon of the X-linked gene UBA1, which codes for a major E1 enzyme that initiates ubiquitylation, were identified in three men. These UBA1 mutations were confirmed as somatic because they were not found in the matched fibroblasts of the affected individuals and their family members.

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Clinical pathology selected abstracts

April 2021—The incidence of cardiovascular disease and coronary heart disease is disproportionately higher among African-Americans compared with non-Hispanic whites. It has been hypothesized that genetic variation is associated with these higher rates of cardiovascular disease (CVD) and coronary heart disease (CHD) among this race.

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Clinical pathology selected abstracts

March 2021—Convalescent plasma, with neutralizing and non-neutralizing anti-viral antibodies, has been used to treat COVID-19 patients. Plasma is collected from people who have recovered from the disease and transfused to those who are infected. Data have shown improvements in patients with severe infections who are transfused with COVID-19 convalescent plasma. The majority of people who have COVID-19 will demonstrate IgM and IgG antibodies within two weeks of symptom onset. These antibodies have specificity toward the receptor-binding domain (RBD) and spike protein viral epitopes that correspond to virus neutralization.

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Anatomic pathology selected abstracts

March 2021—Prostatic-type differentiation in the lower female genital tract is rarely encountered and its causes and clinical associations are not well established. Reports have invariably described ectopic prostatic-type differentiation within the vagina as restricted to the lamina propria. The authors encountered a patient receiving testosterone for gender dysphoria whose vaginectomy specimen showed a prostatic glandular proliferation within the surface epithelium. To elucidate its potential association with androgen exposure, they sought similar lesions, resected during a 26-year period, from patients with exogenous or endogenous androgen excess. Thirteen cases, involving the vagina (n =12) and exocervix (n =1), were identified.

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Pathology informatics selected abstracts

March 2021—A significant benefit of whole slide imaging is the ability to view digital slides remotely. This benefit has been reinforced during the COVID pandemic as pathologists render pathology diagnoses from home. At the same time, the FDA has temporarily relaxed regulations for modifying FDA-cleared digital pathology devices and the marketing of devices that are not FDA 510(k) cleared. This contrasts with previous requirements that various digital pathology systems use computer displays with specifications that have satisfied regulatory or institutional approval, or both. This, in turn, raises concern about pathologists working in unregulated home settings where they use a variety of monitors that vary in visual quality and, therefore, in image clarity.

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Molecular pathology selected abstracts

March 2021—High tumor mutational burden in certain cancers has become an established biomarker for predicting a response to immune checkpoint inhibitor therapy and longer overall survival after such treatment. The immune checkpoint inhibitor (ICI) pembrolizumab, for example, has recently been approved by the FDA for patients whose solid tumors, regardless of histology, have a high tumor mutational burden (TMB), defined as 10 or more mutations per megabase. TMB, assessed by next-generation sequencing, varies considerably among cancers and can range from 0.01 to more than 1,000 somatic mutations per megabase of sequenced genome. The presumed mechanism for the enhanced responsiveness to immunotherapy associated with high TMB is the creation, by somatic mutation, of potentially immunogenic neoantigens that facilitate an enhanced antitumor immune response. Given this presumed mechanism, the authors addressed whether high TMB levels, which are associated with better cancer outcomes in patients treated with immune checkpoint inhibitors, might also lead to better outcomes for patients treated with other anti-cancer therapies.

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Clinical pathology selected abstracts

February 2020—SARS-CoV-2 is transmitted through respiratory droplets, close person-to-person contact, and infected surfaces. Those with COVID-19 often present with fever and respiratory symptoms, and diagnosis relies on detecting the virus through specimens from the upper and lower respiratory tract. However, an increasing number of patients are exhibiting such gastrointestinal symptoms as diarrhea, vomiting, and abdominal pain. A growing number of studies are reporting the presence of SARS-CoV-2 RNA in stool samples and anal swabs, generating interest in research focused on a fecal-oral route of transmission. The authors conducted a study to assess the clinical relevance of testing stool samples and anal swabs for SARS-CoV-2 and to provide a critical overview of literature addressing possible fecal-oral transmission.

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Anatomic pathology selected abstracts

February 2021—SARS-CoV-2 primarily causes pulmonary injury, but it has been implicated in hepatic injury through the use of serum markers and histologic evaluation. The histologic pattern of injury has not been completely described, and studies quantifying viral load in the liver are lacking. The authors conducted a study in which they reported the clinical and histologic findings related to the liver in 40 patients who died of complications of COVID-19. For the study, they subjected a subset of liver tissue blocks to polymerase chain reaction (PCR) for viral RNA. Peak levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were elevated, with a median ALT peak of 68 U/L (normal up to 46 U/L) and median AST peak of 102 U/L (normal up to 37 U/L). Macrovesicular steatosis was the most common finding, involving 30 (75 percent) patients.

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Molecular pathology selected abstracts

February 2021—Beta-thalassemia and sickle cell disease are common hereditary conditions that can have life-threatening complications. Both diseases are caused by genetic alterations affecting the beta subunit of hemoglobin. Mutations that reduce or prevent the synthesis of the beta-globin protein cause beta-thalassemia, a disease characterized by inadequate red blood cell production and, therefore, anemia. In contrast, sickle cell anemia results from a specific point mutation in the beta-globin gene that causes the resulting protein to polymerize. These protein polymers form rigid fibers that affect the stability of the red blood cell and cause its characteristic sickling deformity. Destruction of the aberrant red blood cells leads to anemia, and the sickled cells can also cause painful vaso-occlusive episodes and tissue damage.

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Clinical pathology selected abstracts

January 2021—Annual expenditures for clinical laboratory testing account for approximately $71.6 billion of health care costs and represent about 2.4 percent of all health care spending. While laboratory testing is critical, recommendations of the Choosing Wisely initiative focus on reducing laboratory costs and unnecessary testing, in part through dialogue between physicians and patients. Specialty societies widely accept and participate in Choosing Wisely recommendations, but outcomes of the initiative are largely unknown. The American Society for Clinical Pathology put forth 25 recommendations for Choosing Wisely, of which the 13th recommendation stated that serum lipase is the preferred test for diagnosing acute pancreatitis because lipase peaks by 24 hours and remains elevated for eight to 14 days. It was also recommended that serum amylase tests not be ordered with serum lipase tests because one or the other is sufficient for the diagnosis.

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Anatomic pathology selected abstracts

January 2021—The authors conducted a review of postmortem pulmonary histopathologic findings of COVID-19 pneumonia in patients who had a spectrum of disease course that ranged from rapid demise to prolonged hospitalization. They analyzed histopathologic findings in postmortem lung tissue from eight patients who died from COVID-19 pneumonia. Immunohistochemistry and next-generation sequencing (NGS) were used to detect the virus. Diffuse alveolar damage (DAD) was seen in all cases with a spectrum of acute phase or organizing phase, or both. IHC with monoclonal antibodies against SARS-CoV-2 viral nucleoprotein and spike protein detected virus in areas of acute but not organizing DAD.

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Molecular pathology selected abstracts

January 2021—Circular RNAs are a novel class of recently discovered RNA with emerging roles in gene regulation, homeostasis, and disease. They are generated by ligation of the distal ends to form a circular product and originate from parental-coding genes and noncoding regions of the genome. Circular RNAs (circRNAs) are widespread in the plant and animal kingdoms and conserved in multiple species. Recent literature suggests that they inhibit micro RNA (mi­RNA), an important class of RNAs that regulates gene expression by binding to messenger RNAs (mRNA). Therefore, the post-transcriptional regulation of gene expression by RNAs has expanded to include a circRNA–mi­RNA–mRNA regulatory network.

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Pathology informatics selected abstracts

January 2021—A major barrier to adopting whole slide imaging for primary diagnosis in the United States was FDA regulatory approval. However, the FDA approved marketing of the first whole slide imaging (WSI) system for digital pathology in 2017. The agency subsequently cleared Leica’s Aperio AT2 DX system for in vitro diagnostic use to aid pathologists in reviewing and interpreting digital images of surgical pathology slides prepared from formalin-fixed paraffin-embedded tissue. The authors conducted a study in which they compared pathologists’ primary diagnoses rendered through the use of WSI versus standard glass microscopy. Their multicenter, double-blind, randomized clinical trial was conducted at five sites: the University of California Davis, Pacific Rim Pathology, Dignity Health, TriCore Reference Laboratories, and Intermountain Healthcare.

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Clinical pathology selected abstracts

December 2020—The National Academy of Medicine estimated that approximately 30 percent of U.S. health care spending constitutes nonvalue-added waste. This waste may be generated through unnecessary laboratory tests and services, inefficiency of care delivery, ex­cessive administrative costs, and high prices. A goal of medical educators is to inform undergraduate medical students about health care management and health care delivery to make them better stewards of cost-effective, high-value care (HVC). The authors described the results of a needs analysis to inform the design of an online case-based educational tool for teaching laboratory stewardship to medical students. To this end, they conducted a needs assessment that included semi-structured interviews of core clerkship directors and residency program directors, a national survey of the Undergraduate Medical Educators Section of the Association of Pathology Chairs, and a review of existing online resources for teaching HVC. Their results showed that all of the core clerkship directors and residency program directors thought that teaching laboratory stewardship as part of the undergraduate medical education (UME) curriculum was important. The two major themes that emerged from the analysis to enhance laboratory stewardship education were appropriate test ordering and interpretation. The authors also found several organizations that provide HVC education through online modules or clinical cases.

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Anatomic pathology selected abstracts

December 2020—It can be difficult to distinguish metastatic melanoma from melanocytic nevi in lymph nodes. Because diffuse IHC PRAME (preferentially expressed antigen in melanoma) expression is detected in the majority of primary and metastatic melanomas, but rarely in nevi, the authors conducted a study in which they hypothesized that PRAME could be a useful adjunct marker for the diagnosis of melanocytes in lymph nodes. They examined 45 nodal melanocytic deposits comprising 30 nodal nevi and 15 melanoma metastases. The latter were not straightforward from a diagnostic perspective because they coexisted with nodal nevi or were present in perinodal fibrous tissue. All nodal nevi were negative for PRAME and all melanoma metastases were diffusely positive for PRAME IHC.

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Molecular pathology selected abstracts

December 2020—Next-generation sequencing-based mutation testing of various cancer types is clinically indicated and widely used to diagnose disease, inform potential therapeutic targets, prognosticate disease course, and monitor responses to targeted and nontargeted therapies. The genetic variants discovered by tumor-based next-generation sequencing (NGS) can be somatically acquired by the neoplastic cells or a fixed inherited component of the patient’s germline genome. Distinguishing the germline versus somatic status of tumor NGS-defined variants is of significant clinical importance not only for patient care but possibly for patients’ families. Because many cancers have a substantial inherited component, the discovery of a pathogenic germline mutation by tumor-based NGS may have substantial familial implications. For example, being aware of a cancer risk allele, such as BRCA1, can lead to the use of highly effective interventions to prevent or treat the related cancer in family members. Consensus guidelines recommend germline genetic testing only for those cancer patients who have a clinical presentation or family history suggestive of hereditary disease.

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Clinical pathology selected abstracts

November 2020—Smoking is a leading cause of death in the United States and is associated with many postoperative complications, including increased transfusion needs. Toxins in tobacco that create free radicals that damage the arterial walls and make them more susceptible to rupture and bleeding may be the link between smoking and surgical bleeding. Smoking also impairs tissue healing after surgery, most likely due to reduced oxygenation and altered function of inflammatory cells during the healing process. This may impact bleeding risk in the immediate postoperative period. The authors conducted a study in which they queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File 2007–2016, which contained data from up to 680 U.S. hospitals, to test the hypothesis that smoking is associated with a higher risk of bleeding in various surgical procedures.

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Molecular pathology selected abstracts

November 2020—Sporadic vascular malformations are congenital malformations of arteries, veins, capillaries, or lymphatic vessels, or a combination of these, and are associated with significant morbidity. The majority of them are caused by postzygotic somatic pathogenic variants in oncogenes in the PI3K-MTOR and RAS-MAPK pathways, including within PIK3CA, TEK, MAP2K1, BRAF, and KRAS. Investigators have assessed whether therapeutic agents targeting these pathways should be used to augment or replace traditional surgical management. But because these somatic variants are restricted to cells within the tissue of vascular malformations (VM), it is necessary to conduct genetic testing on the surgically resected tissue to qualify patients for trials of targeted therapies. Approximately 10 percent of cell-free DNA (cfDNA) originates from endothelial cells.

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Anatomic pathology selected abstracts

November 2020—Neuroendocrine neoplasms range from well to poorly differentiated and indolent to highly aggressive. The site of origin in metastatic neuroendocrine neoplasms has therapeutic and prognostic implications. SATB2 is a transcriptional regulator involved in osteoblastic and neuronal differentiation and a sensitive and specific marker of colorectal epithelium. The authors conducted a study to evaluate the expression of SATB2 in neuroendocrine neoplasms from various primary sites and its utility as a marker for determining the site of origin of these neoplasms. SATB2 IHC was performed on 266 such neoplasms, including lung small cell carcinomas (n = 39) and carcinoids (n = 30), bladder (n = 21) and prostate (n = 31) small cell carcinomas, and gastrointestinal/pancreatic neuroendocrine neoplasms of various primary sites (n =145) consisting of well-differentiated neuroendocrine tumors (WDNET, n =124) and poorly differentiated neuroendocrine carcinomas (PDNEC, n = 21).

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Pathology informatics selected abstracts

November 2020—Telepathology is a leading application for digital pathology. The ability to easily share a digital image in practice offers pathology laboratories clinical, operational, and financial benefits. This is best demonstrated by the longstanding success of telepathology in allowing pathologists to remotely perform intraoperative consultations—that is, to read frozen sections. Neuropathologists were one of the first specialists to leverage digital pathology for this clinical use. The authors, all of whom were from the University of Pittsburgh Medical Center, performed teleneuropathology at their institution, which implemented the practice 17 years ago.

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Clinical pathology selected abstracts

October 2020—Early in the COVID-19 pandemic, some reports linked ABO blood type to severity of the disease and test positivity. Among these were reports that blood type A was associated with a higher risk for SARS-CoV-2 infection and blood group O with a lower risk of infection and mortality. However, there is a paucity of data regarding the relationship between ABO blood type and severity of COVID-19. Therefore, the authors conducted a large multi-institutional observational study to determine if there is an association between ABO blood type and severity of COVID-19 and if those with specific blood types are more likely to test positive for the disease. For the study, they used a large multi-institutional database of adult patients who tested positive for SARS-CoV-2 at five major hospitals in Massachusetts from March 6 to April 16. The authors evaluated hospitalization, intubation, and death for an association with blood type.

