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Kisch SE, Walker J, Hebert AE, Windon AL, Dee KC, Haddad SM, Langone A, Tan MCB. Emphysematous gastritis due to Sarcina ventriculi infection in an immunocompromised adult. Transpl Infect Dis 2024; 26:e14207. [PMID: 38041487 DOI: 10.1111/tid.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Sean E Kisch
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jasmine Walker
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annette E Hebert
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annika L Windon
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin Christopher Dee
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sara M Haddad
- Department of Infectious Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony Langone
- Department of Renal Transplant, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Marcus C B Tan
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Windon AL, Almazan E, Oliva-Hemker M, Hutchings D, Assarzadegan N, Salimian K, Montgomery EA, Voltaggio L. Lymphocytic and collagenous colitis in children and adolescents: Comprehensive clinicopathologic analysis with long-term follow-up. Hum Pathol 2020; 106:13-22. [PMID: 32991931 DOI: 10.1016/j.humpath.2020.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
Microscopic colitis (MC) is characterized by chronic watery diarrhea, endoscopically normal findings, and abnormal histology. While mostly encountered in adults, pediatric cases are rare and may show varying presentations. Our pathology data system was searched from 1984 to 2019 for patients ≤18 years of age with a lymphocytic colitis (LC) or collagenous colitis (CC) pattern of injury. Twenty-seven cases (23 LC and 4 CC) were retrieved. LC was more prevalent than CC (85% vs 15%, respectively) and affected slightly younger individuals (mean, 9.8 years versus 12.25 years). Immune dysregulation was documented in 11 (41%) patients. Most patients presented with watery diarrhea (n = 26, 96%) and either abdominal pain (n = 18, 67%), nausea/vomiting (n = 5, 19%), flatulence (n = 6, 22%), and/or weight loss (n = 1, 4%). A subset of patients (n = 10, 37%) demonstrated endoscopic abnormalities. Histologically, some patients with LC and CC displayed focal cryptitis or crypt abscess formation (n = 7, 26%) and focally increased crypt apoptosis (n = 9, 33%) in the absence of chronic injury. Clinical follow-up data were available for 23 (85%) patients with variable clinical responses recorded. Only 8 patients experienced complete symptom resolution. Twelve patients (11 LC and 1 CC) had subsequent biopsy material; of which, one developed histologic features of inflammatory bowel disease and another was found to have a CTLA-4 deficiency. Our study shows that pediatric patients with MC may have atypical clinical, histologic, and endoscopic findings and variable clinical responses. Underlying inflammatory and/or genetic conditions may be eventually unmasked, and genetic testing may be helpful in a small subset of patients.
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Affiliation(s)
- Annika L Windon
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Erik Almazan
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA.
| | - Maria Oliva-Hemker
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Johns Hopkins Hospital, 200 N. Wolfe Street, Rubenstein Child Health Building, Baltimore, MD, 21287, USA.
| | - Danielle Hutchings
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Naziheh Assarzadegan
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Kevan Salimian
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
| | - Lysandra Voltaggio
- Department of Pathology and Laboratory Medicine, The Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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Waters KM, Salimian KJ, Assarzadegan N, Hutchings D, Makhoul EP, Windon AL, Wong MT, Voltaggio L, Montgomery EA. Cell polarity (the 'four lines') distinguishes gastric dysplasia from epithelial changes in reactive gastropathy. Histopathology 2020; 78:453-458. [PMID: 32841414 DOI: 10.1111/his.14242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/06/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
AIMS Gastric dysplasia is a risk factor for synchronous and subsequent gastric carcinoma. Distinguishing gastric dysplasia from reactive changes is subject to interobserver disagreement and is a frequent reason for expert consultation. We previously used assessment of surface cell polarity (the 'four lines') as a key feature to decrease equivocal diagnoses in Barrett oesophagus. In the current study, we examined for the presence or absence of the four lines in gastric dysplasia and reactive gastropathy. MATERIALS AND METHODS The study includes all (n = 91) in-house biopsies with at least gastric dysplasia from the surgical pathology archives of two academic institutions during a 5-year period from 2008 to 2012. A reactive gastropathy group (n = 60) was created for comparison. RESULTS The dysplasia/neoplasia group was comprised of 14 biopsies of gastric foveolar-type dysplasia, 59 of intestinal-type dysplasia, 14 with dysplasia in fundic gland polyps, three pyloric gland adenomas and one oxyntic gland adenoma. Loss of surface cell polarity was seen in all 88 dysplasia cases with evaluable surface epithelium. All 57 reactive gastropathy cases with evaluable surface epithelium showed intact surface cell polarity except in focal areas directly adjacent to erosions in 17 cases, where the thin wisp of residual surface mucin could not be appreciated on haematoxylin and eosin. CONCLUSION Surface cell polarity (the four lines) was lost in all gastric dysplasia biopsies with evaluable surface epithelium and maintained in all biopsies of reactive gastropathy. Caution should be taken in using this feature adjacent to erosions in reactive gastropathy.
