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    Education Guide: Special Stains & H&E, Chapter 21: Biological Micro-techniques
    (Dako, 2010-01-01) Wood, Debra
    Chapter 21 | Biological Microtechniques What Is the correct pH for the hematoxylin staining solution? | What are the “rocks” at the bottom of some bottles of the Harris hematoxylin? | What Is the metallic-appearing material that precipitates on the surface of Harris hematoxylin? | How do bluing reagents work? | What is the correct pH for an eosin dye solution? What is the purpose of the alcohol rinse prior to the eosin stain? | What causes poor nuclear detail in tissue sections? | What is Köhler illumination? | Stained sections sometimes appear sharp microscopically when viewed using the 10× objective, but hazy when seen using the “high-dry” 40× objective. What is responsible for the difference? | Can you recommend an effective way to destain H&E sections? | What is formalin pigment? | How do fixatives that contain metal additives affect special stains, particularly silver stains? | What is B5 fixative and how does it impact special stain performance quality for bone marrows smears and tissue specimens (e.g., Giemsa, Iron staining). What are the regulatory/safety implications in the United States that may affect the handling of “B5” fixative?
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    Leprosy in Nepal
    (National Society for Histotechnology, 2020) Wood, Debra M.
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    Elements of Successful Distance Education
    (2012) Wood, Debra M.
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    Evaluation of an institutional series of low-grade oncocytic tumor (LOT) of the kidney and review of the mutational landscape of LOT
    (Springer, 2023) Ricci, Costantino; Ambrosi, Francesca; Franceschini, Tania; Giunchi, Francesca; Grillini, Alessia; Franchini, Eugenia; Grillini, Marco; Schiavina, Riccardo; Massari, Francesco; Mollica, Veronica; Tateo, Valentina; Bianchi, Federico Mineo; Bianchi, Lorenzo; Droghetti, Matteo; Maloberti, Thais; Tallini, Giovanni; Colecchia, Maurizio; Acosta, Andres Martin; Lobo, João; Trpkov, Kiril; Fiorentino, Michelangelo; de Biase, Dario; Pathology and Laboratory Medicine, School of Medicine
    The 2022 WHO classification of urinary and male genital tumors introduced several novel kidney entities exhibiting eosinophilic/oncocytic features with specific mutational backgrounds. Thus, molecular techniques, such as next-generation sequencing (NGS), became more commonly used for their evaluation. We studied 12 low-grade oncocytic tumors (LOT) of the kidney (from 11 patients), identified in a cohort of 210 eosinophilic/oncocytic renal tumors, diagnosed in our institution between October 2019 and May 2023, which represented 5.7% (12/210) of all eosinophilic/oncocytic renal tumors during this period. We reviewed their clinicopathologic, histologic, and immunohistochemical features, as well as their mutational profiles. We also reviewed the literature on NGS-derived data of LOT, by selecting papers in which LOT diagnosis was rendered according to the criteria proposed initially. Median age was 65 years (mean: 63.5; range 43–79) and median tumor size was 2.0 cm (mean: 2.2; range: 0.9–3.1). All tumors were positive for PAX8, CK7, and GATA3, and negative or focally positive for CD117/KIT. We found the following gene mutations: MTOR ((6/11), 54.5%)), TSC1 ((2/11), 18.2%)), and 1 had both NOTCH1 and NOTCH4 ((1/11), 9.1%)). Wild-type status was found in 2/11 (18.2%) patients and one tumor was not analyzable. A review of 8 previous studies that included 79 LOTs revealed frequent mutations in the genes that regulate the mammalian target of rapamycin (mTOR) pathway: MTOR (32/79 (40.5%)), TSC1 (21/79 (26.6%)), and TSC2 (9/79 (11.4%)). Other mutated genes included PIK3CA, NF2, and PTEN, not typically known to affect the mTOR pathway, but potentially acting as upstream and downstream effectors. Our study shows that LOT is increasingly diagnosed in routine practice when applying the appropriate diagnostic criteria. We also confirm that the mTOR pathway is strongly implicated in the pathogenesis of this tumor mainly through MTOR, TCS1, and TSC2 mutations, but other genes could also be involved in the pathway activation, especially in LOTs without “canonical” mutations.
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    Malakoplakia in the Urinary Bladder of 4 Puppies
    (Sage, 2021) Davis, Katelin L.; Cheng, Liang; Ramos-Vara, José; Sánchez, Melissa D.; Wilkes, Rebecca P.; Sola, Mario F.; Pathology and Laboratory Medicine, School of Medicine
    Malakoplakia in humans most often affects the urinary bladder and is characterized by inflammation with von Hansemann–type macrophages, with or without Michaelis-Gutmann bodies, and is frequently associated with Escherichia coli infection. We describe the microscopic features of malakoplakia in the urinary bladder of 4 puppies. In all cases, the lamina propria of the urinary bladder was markedly expanded by sheets of large, round to polygonal macrophages with intracytoplasmic, periodic acid-Schiff-positive granules and granular inclusions, and rare Prussian blue–positive inclusions. Macrophages were positive for CD18 and Iba1. In 2 cases, Michaelis-Gutmann bodies were detected with hematoxylin and eosin stain and were best demonstrated with von Kossa stain. E. coli infection was confirmed in 2 cases with bacterial culture or polymerase chain reaction (PCR) and sequencing of the bacterial 16S ribosomal RNA gene. Transmission electron microscopy of one case demonstrated macrophages with abundant lysosomes, phagolysosomes, and rod-shaped bacteria. Microscopic features were similar to human cases of malakoplakia. In dogs, the light microscopic characteristics of malakoplakia closely resemble granular cell tumors and histiocytic ulcerative colitis.