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Anatomic pathology selected abstracts

October 2020—Immune checkpoint inhibitors are frequently used to treat a variety of solid tumors. These drugs involve upregulation of cytotoxic T cells, which can lead to immune-related adverse events, including those involving the gastrointestinal tract. The authors conducted a study to characterize the histological features of immune checkpoint inhibitor therapy-associated gastritis. Gastric biopsies from patients on immune checkpoint inhibitor therapy who had clinical suspicion of drug-associated gastrointestinal injury were identified. The predominant histological pattern of injury, distribution of injury, degree of tissue eosinophilia, and prominence of apoptosis were recorded.

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Molecular pathology selected abstracts

October 2020—An increase in the number of copies of a gene, or amplification, is regarded as the most common gain-of-function alteration across various cancer types. The authors developed a bioinformatics tool (Amplicon Architect) to identify extrachromosomal oncogene (ecDNA) amplification from whole genome sequencing (WGS) data based on three characteristic features: circularity of ecDNA, absence of a centromere, and high levels of amplification. The tool was validated in 44 cancer-derived cell lines known to have ecDNA. A combination of centromeric and noncentromeric FISH probes was used to identify extrachromosomal DNA, and the tool was able to classify 83 percent of these signals as representing circular ecDNA amplicons. Interestingly, some of these cases revealed the presence of concurrent extrachromosomal and intrachromosomal signals, suggesting that some ecDNA had reintegrated into the genome.

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Clinical pathology selected abstracts

September 2020—The clinical features and immune responses of people infected with SARS-CoV-2 who are asymptomatic are under investigation since people without disease symptoms can unknowingly spread the virus. As of Aug. 3, there were 17,965,128 confirmed COVID-19 cases worldwide, 4,749,138 of which were in the United States. The majority of those with SARS-CoV-2 infection have mild to severe respiratory illness with fever, cough, and shortness of breath, which appears two to 14 days after exposure. The authors conducted a study in which they described the epidemiological and clinical characteristics, viral levels, and immune responses in 37 asymptomatic people to better understand the clinical features and immune responses of people who are infected with SARS-CoV-2 and asymptomatic. The 37 asymptomatic people, all in the Wanzhou district of China, were diagnosed with RT-PCR–confirmed SARS-CoV-2 infections but had no relevant clinical symptoms in the preceding 14 days or while quarantined at the government-designated hospital for centralized isolation in Wanzhou.

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Anatomic pathology selected abstracts

September 2020—Identifying patients who respond to immune checkpoint blockade is a significant challenge in oncology. PD-L1 expression by immunohistochemistry is the diagnostic gold standard for patient selection, but it does not capture all patients who may respond to immune checkpoint blockade (ICB). Recent gene-expression studies of high-grade serous ovarian carcinoma have defined an immunoreactive molecular subtype that shows a measurable favorable difference in patient survival compared with nonimmunoreactive subtypes, but no studies have demonstrated its impact on predicting response to ICB. As a step toward establishing the predictive value of gene-expression classifiers in ICB, the authors assessed the relationship between PD-L1 IHC and molecular subtypes of ovarian epithelial cancer. They analyzed 93 tissue specimens from patients with stages III and IV disease and compared PD-L1 IHC with gene expression by Agilent microarrays using The Cancer Genome Atlas-defined subtypes.

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Molecular pathology selected abstracts

September 2020—Whole genome methylation profiling is used to subclassify neuroepithelial tumors and soft tissue sarcomas. Extending its use to much more common cancers, such as prostate cancer, has the potential to benefit a large number of patients. Metastatic castration-resistant prostate cancer (mCRPC) is the incurable and lethal form of prostate cancer and consists of different subgroups with variable morphologies and genomic alterations. The emergence of distinct subtypes of mCRPC likely represents adaption of the cancer cells to treatment and the microenvironment. The authors conducted a study that integrated methylation profiling with genomic sequencing and RNA transcriptome analysis in 100 mCRPC tumors, yielding a comprehensive molecular profile of these metastatic tumors.

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Pathology informatics selected abstracts

September 2020—Whole slide imaging has been available for clinical, research, and educational use for decades, with several digital pathology systems cleared by the FDA for primary diagnosis. However, widespread adoption of this technology for routine practice has been slow. Likely reasons for the slow uptick in employing whole slide imaging (WSI) for sign-out include the cost of these systems, their lack of interoperability with laboratory information systems, pathologist resistance to using this digital modality, and regulatory restrictions on remote sign-out imposed by the Clinical Laboratory Improvement Amendments (CLIA). However, the COVID-19 pandemic led the Trump administration, on March 26, to temporarily waive these CLIA regulations, giving pathologists the flexibility to sign out cases digitally from their homes.

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Clinical pathology selected abstracts

August 2020—Bacterial contamination of platelets continues to be an important cause of transfusion-associated morbidity and mortality. From 2001 to 2016, there were 51 deaths reported to the FDA due to transfusion of apheresis products contaminated with bacteria, including 30 deaths since testing for bacterial contamination was mandated in 2004. This mandate was implemented through primary culture of single-donor apheresis platelets in 2004 and then prestorage pooled platelets (PSPPs) in 2007. The authors conducted a study to compare the platelet bacterial contamination and septic transfusion rates before and after introducing testing of pooled and apheresis platelets by primary culture over an extended time period. They cultured platelet aliquots at issue and evaluated transfusion reactions.

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Anatomic pathology selected abstracts

August 2020—The authors conducted a study in which they reviewed 354 cases of malignant diffuse mesothelioma in women from a database of 2,858 histologically confirmed cases. Pleural predominance was noted with 78 percent of pleural malignant mesotheliomas (MM) and 22 percent of peritoneal MM. The pleural tumors consisted of 72 percent epithelioid, 19 percent biphasic, and nine percent sarcomatoid variant. The peritoneal tumors consisted of 82 percent epithelioid, 13 percent biphasic, and five percent sarcomatoid. The immunohistochemical profile was typical of what is well accepted and previously described for MM.

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Molecular pathology selected abstracts

August 2020—Patients and families suspected of having Mendelian diseases, syndromes thought to be caused by a single mutated gene, often undergo comprehensive next-generation sequencing to determine the underlying pathogenic variant. Whole exome sequencing, in which the coding regions of all genes are analyzed, is usually the preferred testing method. However, this identifies the diagnostic pathogenic variant in only 25 to 52 percent of cases. Whole genome sequencing appears to confer only marginal benefit over whole exome sequencing, presumably because the pathogenic variants likely are not missed by whole exome sequencing but may be misinterpreted as nondiagnostic. Among the variants that are difficult to interpret are those that affect RNA by directly influencing transcription, or altering normal splicing, or by mediating their effects through chromatin.

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Clinical pathology selected abstracts

July 2020—The College of American Pathologists launched the Pathology and Laboratory Quality Center for Evidence-Based Guidelines in 2009 to develop and promote laboratory practice guidelines (LPGs) using the National Academy of Medicine’s (NAM) standards for developing trustworthy guidelines. The center has published 17 evidence-based LPGs, including updated versions, using NAM’s criteria. In 2013, the CAP was awarded a five-year cooperative agreement grant from the Centers for Disease Control and Prevention to increase the effectiveness of its LPGs. The intent of the agreement was to assess awareness and adoption of two CAP LPGs: IHC assay validation (IHC VAL) and initial workup of acute leukemia (AL).

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Anatomic pathology selected abstracts

July 2020—Smooth muscle tumors represent the second most common mural mesenchymal neaoplasm in the gastrointestinal tract, yet established criteria for prognostically assessing these tumors are lacking. The authors conducted a study on a large cohort of surgically resected intramural gastrointestinal smooth muscle tumors from 31 institutions to identify potential prognostic features. At each location, expert gastrointestinal or soft tissue pathologists, or both, assessed pathologic features. IHC confirmation was required.

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Molecular pathology selected abstracts

July 2020—Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DiHS/DRESS) is a rare but well-known full-body inflammatory skin condition that leads to life-threatening complications if untreated. The authors conducted a case study that involved a 44-year-old male who developed DiHS/DRESS after taking the combined antibiotic trimethoprim-sulfamethoxazole. Following standard treatment for this condition, the patient was started on high-dose prednisone, which provided no benefit. Subsequent tapering of prednisone advanced the disease to a toxic epidermal necrolysis-like condition. The patient was then given etanercept and high-dose intravenous immunoglobulin, without benefit. Next, the patient received cyclosporine, which resulted in some improvement but led to uncontrollable renal hypertension.

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Clinical Pathology Selected Abstracts

June 2020—More than 1.7 million new diagnoses of cancer occur in the United States each year, and they are almost exclusively made by pathologists who evaluate patient specimens and issue a written diagnostic report. These patients often are not given the opportunity to talk with the pathologist who made the diagnosis or view their tissue through a microscope. There is little published data on patient-pathologist consultation programs in which patients can review their reports and slides with the pathologist. In addition, the number of patients who may be interested in this service is not known. The authors conducted a study to quantify patients’ interest in patient-pathologist consultation programs and qualitatively analyze their motivations for interest or disinterest.

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Anatomic Pathology Selected Abstracts

June 2020—The authors conducted a study in which they independently evaluated the utility and prognostic value of tumor budding according to International Tumour Budding Consensus Conference (ITBCC) criteria in a large well-characterized European gastric cancer cohort. They assessed tumor budding according to the ITBCC criteria for 456 consecutive, surgically treated gastric cancers using the scoring system Bd0 (no buds), Bd1 (one to four buds), Bd2 (five to nine buds), and Bd3 (10 or more buds). Cases with tumor budding were divided into low-budding (Bd1/Bd2) and high-budding (Bd3) groups. The tumor budding score was analyzed in relation to clinicopathological parameters, overall survival, and tumor-specific survival. The authors found that 115 (25.2 percent) cases had no tumor budding, 104 (22.8 percent) had low tumor budding, and 237 (52 percent) had high tumor budding.

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Molecular Pathology Selected Abstracts

June 2020—The COVID-19 pandemic has focused the world’s attention on using sensitive high-throughput molecular diagnostic testing for the SARS-CoV-2 virus as a public health tool for “flattening the curve” of the infection. Although initial shortages of specialized polymerase chain reaction (PCR) testing reagents that plagued the early weeks of the pandemic have slowly improved (as of CAP TODAY press time), an obstacle to universal testing continues to be the first-step bottleneck of collecting respiratory tract samples for virus-specific reverse transcriptase-PCR (RT-PCR) testing. The traditional gold standard sample for COVID-19 testing has been a nasopharyngeal (NP) swab. However, nationwide shortages of NP swabs, personal protective equipment (PPE), and viral transport media have intermittently delayed the testing process. In an attempt to alleviate these critical sample-collection issues and promote more widespread testing, the medical community and other entities have been investigating alternative sample-collection procedures.

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Clinical Pathology Selected Abstracts

May 2020—Laboratory costs represent approximately three to four percent of overall health care expenses but drive 70 to 80 percent of decisions made by physicians. One way to control laboratory testing expenditures is through appropriate utilization. For example, thyroid and antinuclear antibody (ANA) testing have reliable initial screening tests, yet specialized testing is overutilized for both. In 2000 guidelines, the College of American Pathologists and American College of Rheumatology established that the ANA screen by immunofluorescence in the setting of a negative result is sufficiently sensitive not to perform further testing with subserologies and that thyroid-stimulating hormone (TSH) is a sensitive marker of thyroid function and can often be used without further testing with a normal TSH.

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Anatomic Pathology Selected Abstracts

May 2020—Flat epithelial atypia is an alteration of terminal duct lobular units by a proliferation of ductal epithelium with low-grade atypia. No consensus exists regarding whether the diagnosis of flat epithelial atypia in core needle biopsy necessitates excision. The authors retrospectively identified all in-house core needle biopsies with flat epithelial atypia obtained at their institution between January 2012 and July 2018. They reviewed all core needle biopsy slides and assessed radiologic-pathologic concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ in the excision, or both. The excision slides of all upgraded cases were re-reviewed.

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Molecular Pathology Selected Abstracts

May 2020—Each year a growing number of novel viruses are discovered in the wild animal kingdom with the use of next-generation sequencing technology. However, the current method of functionally assessing the zoonotic potential—that is, the potential to be transmitted to humans—of novel viruses involves synthesis of viral genomes (tens of thousands of bases) and reverse genetic engineering to produce a recombinant virus. This is expensive and time-consuming, and it is not practical due to the scale of new viral strains being discovered. To overcome this hurdle, Letko, et al., developed a rapid and cost-effective method that could functionally assess a number of related viruses for zoonotic potential. The essential component of viral cross-species transmission is cell entry, which is a multi-step process involving attachment of the virus to the host cell surface, receptor engagement, processing of host proteases, and downstream membrane fusion.

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Clinical Pathology Selected Abstracts

April 2020—An outbreak of pneumonia occurred in Wuhan, Hubei province, China, in December 2019. A novel coronavirus was identified as the causative agent and named SARS-CoV-2 by the World Health Organization (WHO). The disease, COVID-19, is considered a relative of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). SARS-CoV-2–infected patients presented with a dry cough, dyspnea, fever, and bilateral lung infiltrates.

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Anatomic Pathology Selected Abstracts

April 2020—Lymphocytic esophagitis is a well-known manifestation of Crohn disease among children but is not considered an immune-mediated mucositis in adults. The authors conducted a study for which they hypothesized that adult-onset lymphocyte-predominant esophagitis is also an immune-mediated inflammatory pattern, the nature of which has been masked by other conditions that feature esophageal lymphocytosis and occur in older adults. The intent of the study was to consolidate diagnostic criteria for lymphocyte-predominant esophagitis and determine its clinical significance.

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Molecular Pathology Selected Abstracts

April 2020—Prior to the recent novel coronavirus outbreak, the vast majority of coronaviruses that were known to be pathogenic in humans caused mild symptoms, with the exception of two strains. These included SARS (severe acute respiratory syndrome coronavirus [SARS-CoV]) and MERS (Middle East respiratory syndrome coronavirus [MERS-CoV]). SARS was documented as having emerged in the Guangdong province in southern China in 2002 and having caused at least 774 reported fatalities worldwide, while MERS, which was first detected in Saudi Arabia in 2012, was responsible for at least 858 fatalities worldwide.