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Affiliation(s)
- Kevin M Waters
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kevan J Salimian
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - Elias P Makhoul
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Annika L Windon
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mary T Wong
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Ware AD, Murdock T, Voltaggio L, Windon AL, Troncoso JC, Hruban RH, White MJ. The "Race" Toward Diversity, Inclusion, and Equity in Pathology: The Johns Hopkins Experience. Acad Pathol 2019; 6:2374289519873104. [PMID: 31523705 PMCID: PMC6734606 DOI: 10.1177/2374289519873104] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/08/2019] [Accepted: 07/19/2019] [Indexed: 11/16/2022] Open
Abstract
With 3.8% black trainees in 2012, pathology had significantly fewer trainees from groups underrepresented in medicine compared to other specialties. To address this, faculty in the Johns Hopkins Department of Pathology established an outreach program and funded rotation for students underrepresented in medicine and from disadvantaged groups. The aims were to increase exposure to the field and improve diversity, inclusion, and equity in pathology. A 1-month rotation for students underrepresented in medicine was established in 2013. Rotation schedules tailored to each rotator's interests included resident conferences and individual faculty meetings. In 2016, a proactive outreach program was established. Faculty visited historically black medical schools and underrepresented in medicine student groups at other institutions, where they gave a "Careers in Pathology" presentation targeted to second- and third-year medical students. Faculty also attended underrepresented in medicine student conferences and participated in high school student programs to further expand the underrepresented in medicine pipeline into medicine and pathology. Since 2016, fourteen outreach presentations have been delivered. The number of rotators increased from 1 in 2013 to 18 in July 2019. Rotators self-identified as African, African American, Hispanic, and Native American. Most were second- to fourth-year medical students, and 1 was a pathology resident. Six rotators are currently pathology residents, and others are strongly considering applying to pathology. The outreach efforts account for the success of our rotation, which, in turn, has had a positive impact on interest in pathology. However, we recognize barriers to retention and intend to incorporate additional professional development activities to further address equity.
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Affiliation(s)
- Alisha D Ware
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tricia Murdock
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lysandra Voltaggio
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annika L Windon
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Juan C Troncoso
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph H Hruban
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa J White
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Windon AL, Tondon R, Singh N, Abu-Gazala S, Porter DL, Russell JE, Cook C, Lander E, Smith G, Olthoff KM, Shaked A, Hoteit M, Furth EE, Serper M. Erythropoietic protoporphyria in an adult with sequential liver and hematopoietic stem cell transplantation: A case report. Am J Transplant 2018; 18:745-749. [PMID: 29116687 DOI: 10.1111/ajt.14581] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/18/2017] [Accepted: 10/28/2017] [Indexed: 01/25/2023]
Abstract
Erythropoietic protoporphyria (EPP) is a rare inherited disorder of the heme biosynthesis pathway resulting in the accumulation of protoporphyrins in the blood, erythrocytes, and other tissues. Because of a gene mutation in the FECH gene, ferrochelatase, the enzyme involved in the final step of heme synthesis, is deficient in these patients. Although the major symptom of this disorder is photosensitivity, rarely, it can cause progressive liver disease requiring liver transplantation (LT). However, LT is not curative and only bone marrow transplantation (BMT) can correct the underlying enzymatic defect. Because liver disease results from accumulation of protoporphyrin in the liver, LT without hematopoietic stem cell transplantation leaves the new liver at risk for similar EPP-related damage. A handful of pediatric patients undergoing sequential LT and stem cell transplantation have been described in the literature; however, to date none has been described in detail in adults. We report a case of an adult male with EPP and liver failure who successfully underwent a sequential liver and hematopoietic stem cell transplantation (HSCT).
