Carole Boudreaux

Collagenous colitis in children

Collagenous colitis, a disorder characterized by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria, has been reported infrequently in children. An 8-year-old girl with collagenous colitis is described who presented with chronic watery diarrhea and abdominal pain. Biopsy specimens of the colonic mucosa showed the pathological features of collagenous colitis. The patients symptoms resolved following corticosteroid therapy. Collagenous colitis should be considered in the differential diagnosis of children with chronic diarrhea.

Fatal Cerebral Phaeohyphomycosis Due to Curvularia lunata in an Immunocompetent Patient

ABSTRACT Curvularia infections in humans are relatively uncommon despite the ubiquitous presence of this soil-dwelling dematiaceous fungus in the environment. Originally thought to be solely a pathogen of plants, Curvularia has been described as a pathogen of humans and animals in the last half-century, causing respiratory tract, cutaneous, and corneal infections. Only three previous cases of central nervous system involvement by Curvularia have been documented in the medical literature. We report a fatal case of cerebral Curvularia infection in which there was no known history of immunocompromise or prior respiratory tract or sinus infection in the patient.

Halicephalobus gingivalis: A Rare Cause of Fatal Meningoencephalomyelitis in Humans

The genus Halicephalobus consists of eight species of free-living nematodes. Only one species (H. gingivalis) has been reported to infect vertebrates. Human infection is extremely rare, and only four cases have been reported in the literature. These nematodes seem to exhibit neurotropism, but their life cycle, mode of infection, and risk factors are poorly understood. Neurohelminthiases are not commonly recognized in the United States and when they do occur, pose great diagnostic challenges because of lack of appropriate non-invasive screening and/or confirmatory tests. We report a challenging case of meningoencephalomyelitis caused by a Halicephalobus sp., in which the patient had a rapidly deteriorating clinical course. The case did not raise any clinical suspicion of neurohelminthiases, although increased eosinophils were present in the cerebrospinal fluid. This case presents an opportunity to highlight the importance of considering parasitic infection in meningoencephalitis or meningoencephalomyelitis presenting atypically.

Hyperspectral imaging fluorescence excitation scanning for colon cancer detection

Abstract. Optical spectroscopy and hyperspectral imaging have shown the potential to discriminate between cancerous and noncancerous tissue with high sensitivity and specificity. However, to date, these techniques have not been effectively translated to real-time endoscope platforms. Hyperspectral imaging of the fluorescence excitation spectrum represents new technology that may be well suited for endoscopic implementation. However, the feasibility of detecting differences between normal and cancerous mucosa using fluorescence excitation-scanning hyperspectral imaging has not been evaluated. The goal of this study was to evaluate the initial feasibility of using fluorescence excitation-scanning hyperspectral imaging for measuring changes in fluorescence excitation spectrum concurrent with colonic adenocarcinoma using a small pre-pilot-scale sample size. Ex vivo analysis was performed using resected pairs of colorectal adenocarcinoma and normal mucosa. Adenocarcinoma was confirmed by histologic evaluation of hematoxylin and eosin (H&E) permanent sections. Specimens were imaged using a custom hyperspectral imaging fluorescence excitation-scanning microscope system. Results demonstrated consistent spectral differences between normal and cancerous tissues over the fluorescence excitation range of 390 to 450 nm that could be the basis for wavelength-dependent detection of colorectal cancers. Hence, excitation-scanning hyperspectral imaging may offer an alternative approach for discriminating adenocarcinoma from surrounding normal colonic mucosa, but further studies will be required to evaluate the accuracy of this approach using a larger patient cohort.

Diagnosis of Linitis Plastica–Type Gastric Adenocarcinoma by Endoscopic Ultrasound-Guided Fine Needle Aspiration

BACKGROUND The diagnosis of linitis plastica-type adenocarcinomas of the stomach has traditionally been made by brush cytology and mucosal biopsy. These techniques may yield false negative results due to the often submucosal location of these lesions. CASE A 46-year-old woman presented witb epigaseric abdominal pain and loss of abbetite. Computed tomography of her abdomen revealed diffuse thickening of a portion of the gastric wall. Subsequent endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the stomach yielded abundant single, discohesive malignant cells suspicious for lymphoma vs. poorly differentiated carcinoma. Special stains and immunohistochemical stains confirmed the diagnosis of poorly differentiated adenocarcinoma ofsignet ring cell type. CONCLUSION As many linitisplastica-type adenocarcinomas are submucosal lesions, mucosal sampling by biopsy may yield nondiagnostic material in up to one third of cases. With its ability to sample deep submucosal lesions, EUS-FNA is an appropriate technique for establishing this diagnosis and guiding patient treatment.