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Clinical Pathology Selected Abstracts

March 2020—U.S. guidelines for human papillomavirus vaccination are 11 to 12 years, with a catch-up vaccination up to age 26 for women and 21 for men. The FDA recently expanded the approved age for HPV vaccination in adult women and men from nine through 45 years. The changes are based on safety data and efficacy as well as potential incremental population-level health benefits. The authors conducted a study to evaluate the added population-level effectiveness and cost-effectiveness of extending the current U.S. HPV vaccination program to women ages 27 through 45 years and men ages 22 through 45 years. They used HPV-ADVISE (agent-based dynamic model for vaccination and screening evaluation), a model for HPV infection and associated diseases specific to U.S. data.

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Molecular Pathology Selected Abstracts

March 2020—Microsatellite instability status in solid tumors is a critical biomarker for predicting tumor response to an immune checkpoint inhibitor drug. The immune system is more likely to attack those tumors that have a high degree of microsatellite instability, a consequence of the genomic instability that also leads to generation of the neoantigens the immune system is designed to recognize.

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Anatomic Pathology Abstracts

March 2020—Conflicting data about the clinical significance of microscopic Crohn disease activity at resection margins have led to varying practice patterns for routine reporting by pathologists. The authors performed a multicenter retrospective cohort study of 101 consecutive Crohn disease bowel resections during a 10-year period to characterize the association between active disease at resection margins and postoperative Crohn disease recurrence and time to recurrence. Margin slides were reviewed, and Crohn disease activity at the margins was graded as none, mild, moderate, or severe. The authors used logistic regression and Cox regression analyses, respectively, to evaluate the association between microscopic Crohn disease activity at the margins and postoperative recurrence and time to recurrence.

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Clinical Pathology Selected Abstracts

Blood utilization and transfusion reactions in pediatric patients transfused with platelets

February 2020—Even with advances in donor screening and infectious disease testing, the risk of transfusion-transmitted infections continues to be a concern. The FDA has approved a pathogen-reduction system for single-donor platelets, called Intercept Blood System (Cerus Corp.), to treat thrombocytopenic adult and pediatric patients.

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Anatomic Pathology Selected Abstracts

DNAJB1-PRKACA fusions in fibrolamellar hepatocellular carcinoma

February 2020—Recently discovered DNAJB1-PRKACA oncogenic fusions have been considered diagnostic for fibrolamellar hepatocellular carcinoma. The authors conducted a study in which they described six pancreatobiliary neoplasms with PRKACA fusions, five of which harbored the DNAJB1-PRKACA fusion.

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Molecular Pathology Selected Abstracts

Overall survival rates for lung cancer patients receiving osimertinib

Guidelines recommend testing patients with advanced or metastatic nonsmall cell lung cancer (NSCLC) for epidermal growth factor receptor (EGFR) alterations because targeted treatment with a tyrosine kinase inhibitor (TKI) is available for patients with EGFR exon 19 deletions or L858R point mutations. Osimertinib is a third-generation, irreversible, oral EGFR-TKI that selectively inhibits EGFR-TKI–sensitizing and EGFR p.Thr790Met-resistance mutations.

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Clinical pathology selected abstracts

Use of thromboelastography to guide blood product transfusion
January 2020—Thromboelastography and rotational thromboelastometry provide insights into blood clot development, stabilization, and dissolution. The coagulation tests provide a tracing through the clotting process, but although they are similar, they are not interchangeable.

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Anatomic pathology selected abstracts

Distinct patterns of human liver regeneration following massive hepatic necrosis
January 2020—Massive hepatic necrosis is a rare and often fatal complication of various liver injuries. However, some patients survive by spontaneous hepatic regeneration. It is known that surviving hepatocytes or progenitor cells, or both, can participate in this process, but the mechanism of hepatic recovery is vague.

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Molecular pathology selected abstracts

Virtual staining of tissue slides to conserve precious diagnostic samples
January 2020—Precise classification of neoplasms improves risk stratification and the ability to apply targeted treatment options, enhancing patient care. These granular diagnostic classifications increasingly rely on molecular findings that go beyond what the microscope shows the pathologist.

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Clinical pathology selected abstracts

Intraoperative red blood cell transfusion and mortality after cardiac surgery
December 2019—Patients with underlying cardiac disease are at risk for myocardial ischemia if they have untreated anemia at the time of cardiac surgery. During surgery, ongoing blood loss and hemodilution as a result of cardiopulmonary bypass (CPB) cause low hemoglobin levels. The optimal transfusion trigger for cardiac surgery patients continues to be debated. A more restrictive RBC transfusion strategy is used in patients with stable cardiovascular disease and is considered safe.

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Anatomic pathology selected abstracts

Evaluation of tumor quantitation as an aid in predicting biochemical recurrence in organ-confined prostate cancer
December 2019—In the eighth edition of the AJCC Cancer Staging Manual, all organ-confined disease is assigned pathologic stage T2, without subclassification. The authors investigated whether total tumor volume (TTV) or maximum tumor diameter (MTD) of the index lesion, or both, enhance the ability to predict biochemical recurrence in pT2 patients. They identified 1,657 patients using digital tumor maps and quantification of TTV/MTD who had pT2 disease on radical prostatectomy.

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Molecular pathology selected abstracts

Personalized oligonucleotide therapy for treatment of a rare genetic disease December 2019—A variety of molecular diagnostic laboratory tools are available to diagnose diseases caused by mutations in the human genome. However, few treatments are available to correct the underlying pathophysiology driven by these mutations. This is due, in part, to pharmaceutical companies’ inability to justify, from a business perspective, the expense and time necessary to develop and obtain FDA approval for novel therapies that benefit only a small number of patients.

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Clinical pathology selected abstracts

Intensive versus standard blood pressure control with cerebral white matter lesions
November 2019—The effect of intensive systolic blood pressure control on brain health is uncertain, despite its efficacy for reducing cardiovascular morbidity and mortality. However, hypertension is a primary risk factor for cerebral small vessel ischemic disease (SVID), especially in developing white matter lesions (WML). The pathogenesis of Alzheimer disease and related dementia is known to be associated with SVID and cognitive decline.

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Anatomic pathology selected abstracts

Angiosarcoma of the liver: clinicopathologic features and morphologic patterns
November 2019—Angiosarcoma is a rare malignant neoplasm of the liver for which morphologic patterns have not been systematically studied. To provide more comprehensive data on morphologic patterns, the authors reviewed angiosarcomas that had been diagnosed between 1996 and 2016 at a large medical referral center. The major growth patterns were classified as sinusoidal (nonmass forming) or mass forming.

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Molecular pathology selected abstracts

Tumor microbiome diversity 
and composition: influence on pancreatic cancer outcomes November 2019—Pancreatic adenocarcinoma has a dismal prognosis, with a high incidence of relapse and a median overall survival of 24 to 30 months. Only nine percent of patients are alive five years after surgery. Genome-wide mutational landscape studies to decipher the factors that contribute to long-term survival have been futile. Recent studies in patients with melanoma and lung cancer have shown that the gut microbiota can mediate tumor responses to chemotherapy and immunotherapy, influencing overall outcome.

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Clinical pathology selected abstracts

Cardiovascular events and mortality in white coat hypertension
October 2019—Hypertension is the most common preventable cause of disability and premature mortality worldwide. It is often diagnosed using in-office blood pressure measurements. More recent guidelines encourage out-of-office blood pressure monitoring, such as at-home self-monitoring, for diagnosing and managing hypertension.

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Anatomic pathology selected abstracts

Keratin 17: a sensitive and specific biomarker of urothelial neoplasia
October 2019—There is a clinical need to identify novel biomarkers to improve diagnostic accuracy for detecting urothelial tumors. The authors conducted a study to evaluate keratin 17 (K17), an oncoprotein that drives cell cycle progression in cancers of multiple anatomic sites, as a diagnostic biomarker of urothelial neoplasia in bladder biopsies and urine cytology specimens. The authors evaluated K17 expression using IHC in formalin-fixed, paraffin-embedded tissue specimens of nonpapillary invasive urothelial carcinoma (UC; classical histological cases), high-grade papillary UC (PUC-HG), low-grade papillary UC (PUC-LG), papillary urothelial neoplasia of low malignant potential (PUNLMP), and normal bladder mucosa.

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Molecular pathology selected abstracts

Circulating tumor DNA as a clinical test in resected pancreatic cancer
October 2019—Pancreatic ductal adenocarcinomas are associated with high rates of mortality due, in part, to a lack of effective screening strategies and advanced disease at diagnosis. Residual occult disease is thought to contribute to disease recurrence in up to 80 percent of patients treated surgically for localized disease. These findings highlight the critical need for biomarkers for detecting disease early and monitoring tumor dynamics. Current strategies involve a combination of serum markers (carbohydrate antigen [CA] 19–9) and imaging modalities, both of which have limitations, particularly for detecting early disease recurrence postoperatively.

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Anatomic pathology selected abstracts

Validation of 2016 ITBCC recommendations for tumor budding in stages I–IV colorectal cancer
September 2019—Tumor budding is a robust prognostic parameter in colorectal cancer and can be used as an additional factor to guide patient management. Although backed by large bodies of data, a standardized scoring method is essential for integrating tumor budding into reporting protocols.

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Molecular pathology selected abstracts

September 2019—The pathologist’s ability to interpret the complex spatial organization within and between cells and intercellular matrices is the basic underlying principle of morphologic pathology. Even in the genomic era, molecular genetic information is not clinically useful without tissue context. Modern spatial capturing methods, either by low-fidelity light microscopy or high-fidelity electron microscopy, cannot concomitantly interrogate a nucleic acid sequence.

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Anatomic pathology selected abstracts

July 2019—Although the majority of low-grade, early stage endometrial cancer patients have good survival rates with surgery alone, patients who recur tend to do poorly. Identifying patients at high risk of recurrence who would benefit from adjuvant treatment or more extensive surgical staging would improve individualized care for endometrial cancer patients.

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Molecular pathology selected abstracts

July 2018—The use of liquid biopsies to non-invasively detect and monitor cancer is rapidly expanding. In these assays, fragments of cell-free DNA (cfDNA), which are released when cells undergo necrosis or apoptosis, are isolated from the patient’s plasma and sequenced. Because cfDNA can originate from cancer cells and normal cells, the variant allele frequency of cancer-specific somatic mutations can often be very low.

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Clinical pathology selected abstracts

June 2019—Dietary patterns during adulthood and cognitive performance in midlife. Cognitive impairment is associated with an increased risk of mortality, disability, and late-life dementia, which contributes to the rising costs of health care. Several studies have demonstrated cognitive decline in midlife, and some data have linked this decline to cardiovascular disease risk factors or a more sedentary lifestyle. Diet is a modifiable exposure, but few studies have analyzed the risk of cognitive impairment due to dietary factors.

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Anatomic pathology selected abstracts

June 2019—Markers for differentiating triple-negative breast cancer from TTF1-negative
lung adenocarcinoma. Triple-negative breast cancer patients have an increased risk of developing visceral metastases and other primary nonbreast cancers, particularly lung cancer. The differential diagnosis of triple-negative breast cancer (TNBC) metastases and primary cancers from other organs can be difficult due to lack of a TNBC standard immunoprofile.

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Molecular pathology selected abstracts

June 2019—Link between immunogenic neoantigens derived from gene fusions and T-cell responses. Immunotherapy is quickly emerging as an important therapeutic strategy for hematologic and solid tumors. In 
principle, immune cells recognize unique non-self antigens expressed by cancer cells and this serves as the initial step in eliminating such cells. Among the metrics used to assess the likelihood of response to immunotherapy is the presence of a high level of somatic mutations, referred to as tumor mutation burden (TMB). This serves as a surrogate for extrapolating the level of neoantigens ex-
pressed by cancer cells.

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Clinical pathology selected abstracts

May 2019—Optimization of laboratory ordering practices for CBC with differential: Over 5 billion laboratory tests are performed in the United States each year, and more than 20 percent are considered unnecessary. The American Board of Internal Medicine Foundation initiated the Choosing Wisely campaign in 2012 to increase awareness of wasteful or unnecessary medical tests, procedures, and treatments. Studies have shown that tests ordered without a clear rationale not only waste resources but are also a source of iatrogenic anemia, which has been associated with increased blood transfusions, lengths of stay, and mortality.

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Anatomic pathology selected abstracts

May 2019—ALK-rearranged tumors in the STUMP subcategory of uterine tumors: Smooth muscle tumor of uncertain malignant potential is a rare diagnosis rendered when there is uncertainty concerning the biological potential of a smooth muscle tumor. The initial differential diagnosis is often broad, as tumors in this subgroup are morphologically heterogeneous. Recent data suggest that uterine inflammatory myofibroblastic tumors (IMTs) with anaplastic lymphoma kinase (ALK) rearrangement may be misclassified as smooth muscle tumor of uncertain malignant potential (STUMP), but the extent to which this occurs has not been examined.

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Clinical pathology selected abstracts

April 2019—Trauma resuscitation considerations: gender as a biological variable: Sex dimorphisms in coagulation are well established, with females manifesting a more hypercoagulable profile, but the relationship between sex dimorphism in coagulation and trauma outcomes has not been investigated. Trauma-induced hemorrhage remains a leading cause of early post-injury death.

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Anatomic pathology selected abstracts

April 2019—Frequent GNAQ and GNA14 mutations in hepatic small vessel neoplasm: April 2019—Hepatic small vessel neoplasm is a recently described infiltrative vascular neoplasm of the liver composed of small vessels. Although its infiltrative nature can mimic angiosarcoma, hepatic small vessel neoplasms (HSVNs) are thought to be benign or low-grade neoplasms because they lack cytologic atypia and increased proliferation.

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Molecular pathology selected abstracts

April 2019—Variants in NUDT15: association with thiopurine–induced myelosuppression: The thiopurines mercaptopurine, thioguanine, and azathioprine are purine antimetabolites widely used as anticancer and immunosuppressive agents. Commonly prescribed in patients with inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, they are valuable steroid-sparing treatment options.

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Anatomic pathology selected abstracts

March 2019—ALK expression in angiomatoid fibrous histiocytoma: a potential diagnostic pitfall: The authors recently encountered a case of primary pulmonary angiomatoid fibrous histiocytoma (AFH), which was initially misdiagnosed as inflammatory myofibroblastic tumor based in part on anaplastic lymphoma kinase expression by IHC. Prompted by this experience, they evaluated anaplastic lymphoma kinase (ALK) expression in 11 AFH, 15 inflammatory myofibroblastic tumors (IMT), and 11 follicular dendritic cell sarcomas using three antibody clones: D5F3, 5A4, and ALK1.

