American Journal of Clinical Pathology

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ISSN / EISSN : 0002-9173 / 1943-7722
Published by: Oxford University Press (OUP) (10.1093)
Total articles ≅ 29,781
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Omer Saeed, Nicole Panarelli, Kavita Umrau, Hwajeong Lee, Maria Westerhoff, Jerome Cheng, Jingmei Lin
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab188

Abstract:
In the article by Saeed et al. (Saeed O, Panarelli N, Umrau K, et al. The Histopathologic Features of Sickle Cell Hepatopathy: A Multi-Institutional Study. Am J Clin Pathol. 2021.), there was an error in the article title. The correct title is: “The Histopathologic Features of Sickle Cell Hepatopathy: A Multi-Institutional Study”. This error has been corrected.
, Virginia Livolsi, Kathleen Montone, Zubair Baloch
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab156

Abstract:
Objectives Although primary adrenal lesions and metastases are most commonly encountered, de novo cysts of the adrenal gland can occasionally occur. Methods We analyzed the pathology archives at the Hospital of the University of Pennsylvania for diagnoses of cystic lesions of the adrenal gland between 1998 and 2020. Patient demographics and clinical information were extracted, and pathology slides and stains, as appropriate, were analyzed. The literature between 1998 and 2020 was also searched for large case series involving cystic adrenal lesions. Results We found 18 cystic lesions of the adrenal gland in our archives, categorized as pseudocysts (7), endothelial cysts (5), mesothelial cysts (2), mature teratoma (1), cystic adrenal cortical adenoma (1), cystic pheochromocytoma (1), and cystic metastasis (1). The mean age at time of diagnosis was 52.3 years, and the mean size of the cysts was 6.0 cm. There was a slight female predilection, and cysts were more likely to be found on the left side. All lesions were incidental findings. The cystic metastasis was clear cell renal cell carcinoma. Our findings were also compared with those found in the literature published within the same timeframe. Conclusions Adrenal cysts are rare entities. Our findings are concordant with other large studies and provide additional cases to the existing literature. In addition, our literature search expands the possible differential diagnoses for cystic lesions arising in the adrenal gland.
, Lanisha D Fuller, Xuefeng Zhang, David J Papke, Lei Zhao, Dongwei Zhang, , Xiuli Liu, Maria I Fiel, Xuchen Zhang
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab142

Abstract:
Objectives Amiodarone-induced liver injury (AILI) is histopathologically similar to alcoholic steatohepatitis (ASH). We sought to elucidate their histologic differences and develop a scoring system to differentiate these two entities. Methods A cohort of 17 AILI and 17 ASH cases was included in the initial study. Cases from three different institutions were included for further validation. Results Macrovesicular steatosis was usually below 10% of the liver parenchyma in AILI. Hepatocyte ballooning degeneration was more common in ASH than in AILI. “Balloon-like” hepatocyte was more common in AILI than in ASH. Lobular neutrophilic inflammation, satellitosis, and cholestasis were more common in ASH. Mallory-Denk bodies and pericellular fibrosis in AILI were mainly located in zone 1 compared with a panacinar or zone 3 distribution in ASH. A scoring system was developed in which points were assigned to different histologic features; a total sum of less than 5 suggests AILI, more than 5 is ASH, and 5 is equivocal. This scoring system was then evaluated on a test cohort comprising 14 AILI cases, in which 13 cases were correctly assigned with a score less than 5. The sensitivity, specificity, and accuracy for diagnosing AILI in the test cohort were 92.9%, 91.7%, and 92.3%, respectively. Conclusions This scoring system can aid pathologists to differentiate AILI from ASH.
Archan Kakadekar, , , Mahmoud A Khalifa, Alicia R Andrews
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab143

Abstract:
Objectives The objective of this review is to characterize the literature addressing postprocedural complications in persons undergoing gender-affirming surgeries. Methods A literature search using the OVID MEDLINE and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender persons from 1946 to April 2021. The studies describing postsurgical complications were categorized based on anatomic site, type of complication, study design, publication region, and date. Results Thirty-nine studies describing postsurgical complications in transgender women were identified. The most common sites of postprocedural pathology included the breasts and neovagina, with additional studies including buttocks and thighs, cutaneous sites, and the pulmonary system. Most of the literature comprised case reports, followed by case series and comparative studies. The search did not identify any studies of complications secondary to masculinizing surgeries. Conclusions This body of literature is small but growing. Most studies are case reports. There are significant gaps in the literature. The literature in this area is not yet mature enough to support a meta-analysis.
Muhammad Ahmed, , Liying Fu, Elizabeth H Holt, Adebowale J Adeniran, Guoping Cai
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab141