Hyperspectral imaging fluorescence excitation scanning for detecting colorectal cancer: pilot study

Optical spectroscopy and hyperspectral imaging have shown the theoretical potential to discriminate between cancerous and non-cancerous tissue with high sensitivity and specificity. To date, these techniques have not been able to be effectively translated to endoscope platforms. Hyperspectral imaging of the fluorescence excitation spectrum represents a new technology that may be well-suited for endoscopic implementation. However, the feasibility of detecting differences between normal and cancerous mucosa using fluorescence excitation-scanning hyperspectral imaging has not been evaluated. The objective of this pilot study was to evaluate the changes in the fluorescence excitation spectrum of resected specimen pairs of colorectal adenocarcinoma and normal colorectal mucosa. Patients being treated for colorectal adenocarcinoma were enrolled. Representative adenocarcinoma and normal colonic mucosa specimens were collected from each case. Specimens were flash frozen in liquid nitrogen. Adenocarcinoma was confirmed by histologic evaluation of H&E permanent sections. Hyperspectral image data of the fluorescence excitation of adenocarcinoma and surrounding normal tissue were acquired using a custom microscope configuration previously developed in our lab. Results demonstrated consistent spectral differences between normal and cancerous tissues over the fluorescence excitation spectral range of 390-450 nm. We conclude that fluorescence excitation-scanning hyperspectral imaging may offer an alternative approach for differentiating adenocarcinoma and surrounding normal mucosa of the colon. Future work will focus on expanding the number of specimen pairs analyzed and will utilize fresh tissues where possible, as flash freezing and reconstituting tissues may have altered the autofluorescence properties.

Colorectal cancer detection by hyperspectral imaging using fluorescence excitation scanning

Hyperspectral imaging technologies have shown great promise for biomedical applications. These techniques have been especially useful for detection of molecular events and characterization of cell, tissue, and biomaterial composition. Unfortunately, hyperspectral imaging technologies have been slow to translate to clinical devices – likely due to increased cost and complexity of the technology as well as long acquisition times often required to sample a spectral image. We have demonstrated that hyperspectral imaging approaches which scan the fluorescence excitation spectrum can provide increased signal strength and faster imaging, compared to traditional emission-scanning approaches. We have also demonstrated that excitation-scanning approaches may be able to detect spectral differences between colonic adenomas and adenocarcinomas and normal mucosa in flash-frozen tissues. Here, we report feasibility results from using excitation-scanning hyperspectral imaging to screen pairs of fresh tumoral and nontumoral colorectal tissues. Tissues were imaged using a novel hyperspectral imaging fluorescence excitation scanning microscope, sampling a wavelength range of 360-550 nm, at 5 nm increments. Image data were corrected to achieve a NIST-traceable flat spectral response. Image data were then analyzed using a range of supervised and unsupervised classification approaches within ENVI software (Harris Geospatial Solutions). Supervised classification resulted in >99% accuracy for single-patient image data, but only 64% accuracy for multi-patient classification (n=9 to date), with the drop in accuracy due to increased false-positive detection rates. Hence, initial data indicate that this approach may be a viable detection approach, but that larger patient sample sizes need to be evaluated and the effects of inter-patient variability studied.

Demystifying autofluorescence with excitation scanning hyperspectral imaging

Autofluorescence has historically been considered a nuisance in medical imaging. Many endogenous fluorophores, specifically, collagen, elastin, NADH, and FAD, are found throughout the human body. Diagnostically, these signals can be prohibitive since they can outcompete signals introduced for diagnostic purposes. Recent advances in hyperspectral imaging have allowed the acquisition of significantly more data in a shorter time period by scanning the excitation spectra of fluorophores. The reduced acquisition time and increased signal-to-noise ratio allow for separation of significantly more fluorophores than previously possible. Here, we propose to utilize excitation-scanning of autofluorescence to examine tissues and diagnose pathologies. Spectra of autofluorescent molecules were obtained using a custom inverted microscope (TE-2000, Nikon Instruments) with a Xe arc lamp and thin film tunable filter array (VersaChrome, Semrock, Inc.) Scans utilized excitation wavelengths from 360 nm to 550 nm in 5 nm increments. The resultant spectra were used to examine hyperspectral image stacks from various collaborative studies, including an atherosclerotic rat model and a colon cancer study. Hyperspectral images were analyzed with ENVI and custom Matlab scripts including linear spectral unmixing (LSU) and principal component analysis (PCA). Initial results suggest the ability to separate the signals of endogenous fluorophores and measure the relative concentrations of fluorophores among healthy and diseased states of similar tissues. These results suggest pathology-specific changes to endogenous fluorophores can be detected using excitationscanning hyperspectral imaging. Future work will expand the library of pure molecules and will examine more defined disease states.