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    Fatal eosinophilic myocarditis and submassive hepatic necrosis in lamotrigine induced DRESS syndrome
    (BMC, 2023-10-25) Doan, Khanh Duy; Akinsanya, Adeyinka; Kuhar, Matthew; Mesa, Hector; Pathology and Laboratory Medicine, School of Medicine
    Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe and sometimes fatal adverse drug reaction that is known to occur with a number of antiepileptic drugs. It often follows a prolonged clinical course, which can worsen even after discontinuing the causative drug and administering steroid treatment. Failure to promptly identify the delayed involvement of vital organs, such as the heart and liver, may result in irreversible organ failure and death. We report a case of a presumed sudden death of a young woman who had a documented history of a protracted intermittent hypersensitivity reaction to lamotrigine. Postmortem examination revealed the presence of eosinophilic myocarditis and submassive hepatic necrosis diagnostic of fatal DRESS syndrome that progressed despite early discontinuation of the medication and improvement of dermatologic and hematologic symptoms following steroid therapy.
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    Attenuated TGFB signalling in macrophages decreases susceptibility to DMBA-induced mammary cancer in mice
    (BMC, 2021-03-24) Sun, Xuan; Bernhardt, Sarah M.; Glynn, Danielle J.; Hodson, Leigh J.; Woolford, Lucy; Evdokiou, Andreas; Yan, Cong; Du, Hong; Robertson, Sarah A.; Ingman, Wendy V.; Pathology and Laboratory Medicine, School of Medicine
    Background: Transforming growth factor beta1 (TGFB1) is a multi-functional cytokine that regulates mammary gland development and cancer progression through endocrine, paracrine and autocrine mechanisms. TGFB1 also plays roles in tumour development and progression, and its increased expression is associated with an increased breast cancer risk. Macrophages are key target cells for TGFB1 action, also playing crucial roles in tumourigenesis. However, the precise role of TGFB-regulated macrophages in the mammary gland is unclear. This study investigated the effect of attenuated TGFB signalling in macrophages on mammary gland development and mammary cancer susceptibility in mice. Methods: A transgenic mouse model was generated, wherein a dominant negative TGFB receptor is activated in macrophages, in turn attenuating the TGFB signalling pathway specifically in the macrophage population. The mammary glands were assessed for morphological changes through wholemount and H&E analysis, and the abundance and phenotype of macrophages were analysed through immunohistochemistry. Another cohort of mice received carcinogen 7,12-dimethylbenz(a)anthracene (DMBA), and tumour development was monitored weekly. Human non-neoplastic breast tissue was also immunohistochemically assessed for latent TGFB1 and macrophage marker CD68. Results: Attenuation of TGFB signalling resulted in an increase in the percentage of alveolar epithelium in the mammary gland at dioestrus and an increase in macrophage abundance. The phenotype of macrophages was also altered, with inflammatory macrophage markers iNOS and CCR7 increased by 110% and 40%, respectively. A significant decrease in DMBA-induced mammary tumour incidence and prolonged tumour-free survival in mice with attenuated TGFB signalling were observed. In human non-neoplastic breast tissue, there was a significant inverse relationship between latent TGFB1 protein and CD68-positive macrophages. Conclusions: TGFB acts on macrophage populations in the mammary gland to reduce their abundance and dampen the inflammatory phenotype. TGFB signalling in macrophages increases mammary cancer susceptibility potentially through suppression of immune surveillance activities of macrophages.
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    Splenic-vasculature involvement is associated with poor prognosis in resected distal pancreatic cancer
    (Oxford University Press, 2020-11-24) Yin, Feng; Saad, Mohammed; Lin, Jingmei; Jackson, Christopher R.; Ren, Bing; Lawson, Cynthia; Karamchandani, Dipti M.; Bernabeu, Belen Quereda; Jiang, Wei; Dhir, Teena; Zheng, Richard; Schultz, Christopher W.; Zhang, Dongwei; Thomas, Courtney L.; Zhang, Xuchen; Lai, Jinping; Schild, Michael; Zhang, Xuefeng; Xie, Hao; Liu, Xiuli; Pathology and Laboratory Medicine, School of Medicine
    Background: Distal pancreatic carcinoma is one of the most lethal cancers largely due to its high incidence of distant metastasis. This study aims to assess the prognostic value of splenic-vasculature involvement in resected distal pancreatic carcinoma. Methods: In this retrospective study, we collected the clinicopathologic information of 454 patients with pancreatic cancer and performed univariate and multivariate analyses to identify factors associated with progression-free survival (PFS) and overall survival (OS), with an emphasis on the prognostic value of splenic-artery and -vein involvement. Results: Univariate analysis revealed that larger tumor size, non-intraductal papillary mucinous neoplasm (non-IPMN)-associated adenocarcinoma, poor differentiation, stage pT3, nodal metastasis, lymphovascular invasion, perineural invasion, and pathologic and radiographic evidence of splenic-vein invasion were significantly associated with shorter PFS and OS (all P < 0.05). Multivariate analysis confirmed non-IPMN-associated adenocarcinoma, stage pT3, stage pN1-2, and post-operative adjuvant chemotherapy as independent risk factors for both PFS and OS, and larger tumor size and radiographic evidence of splenic-artery invasion as predictors of PFS only. Conclusion: Guidelines should be developed for a uniform approach with regard to the examination and reporting of the status of the splenic vasculature when dealing with distal-pancreatic-cancer specimens.