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Affiliation(s)
- Annika L Windon
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nathan Singh
- Department of Medicine, Blood and Marrow Transplant Program and Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Samir Abu-Gazala
- Transplant Unit, Surgery Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - David L Porter
- Department of Medicine, Blood and Marrow Transplant Program and Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J Eric Russell
- Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Colleen Cook
- Department of Surgery, Division of Transplantation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Elaine Lander
- Department of Surgery, Division of Transplantation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Georgeine Smith
- Department of Surgery, Division of Transplantation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kim M Olthoff
- Department of Surgery, Division of Transplantation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Abraham Shaked
- Department of Surgery, Division of Transplantation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Maarouf Hoteit
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Emma E Furth
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Windon AL, Loaiza-Bonilla A, Jensen CE, Randall M, Morrissette JJD, Shroff SG. A KRAS wild type mutational status confers a survival advantage in pancreatic ductal adenocarcinoma. J Gastrointest Oncol 2018; 9:1-10. [PMID: 29564165 DOI: 10.21037/jgo.2017.10.14] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The KRAS oncogene is a driver mutation and is present in greater than 90% of pancreatic ductal adenocarcinomas (PDAC). A subset of these tumors, however, do not harbor mutations in KRAS (wild type KRAS). Studies have shown that patients with mutated KRAS have a poorer survival on first-line gemcitabine-based chemotherapy compared to wild type KRAS. In this study, we examined a cohort of patients with PDAC at our institution who were either wild type or mutant for the KRAS gene and assessed for differences in survival and response to different chemotherapeutic regimens. Methods We examined clinical records of patients treated at the Abramson Cancer Center of the University of Pennsylvania from 2013 to 2017. Patients with a pancreatic mass and a histologic diagnosis of pancreatic or pancreaticobiliary adenocarcinoma were identified. Thirty-nine patients with PDAC who underwent tumor sequencing at Penn Medicine's Center for Personalized Diagnostics (CPD) were selected for further study. Twelve patients were identified whose tumors were KRAS wild type. Twenty-seven patients with PDAC whose tumors harbored KRAS mutations were selected as controls (KRAS mutant). Results We noted a longer overall survival (OS) among KRAS wild type patients compared to KRAS mutant patients (P=0.026). This was independent of the age at diagnosis, patient gender, stage of diagnosis, tumor morphology, mismatch repair (MMR) status, and chemotherapeutic regimen. Conclusions Similar to previously reported studies, PDAC with a KRAS wild type mutational profile has a better prognosis with a longer OS. This improved prognosis is independent of the protocol utilized in therapy for these patients. Our findings suggest that future clinical trials in pancreatic cancer should take into consideration the presence of KRAS mutations in their pre-planned analysis when assessing the efficacy of a novel therapeutic approach. This may be a crucial factor in trial concepts and outcomes.
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Affiliation(s)
- Annika L Windon
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Christopher E Jensen
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Randall
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer J D Morrissette
- Center for Personalized Diagnostics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stuti G Shroff
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Windon AL, Shroff SG. Iatrogenic Kaposi's Sarcoma in an HIV-Negative Young Male With Crohn's Disease and IgA Nephropathy: A Case Report and Brief Review of the Literature. Int J Surg Pathol 2017; 26:276-282. [PMID: 29169276 DOI: 10.1177/1066896917736610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a vascular tumor arising in association with human herpesvirus-8 (HHV-8) infection, and different variants show different clinical presentations. Isolated intestinal KS in the background of Crohn's disease (CD) is exceedingly rare with only 3 cases reported in the English literature (from 1966 to 2016). CASE PRESENTATION Herein, we report a case of intestinal KS in a 21-year-old HIV-negative Ethiopian male with a long-standing history of steroid therapy for his underlying IgA nephropathy. Recent gastrointestinal biopsies confirmed an additional diagnosis of CD. Despite the addition of Infliximab to his therapy, his CD remained refractory, and a laparoscopic-assisted ileocolectomy was performed to alleviate a partial small bowel obstruction. Examination of his terminal ileum demonstrated a polypoid mass with adjacent incidental ileal submucosal nodules. These nodules were composed of plump spindle cells with scattered mitoses and vascular channels with extravasated red blood cells. Intratumoral hyaline globules were also noted. Immunohistochemistry revealed HHV-8 positivity, confirming the histologic impression of KS. CONCLUSIONS Here we report the fourth case of KS in CD in an HIV-negative patient and only the third case of isolated intestinal KS in the setting of CD. A review of the literature suggests that attenuation of immunosuppressive therapy may be adequate management of iatrogenic KS in the absence of a systemic HHV-8 infection.
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Affiliation(s)
- Annika L Windon
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Stuti G Shroff
- 1 Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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