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Molecular pathology selected abstracts

March 2019—Using circulating cell-free fetal DNA to test for monogenic disorders: Screening for fetal chromosomal abnormalities can be performed by noninvasive methods in which fetal cell-free DNA (cfDNA) circulating in the maternal blood is isolated and analyzed. However, the standard of care for screening for monogenic diseases remains population-based carrier screening—testing the parents for their carrier status of deleterious genes.

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Anatomic pathology selected abstracts

February 2019—Diagnostic algorithmic proposal based on IHC evaluation of invasive endocervical adenocarcinomas: The International Endocervical Adenocarcinoma Criteria and Classification was developed to separate endocervical adenocarcinomas into two main categories based on morphology: human papilloma virus-associated (HPVA) and nonhuman papilloma virus-associated adenocarcinomas.

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Anatomic pathology selected abstracts

January 2019—Distinguishing patients with double somatic mismatch-repair mutations from those with Lynch syndrome: Lynch syndrome is the most common form of hereditary colon cancer. Germline mutations in the mismatch-repair (MMR) genes MLH1, MSH2 (EPCAM), MSH6, and PMS2, followed by a second hit to the remaining allele, lead to cancer development.

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Molecular pathology selected abstracts

Editors: Donna E. Hansel, MD, PhD, chief, Division of Anatomic Pathology, and professor, Department of Pathology, University of California, San Diego; James Solomon, MD, PhD, resident, Department of Pathology, UCSD; Richard Wong, MD, PhD, molecular pathology fellow, Department of Pathology, UCSD; and Sounak Gupta, MBBS, PhD, molecular pathology fellow, Memorial Sloan Kettering Cancer Center, New York. Development of brain circuits ...

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Clinical pathology selected abstracts

Prostate cancer screening with PSA test: systematic review and meta-analysis

December 2018—Prostate cancer is the second most common cancer and the fifth leading cause of cancer-associated mortality among men worldwide. The use of serum prostate-specific antigen (PSA) to screen for prostate cancer is intended to detect the cancer at an early stage to reduce overall and disease-specific mortality. However, evidence that PSA screening for prostate cancer saves lives is somewhat lacking.

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Anatomic pathology selected abstracts

December 2018—Applying deep convolutional neural networks to diagnostic breast biopsies: The breast stromal microenvironment is a pivotal factor in breast cancer development, growth, and metastases. Although pathologists often detect morphologic changes in stroma by light microscopy, visual classification of such changes is subjective and nonquantitative, limiting its diagnostic utility.

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Molecular pathology selected abstracts

December 2018—Profiling of chromatin-accessibility landscape of primary cancers: The chromatin-accessibility profiles generated in this study by The Cancer Genome Atlas represent the largest pan-cancer effort to characterize the regulatory landscape of human cancers. The study primarily used an assay for transposase-accessible chromatin using sequencing (ATAC-seq).

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Clinical pathology selected abstracts

Preparing for passage of regulatory requirements for laboratory-developed tests: November 2018—The FDA has raised concerns, in recent years, about several high-risk laboratory-developed tests (LDTs), including a concern that patients may undergo unnecessary treatment or delay or forego treatment due to the inaccuracy of such tests. Other agencies have also challenged the validity, accuracy, oversight, and safety of LDTs, a subset of IVDs that are intended for clinical use and designed, manufactured, and used within a single laboratory.

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Anatomic pathology selected abstracts

November 2018—HER2: a pan-cancer event highly enriched in AR-driven breast tumors: Approximately one in five breast cancers is driven by amplification and overexpression of the HER2 receptor kinase, and HER2 enriched is one of four major transcriptional subtypes of breast cancer. The authors conducted a study to understand the genomics of HER2 amplification independent of subtype, as well as the underlying drivers and biology of HER2-enriched (HER2E) tumors.

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Molecular pathology selected abstracts

November 2018—Common genetic variants contribute to risk of rare severe neurodevelopmental disorders: The traditional paradigm broadly classifies genetic diseases into rare disorders caused by a single gene variant and common disorders caused by complex interplay among multiple genes. However, recent research has shown that penetrance and disease phenotype, even in disorders thought to be monogenic, are affected by common genetic variation.

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Clinical pathology selected abstracts

RT-PCR detection of B. microti parasites using BMN antigens as amplification targets October 2018—Babesia microti infection, which is transmitted through the bite of an infected tick, is a growing health concern and continues to be a threat to the blood supply, with 22 states having reported cases of babesiosis in 2014. While most healthy adults with Babesia infection are asymptomatic or present with mild symptoms, including fever, fatigue, and anemia, babesiosis can be severe or fatal in neonates, the elderly, and immunosuppressed individuals.

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Anatomic pathology selected abstracts

Analysis of ZC3H7B-BCOR high-grade endometrial stromal sarcomas October 2018—High-grade endometrial stromal sarcoma likely encompasses underrecognized tumors harboring genetic abnormalities besides YWHAE–NUTM2 fusion. Triggered by three initial endometrial stromal sarcomas with ZC3H7B–BCOR fusion characterized by high-grade morphology and aggressive clinical behavior, the authors investigated the clinicopathologic features of this genetic subset by expanding the analysis to 17 such tumors. All of the tumors occurred in women who were a median age of 54 (range, 28–71) years.

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Molecular pathology selected abstracts

Cell-free DNA tumor mutational burden predicts efficacy of immune checkpoint inhibitors October 2018—Immune checkpoint inhibitors have emerged as a potent class of therapy for a variety of malignancies. The biologic rationale for these drugs is that somatic mutations, not necessarily in cancer driver genes, may accumulate in tumor cells, resulting in amino acid changes that create neoantigens (epitopes not present in normal cells during maturation of the immune system).

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Clinical pathology selected abstracts

Outcomes of an audit of repeat lab testing at an academic medical center
September 2018—Overutilization of laboratory tests increases health care costs and may lead to false-positive test results and ambiguous findings. Unnecessary testing can result from a single order from a provider, an automated function in an order set, or a combination of the two.

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Anatomic pathology selected abstracts

Thymoma: a clinicopathological correlation of surgical resection cases
September 2018—The authors presented 1,470 surgical resections for thymoma from the pathology files of 14 institutions in 11 countries with the purpose of determining and correlating a simplified histological classification of thymoma and pathological staging with clinical outcome.

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Molecular pathology selected abstracts

Ability of genetic alterations to predict development of acute myeloid leukemia
September 2018—Acute myeloid leukemia affects more than 60,000 people in the United States every year and has a mortality rate of more than 90 percent. It is the most common form of acute leukemia and is caused by unchecked growth of immature precursor cells in the bone marrow. These immature cells, or blasts, are myeloid precursors that often develop into dysfunctional, cancerous white blood cells that fill the bone marrow and spread into the blood.

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Clinical Pathology Abstracts

Association of perioperative RBC transfusions with venous thromboembolism
August 2018—Hospital-associated venous thromboembolism is a major cause of morbidity and mortality, resulting in 100,000 to 200,000 deaths annually. Surgery can lead to a proinflammatory state and be a prothrombotic stimulus for venous thromboembolism (VTE). General anesthesia, as well as red blood cells transfused in the perioperative setting, is considered an independent risk factor for VTE.

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Anatomic Pathology Abstracts

Analysis of the surveillance of women diagnosed with atypical ductal hyperplasia on core needle biopsy
August 2018—A needle core biopsy diagnosis of atypical ductal hyperplasia is an indication for open biopsy. The launch of randomized clinical trials of active surveillance for low-risk ductal carcinoma in situ leads to the paradoxical situation of women with low-grade ductal carcinoma in situ being observed and those with atypical ductal hyperplasia having surgery.

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Molecular Pathology Abstracts

Prevalence of clonal hematopoiesis mutations in tumor-only clinical genomic profiling of solid tumors
August 2018—Challenges to implementing next-generation sequencing-based comprehensive molecular profiling of solid tumors include reliably separating germline variants from somatic variants. This is an important consideration, particularly when a “tumor-only” profiling approach is used.

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Clinical Pathology Abstracts

Trends in perioperative RBC transfusion from index cases in five surgical specialties
July 2018—In recent years, greater attention has been given to patient blood management. While contemporary national guidelines recommend restrictive red blood cell transfusion, it is not known whether such transfusions have decreased in surgical patients. Approximately 11 million RBC transfusions are performed annually, and two-thirds of those are for patients in the perioperative period.

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Anatomic pathology Abstracts

Clinical and molecular analyses of neuroendocrine carcinomas of breast
July 2018—Clinical and molecular analyses of neuroendocrine carcinomas of breast: Neuroendocrine breast carcinomas represent a rare subtype of breast cancer. Their definition, prevalence, and prognosis remain controversial, as reported in the literature.

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Molecular pathology selected abstracts

July 2018—Correlation between tumor mutation burden and efficacy of combination immunotherapy in nonsmall cell lung cancer: Checkpoint inhibitor therapy has dramatically improved outcomes in many cancer types, with treatments including antibodies against cytotoxic T-lymphocyte–associated protein 4 (CTLA-4), programmed cell death receptor-1 (PD-1), and its ligand (PD-L1).

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Clinical Pathology Abstracts, 5/18

May 2018—Use of a smartphone app to assess neonatal jaundice: Neonates are screened for hyperbilirubinemia before hospital discharge using a transcutaneous or total serum bilirubin measurement. However, levels peak at approximately 96 hours of life, which is after most healthy infants have left the hospital. Outpatient follow-up is often performed by visual inspection, but this can be highly variable and have poor interobserver agreement.

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Anatomic Pathology Abstracts, 5/18

May 2018—Outcomes related to use of hygroscopic sonographically detectable clips: The use of hygroscopic sonographically detectable clips (HSDCs) has dramatically increased in recent years, especially for breast cancer patients who undergo neoadjuvant chemotherapy. The authors conducted a study to define the appearance of HSDC sites in histopathological specimens and allow pathologists to recognize these sites and differentiate them from other lesions.

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Molecular Pathology Abstracts, 5/18

May 2018—DNA methylation-based testing to classify central nervous system tumors: Despite being the mainstay of pathology tissue diagnostics, microscope-based histological review has limitations. Among them is that pathologists may have differing opinions about a case. This interobserver variability may result in over- or undertreatment of the patient and lack of agreement about which diagnosis is correct.

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Molecular Pathology Abstracts

April 2018—Effect of inherited TP53 mutations on children with B-cell ALL: TP53 has been referred to as the “guardian of the genome” because it plays a central role in regulation of the cell cycle, DNA repair, and apoptosis, and because somatic mutations in TP53 are frequently identified in many tumor types.

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Clinical Pathology Abstracts, 3/18

March 2018—Web platform vs. genetic counselor for releasing carrier results from exome sequencing: Genomics can be used to generate a large amount of data that may have important implications for clinical care and selection of therapeutics. However, a bottleneck exists in clinical genomics due to the large volume of results and the lack of availability of knowledgeable professionals to return them to patients in person.

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Anatomic Pathology Abstracts, 3/18

March 2018—Magee equation 3 for predicting response to chemotherapy in some breast tumors: Magee equations were derived as an inexpensive, rapid alternative to the Oncotype DX commercial assay. Magee equation 3 uses immunohistochemical and FISH data for estrogen receptor (ER), progesterone receptor (PR), HER2, and Ki-67 for its calculation: 24.30812+ERIHC×​(–.02177)+PRIHC×(−0.02884)+(0 for HER2 negative, 1.46495 for equivocal, 12.75525 for HER2 positive)+Ki-67×0.18649.

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Molecular Pathology Abstracts, 3/18

March 2018—Nonendoscopic detection of Barrett’s esophagus using DNA methylation biomarkers: Esophageal adenocarcinoma is an aggressive disease, with a less than 20 percent five-year survival rate, and its incidence is rapidly increasing. Early detection of esophageal adenocarcinoma or its precursor lesion, Barrett’s esophagus, would enable more effective treatment strategies and a greater chance of cure.

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Clinical Pathology Abstracts, 2/18

February 2018—Restrictive or liberal approach to red blood cell transfusion for cardiac surgery: Among the largest group of recipients of red blood cell transfusions are patients undergoing cardiac surgery. Whether a restrictive approach to intraoperative and postoperative transfusion in cardiac surgery is superior to a more liberal approach with regard to patient outcomes is unclear.

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Anatomic Pathology Abstracts, 2/18

February 2018—ARTEMIS trial: quantifying pathological response to neoadjuvant chemotherapy: The Affordability and Real-World Antiplatelet Treatment Effectiveness after Myocardial Infarction Study, also known as the ARTEMIS trial, tested standard neoadjuvant chemotherapy with or without bevacizumab in the treatment of HER2-negative early breast cancer.

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Molecular Pathology Abstracts, 2/18

February 2018—Gene expression and risk of leukemic transformation in myelodysplasia: The myelodysplastic syndromes represent a group of clonal hematopoietic disorders with varying prognoses, with survival ranging from a few months to more than 10 years. Multiple laboratory measurements have been used in attempts to provide reliable prognostic assessments, including bone marrow blast counts, severity of peripheral cytopenia, cytogenetic findings, and, most recently, gene-mutation profiling.

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Anatomic Pathology Abstracts, 12/17

December 2017—Gene mutations in HPV-negative penile squamous cell carcinoma: The majority of penile squamous cell carcinomas are caused by transforming human papillomavirus infection. The etiology of HPV-negative cancers is unclear, but TP53 mutations have been implicated. Archival tissue from 108 invasive squamous cell carcinomas from a single pathology institution in a low-incidence area were analyzed for HPV-DNA and p16INK4A overexpression and for TP53 mutations by Ion Torrent next-generation sequencing.

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Clinical Pathology Abstracts, 12/17

December 2017—Chimeric antigen receptor T-cell therapy assessment and management of toxicities: In August, the FDA approved the gene therapy Kymriah (tisagenlecleucel) for pediatric and young adult patients with a form of acute lymphoblastic leukemia. Chimeric antigen receptor (CAR) T-cell therapy is a breakthrough in the treatment of leukemia and lymphoma, but it is associated with unique acute toxicities, such as cytokine-release syndrome and CAR-T-cell-related encephalopathy syndrome.