Subject Index Vol. 52, 2008

Analytical and Quantitative Cytology and Histology: Volume 29, Number 6 (December 2007), 2008; 52:114–116 Analytical and Quantitative Cytology and Histology: Volume 30, Number 1 (February 2008), 2008;52: 255–258 Analytical and Quantitative Cytology and Histology: Volume 30, Number 2 (April 2008), 2008;52: 373–376 Analytical and Quantitative Cytology and Histology: Volume 30, Number 3 (June 2008), 2008;52:505– 508 Analytical and Quantitative Cytology and Histology: Volume 30, Number 4 (August 2008), 2008;52: 631–634 Analytical and Quantitative Cytology and Histology: Volume 30, Number 5 (October 2008), 2008;52: 736–738 Acid-fast bacilli Role of Modified Bleach Method in Staining of Acid-Fast Bacilli in Lymph Node Aspirates. (Gangane et al), 2008;52:325–328 Adenocarcinoma CK5/6 in Effusions: No Difference Between Mesothelioma and Pulmonary and Nonpulmonary Adenocarcinoma. (Dejmek), 2008;52: 579–583 Cytology of Pseudomyxoma Peritonei Associated with Well-Differentiated Appendiceal Adenocarcinoma. (Siddaraju et al), 2008;52:391–394 (Letter) Diagnosis of Linitis Plastica–Type Gastric Adenocarcinoma by Endoscopic Ultrasound-Guided Fine Needle Aspiration: A Case Report. (Carter et al), 2008;52:725–728 Improved Identification of Malignant Cells in Serous Effusions Using a Small, Robust Panel of Antibodies on Paraffin-Embedded Cell Suspensions. (Grefte et al), 2008;52:35–44 Adenocarcinoma, clear cell Clear Cell Carcinoma in a Background of Endometriosis: Case Report of a Finding in a Midline Abdominal Scar 5 Years After a Total Abdominal Hysterectomy. (Rust et al), 2008;52: 475–480 Adenoma Cytologic Features of Pulmonary Alveolar Adenoma. (González et al), 2008;52:739–740 (Letter) Adenoma, microcytic Preoperative Fine Needle Aspiration Cytology Diagnosis of Microcystic Adenoma of the Pancreas: Fact or Fiction? A Report of 2 Cases. (Fitzhugh et al), 2008;52:240–246 Adenoma, pleomorphic Chondromyxoid Fibroma of the Mandible: A Diagnostic Pitfall on Aspiration Cytology of Parotid. (Daneshbod and Khademi), 2008;52:636–638 (Letter) Fine Needle Aspiration Biopsy of Pleomorphic Adenoma and Adenoid Cystic Carcinoma of the Lacrimal Gland. (Siddaraju et al), 2008;52:515– 517 (Letter) Adenoma, pleomorphic metastazing Pleomorphic Adenoma of the Parotid Gland Metastasizing to the Scapular Region: A Case Report. (Ghosh et al), 2008;52:733–735 Adnexa Cytologic Features of Primary Malignant Tumors of Skin and Adnexae. (Prayaga et al), 2008;52: 702–709 Adolescent Fine Needle Aspiration Cytology of Breast Masses in Children and Adolescents: Experience with 1,404 Aspirates. (Kapila et al), 2008;52:681–686 Adult T-cell leukemia/lymphoma Diagnostic Considerations in Prolymphocytes in Pleural Fluid: A Case Report. (Anand et al), 2008; 52:251–254 Africa Into Africa: Cytology for One World. (Kaminsky), 2008;52:399 Alcian blue Cytology of Pseudomyxoma Peritonei Associated with Well-Differentiated Appendiceal Adenocarcinoma. (Siddaraju et al), 2008;52:391–394 (Letter) Analytical and Quantitative Cytology and Histology