Abstract:
Objectives This study reviewed the institutional experience of performing calcitonin immunostain on an additional ThinPrep slide in fine-needle aspiration (FNA) diagnosis of medullary thyroid carcinoma (MTC). Methods Thyroid FNA cases with MTC suspected or included in the differential diagnosis during cytologic evaluation and calcitonin immunostain performed were retrieved and reviewed. Results Calcitonin immunostain was performed in 132 cases with 41 positive, 81 negative, and 10 indeterminate results. All calcitonin-positive cases had a cytologic diagnosis of MTC while all calcitonin-negative cases were cytologically classified as non-MTCs except for two cases suspicious for MTC. In 10 cases with an indeterminate calcitonin result, diagnoses of non-MTC and suspicious for MTC were rendered in 6 and 4 cases, respectively. Histopathologic follow-up was available in 85 (64%) cases. All cytologically diagnosed MTC cases were confirmed on histopathology. In 3 MTC cases with an indeterminate calcitonin result, 1 case was misclassified cytologically as follicular neoplasm. The calculated sensitivity, specificity, positive predictive value, and negative predictive value of calcitonin immunostain were all 100% for diagnosing MTC. Conclusions Our study demonstrates the feasibility of performing calcitonin immunostain on an additional ThinPrep slide. Calcitonin immunocytochemistry is a valuable adjunct test for FNA diagnosis and differential diagnosis of MTC.
, Ronald Balassanian, Matthew C Cheung, Lorenzo Falchi, Robert Hasserjian, Oscar Lin, Steven R Long, Amy Ly, Joshua R Menke, Eric Mou, et al.
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab184

Abstract:
In the originally published version of this manuscript (Zadeh SL, Balassanian R, Cheung MC, et al. Global Cytopathology-Hematopathology Practice Trends. Am J Clin Pathol. 2021.), the name of co-author, Amy Ly, MD5, was omitted. This has been corrected.
, Rance Chad Siniard, Laura J Taylor, Marisa B Marques, Radhika Gangaraju
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab135

Abstract:
Objectives Monitoring is essential to safe anticoagulation prescribing and requires close collaboration among pathologists, clinicians, and pharmacists. Methods We describe our experience in the evolving strategy for laboratory testing of unfractionated heparin (UFH). Results An intrainstitutional investigation revealed significant discordance between activated partial thromboplastin time (aPTT) and antifactor Xa (anti-Xa) assays, prompting a transition from the former to the latter in 2013. With the increasing use of oral factor Xa inhibitors (eg, apixaban, rivaroxaban, edoxaban, betrixaban), which interfere with the anti-Xa assay, we adapted our protocol again to incorporate aPTT in patients admitted on oral Xa inhibitors who require transition to UFH. Conclusions Our experience demonstrates key challenges in anticoagulation and highlights the importance of clinical pathologists in helping health systems adapt to the changing anticoagulation landscape.
Madina Sukhanova, Leena B Mithal, Sebastian Otero, Hooman A Azad, Emily S Miller, Lawrence J Jennings, Elisheva D Shanes,
American Journal of Clinical Pathology; https://doi.org/10.1093/ajcp/aqab139

Abstract:
Objectives To determine maternal vs fetal origin for blood in placental intervillous thrombi (IVTs). Methods We used comparative analysis of microsatellites (short tandem repeats [STRs]), sex chromosome fluorescence in situ hybridization (FISH), and immunohistochemistry (IHC) for fetal (ɑ-fetoprotein [AFP]) and maternal (immunoglobulin M [IgM]) serum proteins to distinguish the origin of IVTs. Using an informatics approach, we tested the association between IVTs and fetomaternal hemorrhage (FMH). Results In 9 of 10 cases, the preponderance of evidence showed that the thrombus was mostly or entirely maternal in origin. In 1 case, the thrombus was of mixed origins. STR testing was prone to contamination by entrapped fetal villi. FISH was useful but limited only to cases with male fetuses. IgM showed stronger staining than AFP in 9 cases, supporting maternal origin. By informatics, we found no association between IVTs and FMH. Conclusions Evidence supports a maternal origin for blood in IVTs. IHC for IgM and AFP may be clinically useful in determining maternal vs fetal contribution to IVTs.
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