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Molecular Pathology Abstracts, 12/17

December 2017—Refining subgroups of pediatric gliomas using molecular markers: Pediatric high-grade and diffuse intrinsic pontine gliomas are a rare and heterogeneous group of tumors that show diverse histology, location, and prognosis. Although little was known regarding the development of these tumors, recent genomic studies have begun to elucidate their biological underpinnings. The authors conducted a study to further understanding of such gliomas by breaking them into subgroups.

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Clinical Pathology Abstracts, 11/17

November 2017—Performance of virological testing for early infant diagnosis: a systematic review: The World Health Organization recommends that HIV-exposed infants receive virological testing for HIV infection between four and six weeks of age and treatment with antiretroviral (ARV) therapy as soon as the diagnosis is made. Despite efforts to expand mother-to-child transmission prevention programs, only an estimated 50 percent of HIV-exposed infants are tested within the first two months of life.

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Clinical Pathology Abstracts, 10/17

October 2017—Association between age at natural menopause and risk of type 2 diabetes: Menopause in women marks the loss of ovarian follicle development and the timing of the final menstrual period. The timing of menopause differs significantly among women and is seen as a marker of aging and cardiovascular health. Studies have shown a link between early onset of menopause and an increased risk of cardiovascular disease (CVD) and overall mortality, whereas menopause at age 50 to 54 years is linked to a decrease in CVD risk and mortality.

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Anatomic Pathology Abstracts, 10/17

October 2017—Lymph node yield is an independent predictor of survival in rectal cancer: Lymph node yield is used as a marker of adequate oncological resection. The American Joint Committee on Cancer recommends at least 12 nodes to confirm node-negative disease for rectal cancer. However, it is not always possible to achieve a lymph node yield of 12, particularly in patients who have undergone neoadjuvant treatment.

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Molecular Pathology Abstracts, 10/17

Editors: Donna E. Hansel, MD, PhD, chief, Division of Anatomic Pathology, and professor, Department of Pathology, University of California, San Diego; John A. Thorson, MD, PhD, associate professor of pathology, director of the Clinical Genomics Laboratory, Center for Advanced Laboratory Medicine, UCSD; Sarah S. Murray, PhD, associate professor, Department of Pathology, and director of genomic technologies, Center for Advanced Laboratory ...

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Clinical Pathology Abstracts, 9/17

September 2017—Hemoccult testing before therapeutic anticoagulation in venous thromboembolism: Gastrointestinal bleeding is a major adverse event associated with therapeutic anticoagulation. Surveys of physicians have shown that concern for this event is one of the most common reasons to withhold anticoagulation in patients who have atrial fibrillation, acute coronary syndromes, or venous thromboembolism (VTE).

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Anatomic Pathology Abstracts, 9/17

Editors: Michael Cibull, MD, professor emeritus, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, PhD, associate professor of pathology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY; Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.; and Rachel Stewart, DO, resident physician, Department of Pathology and Laboratory Medicine, University of Kentucky. Detection of HPV ...

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Molecular Pathology Abstracts, 9/17

September 2017—Ability of cell-free circulating tumor DNA to reflect genomic changes in cancer deposits: Analysis of cell-free circulating tumor DNA is an emerging precision medicine technology that may be used to assess molecular alterations in cancer-derived DNA present in the blood, as well as to monitor cancer genomic changes over time and assess genomic changes and resistance following cancer therapy.

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Molecular Pathology Abstracts, 8/17

August 2017—Mismatch repair-deficient tumors and immune checkpoint inhibitors: Immune checkpoint inhibitors have yielded highly effective therapeutic responses in a subset of tumors by eliciting an endogenous adaptive immune response. The determinants that define this subset of tumors are still unclear, but several markers, including PD-L1 expression and mutational burden, have been evaluated in various tumor types.

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Anatomic Pathology Abstracts, 8/17

August 2017—Analysis of microglandular adenosis and acinic cell carcinoma of the breast: Acinic cell carcinoma is an indolent form of invasive breast cancer, whereas microglandular adenosis has been shown to be a neoplastic proliferation. Both entities display a triple-negative phenotype and may give rise to, as well as display, somatic genomic alterations typical of high-grade triple-negative breast cancers. The authors compared previously published data on eight carcinoma-associated microglandular adenoses and eight acinic cell carcinomas subjected to massively parallel sequencing targeting all exons of 236 genes recurrently mutated in breast cancer or DNA repair related, or both.

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Clinical Pathology Abstracts, 8/17

August 2017—Etiology and clinical presentation of birth defects: a population-based study: Birth defects are inborn errors of development and include any structural or functional anomaly that impacts physical, intellectual, or social well-being. They are a considerable and growing clinical and public health challenge. Major birth defects are common and costly. Collectively, they are estimated to occur in one in 33 births, which translates into approximately 7.9 million babies affected worldwide. In the United States alone, the cost of care during a single year (2004) was estimated to be $2.6 billion.

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Clinical Pathology Abstracts, 7/17

July 2017—Effects of early tranexamic acid administration on women with postpartum hemorrhage: The leading cause of maternal death is postpartum hemorrhage, which is defined as blood loss of more than 500 mL within 24 hours of giving birth. The majority of such deaths occur in low-income and middle-income countries.

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Anatomic Pathology Abstracts, 7/17

July 2017—Potential quality indicators for lymph node staging of colon cancer: Evaluation of 12 or more lymph nodes is used as a quality indicator for adequacy of pathologic examination of colon cancer resections. The authors conducted a study to evaluate the utility of a focused lymph node search in the immediate vicinity of the tumor and a “second-look” protocol for improving lymph node staging in colon cancer.

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Molecular Pathology Abstracts, 7/17

July 2017—Immune checkpoint inhibition therapy, such as blockage of PD-1/PD-L1 interaction, has proven effective in many types of cancers. The mechanism underlying this therapy is postulated to involve “disinhibition” of tumor-infiltrating lymphocytes that respond to neoantigens expressed by tumor cells. In theory, the larger the number of neoantigens expressed, the greater the immune response resulting from disinhibition.

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Anatomic Pathology Abstracts, 6/17

June 2017—Fallopian tube involvement in uterine serous carcinomas: The authors investigated the frequency and histopathologic and immunohistochemical characteristics of tubal involvement in uterine serous carcinoma to clarify the relationship between serous tubal intraepithelial carcinoma (STIC) and uterine serous carcinoma. They prospectively collected and reviewed, for the presence of tubal involvement, cases of the latter with complete tubal examination.

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Clinical Pathology Abstracts, 6/17

June 2017—Stem cell divisions, somatic mutations, cancer etiology, and cancer prevention: Cancers are caused by mutations that may be inherited or induced by environmental factors or that may result from DNA replication errors. The mutations due to random mistakes made during normal DNA replication may explain why cancers occur much more commonly in some tissues than others. Approximately three mutations occur every time a normal human stem cell divides.

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Molecular Pathology Abstracts, 6/17

June 2017—Whole genome single-cell copy number profiling on FFPE tissue samples Single-cell genomic methods take the concept of analyzing intratumor genetic heterogeneity to its logical conclusion. Traditionally, however, single-cell methods can only be used to analyze fresh or rapidly frozen tissue because formalin fixation and paraffin embedding degrades tumor DNA and cross-links proteins.

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Anatomic Pathology Abstracts, 5/17

May 2017—Value of Ki-67 proliferative index in WHO-classified pulmonary carcinoids; Chromosomal abnormalities and genetic changes in uterine smooth muscle tumors; Expression of divergent endodermal lineage markers in yolk sac tumors; Interobserver reproducibility of percent GP4 in prostatic adenocarcinoma on biopsies; MELF pattern invasion: a report of FIGO grade 1 endometrial endometrioid adenocarcinomas; Cost-effectiveness of identifying H. pylori  in gastric biopsies without ancillary stains

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Clinical Pathology Abstracts, 4/17

April 2017—Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women: Chlamydia trachomatis is the most common bacterial sexually transmitted infection in the United States. In 2010, more than 1.3 million such infections in the United States were reported to the Centers for Disease Control and Prevention. In 2013, the estimated direct lifetime cost of treatment for chlamydia and its complications was more than $500 million.

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Anatomic Pathology Abstracts, 4/17

April 2017—Proposing prognostic thresholds for lymph node yield in oral cavity cancers: Prognostic lymph node yield thresholds have been identified and incorporated into treatment guidelines for multiple cancer sites, but not for oral cancer. The authors conducted a study to identify optimal thresholds in elective and therapeutic neck dissection for oral cavity cancers.

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Molecular Pathology Abstracts, 4/17

April 2017—Molecular profiling in MDS to predict clinical outcomes after transplantation: In recent years, several insights have been gleaned regarding the role of molecular markers for prognosis in myeloproliferative disease. This study expanded the use of molecular markers for prognosis in myelodysplastic syndrome (MDS) to predicting clinical outcomes after allogeneic hematopoietic stem-cell transplants.

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Clinical Pathology Abstracts, 3/17

February 2017—Preventing genetic testing order errors via a lab utilization management program: Diagnostic errors, or failure to provide an accurate and timely diagnosis, impact an estimated 12 million outpatient care visits annually in the United States. These errors can often be attributed to the testing process, including test selection, ordering, retrieval, and interpretation. Literature about diagnostic errors has primarily focused on the outpatient setting; study of diagnostic error in the inpatient setting has been limited.

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Anatomic Pathology Abstracts, 3/17

March 2017—An immunohistochemical algorithm for ovarian carcinoma typing: Five major histotypes of ovarian carcinoma exist. Diagnostic typing criteria have evolved over time, and past cohorts may be misclassified by current standards. The authors undertook an endeavor to reclassify the recently assembled Canadian Ovarian Experimental Unified Resource and Alberta Ovarian Tumor Type cohorts using immunohistochemical (IHC) biomarkers and to develop an IHC algorithm for ovarian carcinoma histotyping.

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Molecular Pathology Abstracts, 3/17

March 2017—Effects of ovarian cancer cells manipulating mesothelial cells that line the peritoneal cavity: spread within the peritoneal cavity, resulting in cell implantation and metastasis at many secondary sites. The peritoneal cavity and associated organs are lined by a single layer of mesothelial cells that it has been suggested not only provides a physical barrier to prevent implantation and invasion but also plays a more complex interactive role in regulating cancer spread.

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Molecular Pathology Selected Abstracts, 2/17

February 2017—Concordance between liquid biopsy and patient-matched tumor molecular testing: The use of sequence analyses of extended panels of genes to identify therapeutic targets in cancer is becoming commonplace. These assays typically rely on the availability of tissue biopsies as a source of genomic material, which can become a limitation in situations where insufficient tissue is available or an invasive procedure to collect tissue is impractical. A potential solution to this dilemma is the use of a blood-based, or liquid biopsy, approach, in which a peripheral blood sample is used as a source of tumor-derived genomic material, either in the form of cell-free DNA (cfDNA) or via circulating tumor cells (ctcDNA).

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Anatomic Pathology Abstracts, 2/17

February 2017—Findings in hysterectomy specimens of women with Lynch syndrome; Percentages and architectural types of Gleason pattern 4 cancer in radical prostatectomy; PTEN loss and chromosome 8 alterations in Gleason grade 3 prostate cancer cores; Lymph node count from neck dissection predicts mortality in head and neck cancer; Assessing the adequacy of lymph node yield for papillary thyroid cancer; Addressing perceived versus actual agreement in breast pathology interpretation; Cost-effectiveness of Oncotype DX DCIS score for guiding treatment of DCIS

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Anatomic Pathology Abstracts, 1/17

January 2017—Drawbacks of reflex ER and PR analysis of DCIS in breast needle core biopsies; Analysis of eosinophils and mast cells of gastrointestinal tract in healthy children; Classifying gastric cancer into molecular subgroups; Clinicopathologic significance of mismatch repair defects in endometrial cancer; Use of immunostains to distinguish hepatic adenoma from hepatocellular carcinoma; Prognostic effect of PD-L1 expression patterns in cervical cancers; Variation in pattern-based classification of invasive endocervical adenocarcinoma

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Clinical Pathology Abstracts, 1/17

January 2017—Impact of laboratory cost display on resident attitudes and knowledge of costs: The Institute of Medicine report on health care quality recommends providing better care at lower costs. However, the United States has consistently seen rising health care costs instead of cost reductions. An approach to reducing unnecessary health care spending is to make physicians more aware of the cost of diagnostic tests.

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Molecular Pathology Selected Abstracts, 12/16

December 2016—ANXA1 as a predictive biomarker for resistance to trastuzumab in breast cancer: Treatment with the HER2-targeting antibody trastuzumab (Herceptin) is a key component of therapy for women with HER2-positive breast cancer. However, a subset of women with advanced disease shows initial or acquired resistance to therapy, although the mechanisms that control this resistance are largely unknown. Some studies have suggested that activation of the PI3K/mTOR signaling pathway may be responsible for trastuzumab resistance.

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Anatomic Pathology Abstracts, 12/16

December 2016—Reproducibility of NEPTUNE descriptor-based scoring system with various types of images: The multicenter Nephrotic Syndrome Study Network, or NEPTUNE, digital pathology scoring system uses a novel and comprehensive methodology to document pathologic features from whole-slide images, immunofluorescence, and ultrastructural digital images.

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Clinical Pathology Abstracts, 12/16

December 2016—Process optimization to improve immunosuppressant drug testing turnaround time: The routine use of immunosuppressant medications is critical for patients receiving solid organ transplants. Monitoring immunosuppressant (ISP) drug concentrations helps guide safe and effective dosing. ISP drug monitoring is performed using mass spectrometry or immunoassay methods.

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Anatomic Pathology Abstracts, 11/16

November 2016—Relevance of papillary growth patterns of pulmonary adenocarcinoma, HPV involvement in head and neck cancers: assessment of biomarkers, Distinctive immunoregulatory microenvironment of medullary carcinoma of the colon, Diagnostic challenges caused by endoscopic biopsy of colonic polyps, MicroRNA expression profiling and expression of miR-205 in inflammatory breast cancer

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Clinical Pathology Abstracts, 11/16

November 2016—Neonatal ICU quality initiative: identifying preanalytical variables that contribute to specimen hemolysis: Hemolysis is a major cause of sample rejection and the need to recollect a specimen from a patient. In the neonatal intensive care unit, this may be of particular concern because of limited venous access and the risk of causing iatrogenic anemia.