Contributors Index Vol. 52, 2008

Abascal-Agorreta M (see Vera-Alvarez et al). 2008;52: 264–266 (Letter) Abdali K (see Shamsi et al). 2008;52:187–190 Abdul-Karim FW (see Farag et al). 2008;52:294–296 Abnet CC (see Pan et al). 2008;52:14–23 Abraham EK (see Ramadas et al). 2008;52:396–398 (Letter) Adán A (see Saro et al). 2008;52:87–90 Afarid M (see Mostaghni et al). 2008;52:597–601 Aisner S (see Fitzhugh et al). 2008;52:240–246 Akbulut M, Zekioglu O, Kapkac M, Erhan Y, Ozdemir N. Fine Needle Aspiration Cytology of Glycogen-Rich Clear Cell Carcinoma of the Breast: Review of 37 Cases with Histologic Correlation. 2008;52:65–71 Akbulut M, Zekioglu O, Ozdemir N, Kapkac M. Fine Needle Aspiration Cytology of Mammary Carcinoma with Choriocarcinomatous Features: A Report of 2 Cases. 2008;52:99–104 Aktepe F (see Tokyol et al). 2008;52:235–239 Al-Abbadi M (see Vella et al). 2008;52:377–378 (Letter) Al-Abbadi MA (see Feng et al). 2008;52:434–438 Al-Agha OM, Khader SN, Cajigas A, Blank W, Grafstein N, Seymour AW. Fine Needle Aspiration of Urethral Recurrence of Urothelial Carcinoma After Radical Cystectomy Presenting as a Perineal Mass: A Case Report. 2008;52:94–98 Al-Ayadhy B (see Kapila et al). 2008;52:681–686 Al-Mosawy FA (see Kapila et al). 2008;52:681–686 Al-Sebeih K (see Palmieri et al). 2008;52:691–696 Aledavud A (see Daneshbod et al). 2008;52:387–389 (Letter) Ales A (see Terčelj et al). 2008;52:584–590 Almeida JD, Lima CF, Brandão AAH, Cabral LAG. Evaluation of Staining Methods for Cytologic Diagnosis of Oral Lesions. 2008;52:697–701 Altay M (see Demir et al). 2008;52:309–312 Alvarez-Santín C. Endometrial Adenocarcinoma: Prevention and Early Diagnosis. 2008;52:748 (Book Review) Amadori PL (see Bonzanini et al). 2008;52:541–548 Amano S (see Komatsu et al). 2008;52:591–596 Ambaye AB (see Sherman et al). 2008;52:659–664 Anand M, Sharma S, Kumar R, Raina V. Diagnostic Considerations in Prolymphocytes in Pleural Fluid: A Case Report. 2008;52:251–254 Ang L-C (see Keith et al). 2008;52:260–263 (Letter) Angeloni C (see Maccallini et al). 2008;52:568–574 Anshu (see Gabhane et al). 2008;52:354–356 Anshu (see Gangane et al). 2008;52:325–328 Anshu (see Gangane et al). 2008;52:619–622 Antonelli C (see Maccallini et al). 2008;52:568–574 Apice G (see Fulciniti et al). 2008;52:612–618 Arabi MA (see Daneshbod et al). 2008;52:268–270 (Letter) Argüelles M (see González et al). 2008;52:490–494 Armbruster C, Bernhardt K, Setinek U. Pulmonary Tumorlet: A Case Report of a Diagnostic Pitfall in Cytology. 2008;52:223–227 Aron M (see Mathur et al). 2008;52:740–743 (Letter) Arora VK (see Mathur et al). 2008;52:740–743 (Letter) Arundhati (see Garbyal et al). 2008;52:204–206 Arundhati (see Ghosh et al). 2008;52:733–735 Ashfaq R (see Patino et al). 2008;52:718–720 Ashraf MJ (see Azarpira et al). 2008;52:220–222 Ashraf MJ, Azarpira N, Vasei M, Tavakol MH, Khademi B. Thyroid Paraganglioma: Diagnostic Pitfall in Fine Needle Aspiration Biopsy. 2008;52: 745–747 (Letter) Assiri AH (see Mokhtar et al). 2008;52:169–177 Asthana AK (see Ghosh et al). 2008;52:733–735 Athanassiadou P, Grapsa D. Value of Endoscopic Retrograde Cholangiopancreatography–Guided Brushings in Preoperative Assessment of Pancreaticobiliary Strictures: What’s New? 2008;52:24–34 Azarpira N (see Ashraf et al). 2008;52:745–747 (Letter) Azarpira N, Ashraf MJ, Shishegar M. Fine Needle Aspiration Findings in Angiofollicular Hyperplasia with Eosinophilia: A Case Report. 2008;52:220–222