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Molecular Pathology Selected Abstracts, 11/16

November 2016—Misclassification of genetic variants associated with hypertrophic cardiomyopathy: Hypertrophic cardiomyopathy has a variable clinical presentation and may lead to sudden cardiac death. In many cases, it is associated with pathogenic genetic variants, enabling screening of relatives and, possibly, the ability to individualize treatment strategies through lifestyle modification or invasive procedures.

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Anatomic Pathology Abstracts, 10/16

October 2016—Features of columnar-lined esophagus in gastroesophageal junction biopsies; Significance of Paneth cells in histologically unremarkable rectal mucosa; MicroRNA expression profile related to lymph node status in endometrial cancer; Plasma cells in melanoma: prognostic significance and possible role of IgA; Human epidermal growth factor receptor 2 testing in invasive breast cancer

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Clinical Pathology Abstracts, 10/16

October 2016—Risk factors for transfusion in cesarean section deliveries at a tertiary hospital: Obstetrical hemorrhage is a major cause of morbidity and mortality in young women and may be difficult to predict. In some regions of the world, postpartum hemorrhage (PPH) may account for up to 25 percent of maternal deaths. Many studies have focused on the predictors of PPH before delivery.

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Anatomic Pathology Abstracts, 9/16

September 2016—Digital image analysis versus manual biomarker assessment in breast cancer; Clinical and cost impact of EGFR and ALK testing in early stage NSCLC; Switch/sucrose nonfermenting complex protein expression in an aggressive endometrial cancer; Immune microenvironment of breast ductal carcinoma in situ; Adverse histological features in malignant colorectal polyps; Use of ancillary molecular analysis for diagnosis of soft tissue tumors

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Molecular Pathology Selected Abstracts, 9/16

September 2016—Mutations causing acquired resistance to PD-1 blockade in melanoma: Immunotherapy in metastatic cancer has achieved durable responses in a wide variety of cancer types. Antibodies that block programmed cell death protein-1 (PD-1) are particularly effective in metastatic melanoma, but a recent study showed that approximately 25 percent of patients that achieved a durable response ultimately had disease progression at a median follow-up of 21 months.

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Clinical Pathology Abstracts, 8/16

August 2016—Cold antibodies may be detected with routine pretransfusion testing and may obscure the identification of clinically significant red blood cell antibodies. They may be detected in healthy people or may be transient in appearance after a mycoplasma or mononucleosis infection. In most cases, cold antibodies are benign, and pretransfusion laboratory testing is designed to avoid detecting these antibodies by eliminating testing at room temperature.

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Anatomic Pathology Abstracts, 8/16

August 2016—Use of HSP70 and glutamine synthetase to diagnose hepatocellular carcinoma; Recurrence of benign and low-grade fibroepithelial neoplasms of the breast; Lobular neoplasia detected in MRI-guided core biopsy: a high risk for upgrade; Use of microsatellite instability, MLH1 methylation analysis, IHC to identify Lynch syndrome; Differential diagnosis of bladder versus colorectal adenocarcinoma; Enhanced expression of PD L1 in CIN and cervical cancers

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Molecular Pathology Selected Abstracts, 8/16

August 2016—Germline mutations in men with metastatic prostate cancer: Prostate cancer displays great diversity in clinical behavior, ranging from essentially silent, organ-confined disease to rapid and aggressive metastatic spread. The authors know of no clear-cut screening method that can reliably identify those patients whose tumors are likely to behave aggressively and, therefore, may benefit from a more active treatment strategy. Prostate cancer has also been shown to have a significant component of heritability.

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Clinical Pathology Abstracts, 7/16

July 2016—Utilization management to reduce unnecessary lab testing at a VA hospital: It is estimated that laboratory and pathology testing account for four percent of annual health care costs. A laboratory utilization management system, or laboratory expert system (LES), can be employed to reduce such costs. A variety of functionality, including passive and active alerts, in the computerized physician order entry (CPOE) system provide decision-making support for physicians ordering tests.

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Molecular Pathology Selected Abstracts, 7/16

July 2016—Using single nucleotide polymorphism arrays in acute lymphoblastic leukemia: In patients with acute lymphoblastic leukemia/lymphoma, the identification of chromosomal abnormalities at the time of diagnosis is important for risk classification. The current standard of care includes karyotype and FISH analysis to identify recurrent cytogenetic abnormalities.

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Clinical Pathology Abstracts, 6/16

June 2016—Fasting or nonfasting lipid measurements: The joint American College of Cardiology and American Heart Association “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults” replaces low-density lipoprotein cholesterol treatment thresholds with a more global measurement of risk.

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Anatomic Pathology Abstracts, 5/16

May 2016—Noninfectious aortitis of the ascending aorta: a histological and clinical correlation of cases; Stratifying HPV-induced cervical pathology using E4 with p16 or MCM; Limited resection versus lobectomy for older patients with early-stage lung cancer; L1CAM expression and its association with mutant p53 expression in endometrial cancer; Value of p16 staining for predicting outcome of LSIL/CIN1

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Anatomic Pathology Abstracts, 4/16

April 2016—Comparison of methods for analyzing gene amplification in gastric cancers; Uterine smooth muscle tumor analysis by comparative genomic hybridization; Role of TAZ in aggressive types of endometrial cancer; Reclassification of resected lung carcinomas diagnosed as squamous cell carcinoma; Sequencing of cancer genes in ampullary carcinoma shows trends in histologic subtypes; Prognostic significance of the 2014 ISUP grading system for prostate cancer

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Anatomic Pathology Abstracts, 3/16

March 2016—Reproducibility of residual cancer burden for assessing breast cancer after neoadjuvant chemotherapy: The residual cancer burden index was developed to quantify residual disease ranging from pathological complete response to extensive residual disease. The authors conducted a study to evaluate inter-pathologist reproducibility in the residual cancer burden index score and category and in their long-term prognostic utility.

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Molecular Pathology Selected Abstracts, 3/16

March 2016—Enhancing tumor selectivity of a picornavirus virotherapy: Oncolytic viruses that selectively target tumor cells are a promising cancer therapy and are thought to work not only via direct lysis and destruction of tumor cells but also through recruitment and activation of the host’s anti-tumor immune response. While there are a number of naturally occurring viruses that preferentially replicate in cancer cells and have otherwise limited effects in human tissue, the real therapeutic promise lies in genetically engineered viruses.

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Clinical Pathology Abstracts, 3/16

March 2016—Impact of add-on laboratory testing at an academic medical center: Clinical laboratories are often asked to perform additional laboratory tests after the original sample is received and testing per the original order is complete. It is well known that this significantly increases laboratory workload and impacts turnaround time.

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Clinical Pathology Abstracts, 2/16

February 2016—Link between a liberal transfusion strategy and patient survival: Guidelines support using a restrictive strategy for blood transfusion management in various clinical settings. However, randomized controlled trials in cardiac surgery, oncology, and hip fracture surgery suggest that a more liberal transfusion strategy may benefit survival.

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Anatomic Pathology Abstracts, 2/16

February 2016—Subtype classification of lung adenocarcinoma in patients undergoing complete resection: The classification for invasive lung adenocarcinoma by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization is based on the predominant histologic pattern—lepidic, papillary, acinar, micropapillary, or solid—present in the tumor.

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Molecular Pathology Selected Abstracts, 1/16

January 2016—Genomic sequencing of tumors can be used clinically to identify acquired somatic mutations in cancer-related genes. In an era of personalized medicine, tumor-specific mutational status can be used to acquire prognostic information and guide molecular targeted therapies. However, many patients also have germline variants in these genes, which not only can make it difficult to identify the tumor-specific somatic mutations, but may also affect the biological mechanism of tumorigenesis.

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Anatomic Pathology Abstracts, 1/16

January 2016—Uterine leiomyosarcomas are rare malignant tumors with a poor prognosis, while leiomyomas are common benign tumors unrelated to their malignant counterparts. Diagnostic features commonly present in leiomyosarcoma include cytologic atypia, high mitotic index, and a sarcoma-specific geographic cell death designated as tumor cell necrosis (TCN).

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Clinical Pathology Abstracts, 1/16

January 2016—A logical delta check for identifying erroneous blood cell count results: Regulations require that hospitals have a quality management plan that benchmarks key indicators of quality performance. One such indicator is a delta check, which is a broad quality control for preanalytic and analytic errors that identifies significant variation in a patient’s present lab result when compared with the patient’s previous result for the same test.

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Clinical Pathology Abstracts, 12/15

December 2015—Optimizing transfusion ratios in massive transfusion protocols: The 1:1:1 ratio of packed red blood cells to plasma to platelet use for massive transfusion emerged out of data on mortality in military personnel wounded in combat. Many studies have investigated the optimal ratio for use in massive transfusion. The literature is controversial, and studies continue to support and refute the 1:1:1 ratio.

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Anatomic Pathology Abstracts, 12/15

December 2015—Reappraisal of etiologic field effect in cancer predisposition and progression: The term field effect, which is also known as field defect, field cancerization, and field carcinogenesis, has been used to describe a field of cellular and molecular alteration that predisposes to the development of neoplasms within that territory.

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Molecular Pathology Selected Abstracts, 11/15

November 2015—Off-label use of molecularly targeted therapy: Advances in technology allow for genetic and molecular profiling of tumors, findings that are useful for guiding molecularly targeted therapy. Molecularly targeted agents are usually tested and developed on groups of tumors based on histologic type and primary location, but many genetic abnormalities overlap across tumor types.

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Anatomic Pathology Abstracts, 11/15

November 2015—Variation in reporting extraprostatic extension after radical prostatectomy: Extraprostatic extension of prostate cancer in radical prostatectomy specimens significantly affects patient management. The authors evaluated the degree of interobserver variation between uropathologists at a tertiary referral teaching hospital in assessing the extraprostatic extension of prostate cancer in radical prostatectomy specimens.

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Clinical Pathology Abstracts, 11/15

Editor: Deborah Sesok-Pizzini, MD, MBA, professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and chief, Division of Transfusion Medicine, Children’s Hospital of Philadelphia. Altered lysosomal proteins in neural-derived plasma exosomes in preclinical Alzheimer disease It is necessary to identify biomarkers to detect patients at risk for Alzheimer disease well before neurological signs ...

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Clinical Pathology Abstracts, 10/15

October 2015—Impact of a rapid respiratory panel test on patient outcomes: Studies have examined the impact of polymerase chain reaction tests on patient outcomes. Rapid detection in microbiology and virology allows more appropriate treatment sooner. This, in turn, can reduce hospital length of stay for patients with respiratory pathogens and may generate hospital savings.

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Anatomic Pathology Abstracts, 10/15

October 2015—CD117 expression in phyllodes tumors: correlation with adverse pathologic parameters. CD117 (c-Kit) is a type III receptor tyrosine kinase encoded by the KIT gene. Deregulation of expression and mutations in the gene are implicated in various tumors. Reports of CD117 expression in phyllodes tumors have generated controversy.

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Molecular Pathology Selected Abstracts, 10/15

October 2015—Mutation clearance after induction therapy in acute myeloid leukemia: After initial induction chemotherapy for acute myeloid leukemia, approximately 20 percent of patients fail to achieve complete remission, and approximately 50 percent experience relapse within one year. Therefore, it would be clinically useful to identify patients at higher risk of induction therapy failure or relapse.

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Molecular Pathology Selected Abstracts, 9/15

September 2015—Molecular profile of diffuse lower-grade gliomas: Diffuse low- and intermediate-grade gliomas include World Health Organization grade II and III astrocytomas, oligodendrogliomas, and oligoastrocytomas. These lower-grade gliomas usually arise in the cerebral hemispheres of adults, and they are highly infiltrative and, therefore, cannot be completely resected.

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Clinical Pathology Abstracts, 9/15

September 2015—Costs and outcomes after cardiac surgery in patients refusing transfusion: Numerous randomized, controlled trials have shown no benefit of a liberal blood transfusion strategy compared with a more restrictive strategy in surgical patients. Furthermore, concerns exist regarding the association of transfusion with postoperative morbidity and mortality.

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Anatomic Pathology Abstracts, 9/15

September 2015—Tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy in select breast cancers: Modulation of immunologic interactions in cancer tissue is a promising therapeutic strategy. To investigate the immunogenicity of HER2-positive and triple-negative breast cancers, the authors evaluated tumor-infiltrating lymphocytes and immunologically relevant genes in the neoadjuvant GeparSixto trial.

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Anatomic Pathology Selected Abstracts, 8/15

August 2015—Quality of diagnostic staging in patients with bladder cancer: a process-outcomes link: Muscle sampling is often used as a surrogate for staging quality in patients with bladder cancer. The association of staging quality at diagnosis and survival was examined among patients with bladder cancer. The clinical records of all individuals within the Los Angeles Surveillance, Epidemiology, and End Results registry with an incident diagnosis of nonmuscle-invasive bladder cancer in 2004–2005 were reviewed.

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Molecular Pathology Selected Abstracts, 8/15

August 2015—Studying clonal dynamics in response to cancer therapy using barcoding: The emergence of resistance to targeted cancer therapeutics is a significant problem clinically and is generally believed to result from genetic alterations in tumor cells. Whether resistance exists within a subpopulation of a tumor prior to treatment or develops de novo during treatment is a fundamental question that may significantly impact therapy.

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Anatomic Pathology Selected Abstracts, 7/15

July 2015—Expanding the morphologic spectrum of differentiated VIN by mapping p53 loss; Mitotic count by PHH3 immunohistochemical staining in pancreatic WDNETs; Comparison of prostate cancer markers in lymph node and distant metastases; Evaluation of a new grading system for laryngeal squamous intraepithelial lesions; Breast cancer assessment based on levels of estrogen receptor expression ...

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Anatomic Pathology Selected Abstracts, 6/15

June 2015—Safety and diagnostic accuracy of tumor biopsies in children with cancer; Napsin A as a specific marker for ovarian clear cell adenocarcinoma; Long-term follow-up of an active surveillance cohort of patients with prostate cancer; Primary sources of pelvic serous cancer in patients with endometrial intraepithelial carcinoma; Re-evaluating the role of sentinel lymph node biopsy in microinvasive breast carcinoma; Molecular analyses of six types of uterine smooth muscle tumors

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Clinical Pathology Selected Abstracts, 6/15

June 2015—Effects of red cell storage duration on patients undergoing cardiac surgery: Patients who undergo cardiac surgery often receive multiple units of red blood cells and may be at risk for end-organ injury because of compromised cardiac output or a proinflammatory state that follows cardiopulmonary bypass. At least one large study has shown an increase in adverse outcomes in patients receiving RBCs stored longer than 14 days compared with those receiving RBCs stored less than 14 days.

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Anatomic Pathology Selected Abstracts, 5/15

Editors: Michael Cibull, MD, professor emeritus, University of Kentucky College of Medicine, Lexington; Rouzan Karabakhtsian, MD, attending pathologist, Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.; and Rachel Stewart, DO, resident physician, Department of Pathology and Laboratory Medicine, University of Kentucky. Molecular detection of ...

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Clinical Pathology Selected Abstracts, 5/15

May 2015—Use of hemoglobin content of reticulocytes to evaluate anemia in cancer patients: Evaluating iron-deficiency anemia in patients with cancer is difficult. Malignancy is frequently associated with anemia of chronic disease. However, it is important to distinguish iron-deficiency anemia due to inadequate iron stores from anemia of chronic disease due to decreased iron availability with abundant stores. Advanced reticulocyte indices, such as the cellular hemoglobin content of reticulocytes, named CHr and RET-He, are reportable parameters on newer automated hematology analyzers.

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Molecular Pathology Selected Abstracts, 5/15

May 2015—Clinical and molecular effects of order of acquired mutations in myeloproliferative neoplasms: Cancers arise and evolve from the accumulation of somatic mutations. With the addition of each mutation, tumor subclones are selected for biologic attributes that increase growth and proliferation potential. However, the authors hypothesized that it may not only be the presence of the mutations that affects these attributes but also the order in which the mutations arise, since their interactions and resulting environment likely play a key role in the development of subsequent genetic events and the tumor’s neoplastic behavior.

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Anatomic Pathology Selected Abstracts, 4/15

April 2015—Uterine smooth muscle tumors with features suggesting fumarate hydratase aberration; Histologic and immunohistochemical assessment of penile carcinomas in a North American population; Predictive value of IASLC/ATS/ERS classification of lung adenocarcinoma in tumor recurrence and patient survival; Histomorphology of Lynch syndrome-associated ovarian carcinomas with regard to a screening strategy

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Molecular Pathology Selected Abstracts, 4/15

April 2015—Interpreting pathogenic variants in TTN for dilated cardiomyopathy: In this era of expanding gene panels and whole-exome and whole-genome sequencing for rare disease molecular diagnostics, it remains a challenge to filter numerous resulting variants from these sequencing assays, assign functional consequences of a variant in the resulting protein, and then determine potential pathogenicity.

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Anatomic Pathology Selected Abstracts, 3/15

March 2015—Histopathologic spectrum of thecoma of the ovary: a report of 70 cases: The authors evaluated 70 cases of thecoma of the ovary to ascertain their histopathologic spectrum. The tumors occurred over a wide age range (average, 49.6 years). Presentation in the form of pelvic or abdominal pain was uncommon, but postmenopausal bleeding was relatively frequent.

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Clinical Pathology Selected Abstracts, 3/15

March 2015—Chimeric antigen receptor T cells for sustained remissions in leukemia: Relapsed and refractory acute lymphoblastic leukemia is associated with a poor prognosis. T cells genetically modified to express chimeric antigen receptors targeted to cells expressing CD19 (CTL019) are a promising treatment strategy, with complete responses previously reported in two patients who had relapsed and refractory acute lymphoblastic leukemia (ALL).

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Anatomic Pathology Selected Abstracts, 2/15

February 2015—Alteration of ARID1A gene, PI3K-Akt pathway, and ZNF217 gene in ovarian clear cell carcinoma: AT-rich interactive domain 1A (ARID1A) is a subunit of switch/sucrose nonfermentable (SWI/SNF) complex. Recently, alterations of the ARID1A gene, phosphatidylinositol 3-kinase-protein kinase B (PI3K-Akt) pathway, and zinc-finger protein 217 (ZNF217) gene have been identified as frequent molecular genetic changes in ovarian clear cell carcinoma.

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Clinical Pathology Selected Abstracts, 2/15

February 2015—Alcohol consumption relative to type of breast cancer risk in postmenopausal women: Alcohol consumption is a known risk factor for breast cancer, but it is not known which subtypes of breast cancer, if any, are more likely associated with alcohol consumption. The authors conducted a large study using the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial cohort to test for heterogeneity in alcohol-related risk by breast cancer subtypes defined by estrogen receptor (ER) and progesterone receptor (PR) status and histological type.

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Molecular Pathology Selected Abstracts, 1/15

January 2015—Age-related mutations linked to clonal hematopoietic expansion and malignancies: A common practice in molecular profiling of tumors is to subtract mutations detected in DNA derived from blood (representing germline or inherited polymorphisms) from mutations detected in DNA derived from the paired tumor to assess the tumor’s somatic molecular profile.

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Anatomic Pathology Selected Abstracts, 1/15

January 2015—Are amended surgical pathology reports reaching the correct care provider? Amended reports need to follow patients to treating physicians to avoid erroneous management based on an original diagnosis. The authors undertook a study to determine if amended reports followed patients appropriately. They tracked amended reports with diagnostic changes and discrepancies between ordering and treating physicians.

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Molecular Pathology Selected Abstracts, 12/14

December 2014—Overcoming limitations in the sequencing of whole viral genomes: The identification and analysis of pathogenic viruses, especially the Ebola virus, has recently received significant attention. The sequencing of newly identified viral genomes has presented historical challenges as existing technology fails to capture the 3’ and 5’ terminal ends of the viral genome.

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Clinical Pathology Selected Abstracts, 12/14

December 2014—Prevalence of antimicrobial use in U.S. acute care hospitals: Inappropriate antimicrobial drug use is associated with adverse events in hospitalized patients as well as the emergence of resistant pathogens. Targeting effective interventions to improve antimicrobial use in the acute care setting may help guide safe and effective therapy while reducing the risks and complications of resistant and difficult-to-treat pathogens.

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Anatomic Pathology Selected Abstracts, 12/14

December 2014—Value of autopsies in the era of high-tech medicine: Although the autopsy is still the gold standard for quality assessment of clinical diagnoses, autopsy rates have declined to less than 10 percent. The authors conducted a study to investigate the value of autopsies in the era of high-tech medicine by determining the frequency of discrepancies between clinical and autopsy diagnoses. The authors classified all adult autopsy cases (n=460) performed at the Symbiant Pathology Expert Centre in Holland, in 2007 and from 2012 to 2013, as having major or minor discrepancy or total concordance.

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Anatomic Pathology Selected Abstracts, 1/13

January 2013—Relationship between PAX2-null secretory cell outgrowths in the oviduct and pelvic serous cancer: With the exception of germ-line mutations in ovarian cancer susceptibility genes, genetic predictors for women destined for ovarian serous cancer cannot be identified in advance of malignancy. The authors recently showed that benign secretory cell outgrowths (SCOUTs) in the oviduct increase in frequency with concurrent serous cancer and typically lack PAX2 expression (PAX2-null).

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Clinical Pathology Selected Abstracts, 1/13

January 2013—Chocolate consumption, cognitive function, and Nobel laureates: Dietary flavonoids are associated with health benefits, including improved cognitive function and reduced risks associated with aging, such as the risk of dementia. Flavonoids, or the subclass flavanols, are present in green tea, red wine, cocoa, and some fruits. Evidence has also shown that flavanols are linked to lower blood pressure due to vasodilation in the peripheral vasculature and brain.

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Molecular Pathology Selected Abstracts, 11/14

November 2014—Whole exome sequencing of Merkel cell carcinoma demonstrates conserved retinoblastoma pathway dysregulation: Merkel cell carcinoma is a rare aggressive neuroendocrine malignancy of the skin that is associated with infection by Merkel cell polyomavirus. Viral integration into the human genome and subsequent expression of the large T antigen is thought to cause cell cycle dysregulation via binding and inactivation of the retinoblastoma tumor suppressor protein and is a key step in the development of Merkel cell carcinoma.

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Anatomic Pathology Selected Abstracts, 11/14

November 2014—Final trial report of sentinel-node biopsy versus nodal observation in melanoma: Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase three trial. The authors evaluated outcomes in 2,001 patients with primary cutaneous melanomas who were randomly assigned to undergo wide excision and nodal observation, with lymphadenectomy for nodal relapse (observational group), or wide excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group).

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Clinical Pathology Selected Abstracts, 10/14

October 2014—Benefits of green tea extract to brain connectivity during working memory processing: Green tea extract or its main ingredient has been shown to have a beneficial impact on cognitive functioning and prevention of cognitive decline. The benefit to cognition could be related to altered brain activity in regions engaged during higher order cognitive functioning. Some recent studies demonstrated increased brain activation in the fronto-parietal regions during working memory processing.

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Anatomic Pathology Selected Abstracts, 10/14

October 2014—Role of STAT6 immunohistochemistry in diagnosis of solitary fibrous tumors: Solitary fibrous tumor is an uncommon fibroblastic neoplasm. Although histologic characteristics and frequent CD34 expression allow for an accurate diagnosis in the majority of solitary fibrous tumor (SFT) cases, a wide histologic spectrum and occasional unexpected immunophenotype may pose diagnostic challenges. Molecular analyses have shown that almost all SFTs harbor a NAB2-STAT6 fusion gene, which is considered specific to this tumor type.

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Molecular Pathology Selected Abstracts, 10/14

October 2014—A gene panel to examine mosaic somatic mutations in cerebral malformations: Somatic mutations are widely recognized in cancer, often affecting prognosis and determining candidacy for use of molecular targeted treatments. These somatic mutations may lead to a mosaic population of cells. Recent advances in technology involving deep next-generation sequencing have allowed for detection and quantification of these mosaic variants.

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Anatomic Pathology Selected Abstracts, 9/14

September 2014—Cytokeratin 17: an adjunctive marker of invasion in anal squamous neoplastic lesions: Diagnosing anal squamous cell carcinoma, which is often preceded by anal intraepithelial neoplasia, may be challenging in small biopsies. Cytokeratin 17 (CK17) is a basal/myoepithelial cell keratin induced in activated keratinocytes and associated with disease progression in squamous cell carcinoma (SCC) of the uterine cervix, esophagus, and oral cavity.

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Clinical Pathology Selected Abstracts, 9/14

September 2014—Potential link between vitamin D and subclinical cerebrovascular disease: Vitamin D deficiency has been associated with several diseases, including hypertension, diabetes mellitus, and stroke. A recent prospective population-based study of cardiovascular disease showed that subclinical infarcts and white matter hyperintensities (WMHs) are commonly seen on brain magnetic resonance image scans of older adults and are associated with cardiovascular disease risk factors and prior stroke. The lesions are also associated with reduced functioning on cognitive tests.

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Molecular Pathology Selected Abstracts, 8/14

August 2014—The dystrophin gene is the largest known human gene, comprising 2.2 Mb of the genome and 79 coding exons: Through the use of multiple tissue-specific promoters and alternative splicing of RNA, several isoforms of the protein dystrophin are encoded by the dystrophin (DMD) gene. The primary 427-kDA dystrophin isoform (Dp427) is found in the cytoplasm of skeletal and cardiac muscle cells, where it is involved in physically linking the cytoskeleton to protein structures outside the cell and, therefore, strengthens and protects muscle fibers during contraction and relaxation.

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Anatomic Pathology Selected Abstracts, 8/14

August 2014—GATA3: a multispecific but potentially useful marker in surgical pathology: The transcription factor GATA3 is important for differentiating breast epithelia, urothelia, and subsets of T lymphocytes. It has been suggested that it may be useful in evaluating carcinomas of mammary or urothelial origin or metastatic carcinomas, but its distribution in normal and neoplastic tissues is incompletely mapped. The authors conducted a study in which they examined normal developing and adult tissues and 2,040 epithelial and 460 mesenchymal or neuroectodermal neoplasms for GATA3 expression to explore its diagnostic value in surgical pathology.

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Clinical Pathology Selected Abstracts, 8/14

August 2014—Anti-D alloimmunization after D-incompatible platelet transfusions: Because a small but immunogenic dose of red blood cells may be contained in apheresis platelets, transfusion services establish protocols to provide D– recipients with D– platelets to prevent anti-D alloimmunization. This is of particular concern for young females as there is potential for hemolytic disease of the newborn. In cases where D+ platelets are given to D– recipients, Rh immune globulin (RhIG) may be used to help prevent sensitization. The authors retrospectively analyzed during a 14-year period the anti-D formation in D– recipients who received D+ platelets without the use of RhIG.

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Clinical Pathology Selected Abstracts, 7/14

July 2014—Effects of fish oil in recent-onset rheumatoid arthritis: a patient study: The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaneonic acid (DHA), which are found in fish oil, can suppress synthesis of the omega-6 proinflammatory eicosanoids prostaglandin E2 and leukotriene B4. The effects of fish oil as a dietary supplement in rheumatoid arthritis have been studied in randomized, controlled trials for patient-assessed pain, morning stiffness, number of painful or tender joints, and non-steroidal anti-inflammatory drug consumption.

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Anatomic Pathology Selected Abstracts, 7/14

July 2014—Assessing IHC biomarkers for basal-like breast cancer against a gene-expression profile gold standard: Gene-expression profiling of breast cancer delineates a particularly aggressive subtype referred to as basal-like. This subtype comprises approximately 15 percent of all breast cancers and afflicts younger women. It is refractory to endocrine and anti-HER2 therapies.

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Anatomic Pathology Selected Abstracts, 6/14

June 2014—Utility of triple antibody cocktail intraurothelial neoplasm-3 and AMACR in urothelial CIS and reactive urothelial atypia: Urothelial carcinoma in situ (CIS) is a prognostically and therapeutically significant lesion with considerable morphologic overlap with reactive conditions, especially in the setting of prior therapy. Various markers, including CK20, CD44s, and p53, have been used as an adjunct in making this distinction.

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Clinical Pathology Selected Abstracts, 6/14

June 2014—How a single patient influenced HIV research: 15-year followup: The hope of a cure for human immunodeficiency virus infection is raised by recent reports of people in whom viral replication spontaneously reduced despite the absence of antiretroviral treatment (ART). A “Berlin patient” described in 1999 was immediately treated with ART and hydroxyurea after an acute HIV infection but chose to discontinue treatment.

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Clinical Pathology Selected Abstracts, 5/14

May 2014—Real-time clinical decision support systems for platelet and cryoprecipitate orders: Platelet and cryoprecipitate transfusions are often used to treat patients who are bleeding. However, many clinicians use non-evidence–based approaches to ordering and transfusing these products. Cost and such adverse effects as transfusion-transmitted diseases and transfusion reactions make it desirable to reduce the unnecessary transfusion of these products.

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Anatomic Pathology Selected Abstracts, 5/14

May 2014—Impact of operator techniques and specimen-preparation checklist on bone marrow assessment: Successful bone marrow assessment is essential to the diagnosis and staging of hematologic malignancies. The authors conducted a study to determine whether specific operator techniques or use of a specimen-preparation checklist, or both, could impact the quality of bone marrow assessment by reducing the frequency of obtaining nonspicular aspirates, small cores, and nondiagnostic samples.

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Clinical Pathology Selected Abstracts, 4/14

April 2014—Intervention to improve timing of vancomycin levels: Samples drawn for therapeutic drug monitoring are sometimes drawn too early, which can cause inaccurate results that lead to a potential dosing error. One approach to reducing such errors is to create an information technology tool to assist clinicians in determining the best timing for a sample draw. The authors conducted a study at Brigham and Women’s Hospital, Boston, in which the investigators used both an educational and electronic intervention to reduce the number of vancomycin collection timing errors. The information technology-based intervention provided educational instructions to nurses.

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Anatomic Pathology Selected Abstracts, 4/14

April 2014—Clear cell papillary renal cell carcinoma: diagnosis and immunohistochemical profile: Clear cell papillary renal cell carcinoma is a recently recognized renal neoplasm composed of cells with clear cytoplasm lining cystic, tubular, and papillary structures. These tumors have immunohistochemical and genetic profiles distinct from clear cell renal cell carcinoma and papillary renal cell carcinoma. The authors studied morphologic and immunohistochemical features (cytokeratin 7 [CK7], carbonic anhydrase IX [CAIX], CD10, alpha-methylacyl-CoA racemase [AMACR], smooth muscle actin, desmin, and estrogen and progesterone receptors) in 55 tumors from 34 patients, eight of whom had end-stage renal disease.

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Clinical Pathology Selected Abstracts, 3/14

March 2014—Transfusion-associated hyperkalemic cardiac arrest in pediatric patients: Hyperkalemic cardiac arrest is a potential complication in pediatric patients undergoing rapid massive transfusion. Identifying patients at particular risk for this reaction is critical for determining the best strategies to prevent transfusion-associated hyperkalemic cardiac arrest (TAHCA). Concerns arise over the use of older blood in at-risk pediatric patients. The authors examined the case reports and studies related to transfusion-associated cardiac arrest in a pediatric population.

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Anatomic Pathology Selected Abstracts, 3/14

March 2014—Use of morphological parameters of LN in stereotactic 11-gauge vacuum-assisted needle core biopsy: Management of lobular in situ neoplasia when diagnosed on core biopsy remains controversial. The authors conducted a study to investigate the association between morphological parameters of lobular in situ neoplasia (LN) on vacuum-assisted needle core biopsy (VANCB) and the presence of malignancy (ductal carcinoma in situ, pleomorphic lobular carcinoma in situ, or invasive carcinoma) at surgical excision. The study included 14 pathology departments in Italy.

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Clinical Pathology Selected Abstracts, 2/14

February 2014—Comorbidity-adjusted life expectancy: a new tool to aid cancer screening strategies: Controversy surrounds how best to use cancer screening tests in the elderly and at what age to stop screening. The benefits of early cancer diagnosis and treatment decline with age because many elderly people are more likely to die of a comorbid condition or other cause than of cancer. This impacts the survival benefits of early cancer detection. One must also consider the harms of screening, including complications of further testing and treatment for a disease that may not be symptomatic in a patient’s lifetime.

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Anatomic Pathology Selected Abstracts, 2/14

February 2014—Early stage triple-negative breast cancer treated with mastectomy without adjuvant radiotherapy; Predicting recurrence after limited resection versus lobectomy for small lung adenocarcinoma; HER2 amplification in gastric cancer: a rare event restricted to intestinal phenotype; Gleason score undergrading on biopsy sample of prostate cancer; Fallopian tube intraluminal tumor spread from noninvasive precursor lesions; Factors that influence histopathological diagnosis of differentiated vulvar intraepithelial neoplasia; Impact of molecular analysis on final sarcoma diagnosis; Distinguishing primary bladder adenocarcinoma from secondary involvement by colorectal adenocarcinoma; Determining if close margins warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma; Three methodological approaches for defining basal-like lesions in triple-negative breast carcinoma

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Clinical Pathology Selected Abstracts, 1/14

January 2014—Predictive factors for blood transfusion in living donor pediatric liver transplantation: Patients undergoing liver transplantation, in particular pediatric liver transplantation, may receive massive transfusion. However, technical surgical improvements over the years have made it possible for many patients undergoing pediatric living donor liver transplantation (LDLT) to avoid transfusion.

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Anatomic Pathology Selected Abstracts, 1/14

January 2014—Flat pattern of nephrogenic adenoma unveiled using PAX2 and PAX8 immunohistochemistry; Managing borderline atypical ductal hyperplasia/ductal carcinoma in situ on breast needle core biopsy; Classic lobular neoplasia on core biopsy: a clinical and radiopathologic study with followup excision biopsy; Intestinal-type endocervical adenocarcinoma in situ: a subset of AIS affecting older women; Oncotype DX recurrence score: use of pathology-generated equations from linear regression analysis; Neuroendocrine carcinoma of the stomach: characteristics and prognosis; Interobserver reproducibility in diagnosis of high-grade endometrial carcinoma; Features associated with metastatic potential in invasive adenocarcinomas of the lung

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Clinical Pathology Selected Abstracts, 12/13

December 2013—Impact of blood product ratios in massively transfused pediatric trauma patients

Few studies have included pediatric patients when analyzing the impact of plasma/packed red blood cell (PRBC) ratios during massive transfusions. The implications of changing to a 1:1 plasma/PRBC ratio are significant and relate to additional product exposure, transfusion reaction-related risk, and product wastage.

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Anatomic Pathology Selected Abstracts, 12/13

December 2013— Human papillomavirus-related carcinomas of the sinonasal tract; Localized and metastatic myxoid/round cell liposarcoma; Urothelial carcinoma with prominent squamous differentiation in neurogenic bladder: role of HPV infection; Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases; Clinicopathological significance of HER2/neu genetic heterogeneity in various breast carcinomas; EIN with secretory differentiation: features and underlying mechanisms; Glypican 3 and arginase in diagnosing scirrhous hepatocellular carcinoma

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Anatomic Pathology Selected Abstracts, 11/13

November 2013—Diagnostic and prognostic morphometric features in WHO 2003 invasive endometrial stromal tumors; Association of tumor staging with adverse clinical outcome in neuroendocrine tumors of appendix; Detection of HPV capsid proteins L1 and L2 in squamous intraepithelial lesions; Feasibility and safety of sequential research-related tumor core biopsies in clinical trials; Evaluation of breast amyloidosis finds AL type most prevalent; Outside case review of surgical pathology for referred patients: impact on patient care; Reporting trends for right-sided hyperplastic and sessile serrated polyps; Atypical leiomyomas of the uterus: a clinicopathologic study of 51 cases; Pathological diagnostic criterion of blood and lymphatic vessel invasion in colorectal cancer

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Clinical Pathology Selected Abstracts, 10/13

October 2013—Performance of assays used in the U.S. to diagnose Lyme borreliosis acquired in Europe: The most common tick-borne infection reported in the United States is Lyme disease, which can be acquired in the United States or while traveling in Europe. Evaluation of Lyme disease acquired in Europe, by doctors in the United States, is challenging because assays used in the United States use lysates of the original Borrelia burgdorferi sensu stricto isolate (B31 strain).

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Anatomic Pathology Selected Abstracts, 10/13

October 2013—Acellular mucin in rectal cancer patients showing pathologic complete response to preoperative chemoradiotherapy; Association between p16 expression and human papillomavirus in urinary bladder squamous cell carcinoma; Immunohistochemical signature comprising PTEN, MYC, and Ki-67 and disease progression in prostate cancer; Preoperative BRAF(V600E) mutation screening: likelihood of altering initial surgery for indeterminate thyroid nodules; Claudin expression in high-grade invasive ductal carcinoma of the breast; Interobserver agreement in assessing lung cancer: H&E diagnostic reproducibility for non-small cell lung carcinoma

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Anatomic Pathology Selected Abstracts, 9/13

September 2013—Quantification of the Ki67 proliferative index in neuroendocrine tumors of the gastroenteropancreatic system; Clinicopathologic and immunohistochemical study of intrapulmonary SFTs; Papillary mucinous metaplasia of the endometrium as a precursor of endometrial mucinous adenocarcinoma; Expression of miRNAs and PTEN in endometrial specimens; Molecular investigation of lymph nodes in colon cancer patients using OSNA; Thymidylate synthase expression and molecular alterations in adenosquamous carcinoma of the lung; Microdensitometry of osteopontin as a prognostic biomarker in colorectal carcinoma tissue microarrays; Evaluation of pathological and molecular features in clinically aggressive dermatofibromas; Interobserver agreement in the reporting of colorectal polyp pathology by bowel cancer screening pathologists

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Anatomic Pathology Selected Abstracts, 8/13

August 2013—Endometrium as a primary site of origin of pelvic high-grade serous carcinoma in BRCA1 or BRCA2 mutation carriers; Criteria and pitfalls in diagnosis of lymphovascular invasion in prostatectomy specimens; An interobserver study of reproducibility in subtyping pulmonary adenocarcinomas; Value of PAX8, PAX2, claudin-4, and h-caldesmon in identifying peritoneal epithelioid mesotheliomas; Clinicopathologic study of cutaneous digital papillary adenocarcinoma;

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Anatomic Pathology Selected Abstracts, 7/13

July 2013—Intraoperative pathologic examination in the era of molecular testing for differentiated thyroid cancer: Diagnostic thyroidectomy is typically indicated for indeterminate thyroid cytology results. Traditionally, intraoperative pathologic examination (IOPE) helped guide the extent of initial surgery. Preoperative molecular testing of fine-needle aspiration cytology has emerged as another diagnostic adjunct, is highly specific for thyroid cancer, and can lead to appropriate initial total thyroidectomy.

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Clinical Pathology Selected Abstracts, 7/13

July 2013—Risk factors for first venous thromboembolism around pregnancy: Venous thromboembolism is a serious maternal complication occurring at a rate of one to two per 1,000 maternities during pregnancy and the puerperium. Venous thromboembolism (VTE) is a leading cause of maternal mortality in developed countries and an important source of morbidity in the form of post-thrombotic syndrome.

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Anatomic Pathology Selected Abstracts, 6/13

June 2013—Prolonged cold ischemia time and ER immunohistochemistry in breast cancer: To aid detection of estrogen receptor expression in breast tumors, the American Society of Clinical Oncology and College of American Pathologists recommend that cold ischemia time be kept under one hour. However, data to address the upper threshold of cold ischemia time are limited.

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Clinical Pathology Selected Abstracts, 6/13

June 2013—Ehrlichiosis is a tick-borne disease that may be asymptomatic or result in fatal sepsis. Ehrlichiosis transmitted from transfusion of blood products has not been documented. A case report of a 9-year-old Georgia boy with a history of acute lymphoblastic leukemia is the first report of Ehrlichia ewingii infection transmitted by a platelet transfusion. The authors first describe the patient as presenting to the hospital with complaints of fever, fatigue, malaise, vomiting, diarrhea, and petechial rash.

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Clinical Pathology Selected Abstracts, 5/13

May 2013—Although allogeneic bone marrow transplantation can cure sickle cell disease, human leukocyte antigen-matched donors are difficult to find, and the toxicities of myeloablative conditioning prior to transplants are a major risk factor for morbidity and mortality in most adults. The authors developed for patients with sickle cell disease newer bone marrow transplant regimens using nonmyeloablative conditioning regimens and human leukocyte antigen (HLA)-haploidentical donors.

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Anatomic Pathology Selected Abstracts, 5/13

May 2013—Pseudomyxoma peritonei originating from an appendiceal mucinous neoplasm remains a biologically heterogeneous disease. The authors conducted a study to evaluate outcome and long-term survival after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) consolidated through an international registry study. A retrospective multi-institutional registry was established through the collaborative efforts of units affiliated with the Peritoneal Surface Oncology Group International.

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Anatomic Pathology Selected Abstracts, 4/13

April 2013—Preoperative diagnosis of benign thyroid nodules with indeterminate cytology: Approximately 15 percent to 30 percent of thyroid nodules evaluated by fine-needle aspiration are not clearly benign or malignant. Patients with cytologically indeterminate nodules are often referred for diagnostic surgery, though most of these nodules prove to be benign.

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Clinical Pathology Selected Abstracts, 4/13

April 2013—Variant of TREM2 associated with risk of Alzheimer’s disease: Alzheimer’s disease is the most common form of dementia in the elderly. The disease is characterized by the formation of extracellular amyloid plaques, intracellular neurofibrillary tangles, and loss of neurons, which results in brain atrophy and progressive loss of cognitive function.

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Anatomic Pathology Selected Abstracts, 3/13

March 2013—Immunohistochemical assay versus Oncotype DX qRT-PCR assay for estrogen and progesterone receptors; accuracy and precision of endometrial intraepithelial neoplasia diagnosis; histologic patterns and molecular characteristics of lung adenocarcinoma; MicroRNA expression profiling as a diagnostic tool for thyroid cancer; inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer; and reclassification of serous ovarian carcinoma using a two-tier system.

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Clinical Pathology Selected Abstracts, 2/13

February 2013—Outcome of patients who refuse transfusion after cardiac surgery: Jehovah’s Witness patients may refuse blood transfusion, due to religious beliefs, following cardiac surgery. Strategies to conserve blood for such patients may include the preoperative use of erythropoietin, iron, and B-complex vitamins, as well as hemoconcentration; intraoperative use of antifibrinolytics and cell-saver and smaller cardiopulmonary bypass circuits; and tolerance of low hematocrit levels postoperatively.

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Anatomic Pathology Selected Abstracts, 2/13

February 2013—BRCA1 and BRCA2 mutations, TP53 abnormalities, and immune cell infiltrates in ovarian carcinoma; Significance of loss of ARID1A/BAF250a expression in endometriosis; Relationship between pathologic complete response and prognosis after chemotherapy in breast cancer subtypes; Determining HER2 status on breast core-needle biopsies; Use of MiTF in differentiating cellular neurothekeoma from plexiform fibrohistiocytic tumor; A study of genetic heterogeneity in HER2/neu testing by FISH

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