COVID-19 in recent heart transplant recipients: Clinicopathologic features and early outcomes.

BACKGROUND: The impact of COVID-19 on heart transplant (HTx) recipients remains unclear, particularly in the early post-transplant period. METHODS: We share novel insights from our experience in five HTx patients with COVID-19 (three within 2 months post-transplant) from our institution at the epicenter of the pandemic. RESULTS: All five exhibited moderate (requiring hospitalization, n = 3) or severe (requiring ICU and/or mechanical ventilation, n = 2) illness. Both cases with severe illness were transplanted approximately 6 weeks before presentation and acquired COVID-19 through community spread. All five patients were on immunosuppressive therapy with mycophenolate mofetil (MMF) and tacrolimus, and three that were transplanted within the prior 2 months were additionally on prednisone. The two cases with severe illness had profound lymphopenia with markedly elevated C-reactive protein, procalcitonin, and ferritin. All had bilateral ground-glass opacities on chest imaging. MMF was discontinued in all five, and both severe cases received convalescent plasma. All three recent transplants underwent routine endomyocardial biopsies, revealing mild (n = 1) or no acute cellular rejection (n = 2), and no visible viral particles on electron microscopy. Within 30 days of admission, the two cases with severe illness remain hospitalized but have clinically improved, while the other three have been discharged. CONCLUSIONS: COVID-19 appears to negatively impact outcomes early after heart transplantation.

A rare case of endobronchial and lung metastasis in basal cell carcinoma.

Basal cell carcinoma (BCC) is the most common skin cancer, but rarely metastasizes. This article describes diagnosis and treatment of an extremely rare case of BCC metastasizing to the lung and endobronchial tissue.

Intracaval resection of a partially obstructing intravascular hemangioma using deep hypothermic circulatory arrest.

We report a case of an obstructing hemangioma within the lumen of the inferior vena cava adjacent to the hepatic veins. The technique of resection and pathology are described.

Acute COVID-19 Pneumonia Unmasking a Large Left Atrial Myxoma.

This is a case of acute coronavirus disease 2019 pneumonia that revealed an incidental large atrial myxoma with obstructive physiology that ultimately required emergent treatment with a definitive atriotomy and resection of the underlying myxoma.

Unusual presentation of Nocardia abscessus infection in an immunocompetent patient.

Introduction: Nocardia infections are being increasingly reported in both immunocompetent and immunocompromised patients. We describe a case of Nocardia abscessus infection with an atypical presentation in an immunocompetent patient. Case Presentation: A previously healthy 47-year-old gentleman presented with hiccups and paroxysmal spasms. Imaging revealed a pulmonary nodule, for which he underwent surgical resection. Pathologic evaluation demonstrated evidence of local inflammation, with growth of Nocardia abscessus on tissue cultures. Conclusion: Nocardia abscessus may have atypical presentations in immunocompetent patients. Further research is needed to understand the factors leading to Nocardia infections in immunocompetent patients.

A Professionalism and Mentoring Curriculum for Pathology Residents in Training.

Professionalism is a core Accreditation Council for Graduate Medical Education competency. The Mentoring and Professionalism in Training Program was developed to promote humanism in health-care professionals in our health system. A modified version was implemented in the pathology residency program for professionalism competency. Twenty-one trainees were divided into 3 groups, with a facilitator who was a graduate of the system Mentoring and Professionalism in Training Program. Five sessions included topics on appreciative inquiry, active role modeling, conflict resolution, team building, feedback, mindfulness, and physician well-being. Participants completed pre- and postsurveys. Qualitative responses were very positive, for example, one participant felt the sessions helped "understand intricacies of workplace relationships and ways of effective, respectful, communication." The Mentoring and Professionalism in Training is a curriculum that teaches team building, conflict resolution, and feedback along with strategies to balance well-being with professional commitments and growth. It is an effective educational tool that can satisfy the Accreditation Council for Graduate Medical Education professionalism curriculum.

Eosinophilic coronary monoarteritis.

Eosinophilic coronary monoarteritis is an unfamiliar cause of acute myocardial ischemia. Most commonly, it presents as a left-sided chest pain or sudden death in middle-aged women with no traditional risk factors for coronary artery disease. Because the abrupt onset leaves almost no time for intervention, the symptoms readily lead to death, and most cases are diagnosed at necropsy. Dissection of the coronary artery wall with resultant occlusion of the lumen, which commonly affects the left anterior descending artery, is a consistent gross finding. An inflammatory infiltrate, which is predominantly composed of eosinophils in the tunica adventitia and tunica media and is often accompanied by a hematoma in between these 2 layers, is observed histologically. The etiology remains unclear, but an increase in the activity of eosinophils because of hormonal interactions during pregnancy has been suggested. Interplay of hormones is thought to culminate in the release of histolytic agents by the eosinophils, which initiate the dissection process. Currently, there is no specific treatment for eosinophilic coronary monoarteritis, but cyclophosphamide and prednisone have shown positive results in the treatment of spontaneous coronary artery dissection with unspecified periadventitial inflammation. Percutaneous coronary procedures have also resulted in favorable outcomes in a subset of patients. Because of the high, sudden death rate in eosinophilic coronary monoarteritis, deciphering the underlying pathophysiology of this almost invariably fatal disease remains both a challenge and a key to developing screening methods that will allow timely detection and thus treatment.

Role of PAX-8, CD5, and CD117 in distinguishing thymic carcinoma from poorly differentiated lung carcinoma.

AIM: To determine if PAX-8, CD5, and CD117 can differentiate thymic carcinoma from poorly differentiated lung carcinoma. DESIGN: Archived cases of thymic (n=13) and poorly differentiated lung (n=15) carcinoma were analyzed for intensity and proportion of expression of PAX-8, CD117, and CD5. RESULTS: PAX-8 was positive in 69.2% of thymic and 5.8% of lung carcinomas. CD117 was positive in 84% of thymic and 26.6% of lung carcinomas. A total of 53% of thymic and none of the lung carcinomas were positive for CD5. Forty-six percent, 53%, and 69% of thymic carcinomas were dual positive for combinations of CD5/PAX-8, CD117/CD5, and CD117/PAX-8, respectively. None of the lung carcinomas were dual positive. Positivity for any 2 of the 3 markers was seen in 84% of thymic and none of the lung carcinomas. Triple positivity was seen in 53% of thymic carcinomas. CONCLUSION: Adding PAX-8 to CD117 and CD5 increases the diagnostic yield for thymic carcinoma.

Team-based learning in a pathology residency training program.

OBJECTIVES: Team-based learning (TBL) has been integrated into undergraduate and medical education curricula in many institutions. However, TBL has not been widely introduced into postgraduate medical education. Our study aimed to measure the effect of TBL on promoting learning and teamwork in the setting of pathology residency training. METHODS: Four TBL sessions were held and individual and group readiness assurance tests (IRAT/GRATs) were performed; scores were compared using Wilcoxon matched-pairs signed rank tests. Residents completed 18-item validated team performance surveys measuring the quality of team interactions on a scale of 0 (none of the time) to 6 (all of the time). Mean and standard deviation were calculated for each item. RESULTS: Scores on the IRAT vs GRAT were significantly different (P < .05). The team performance survey received mean scores ranging from 5.3 ± 1.1 to 6.0 ± 0.0. CONCLUSIONS: The use of TBL promotes teamwork and learning in a pathology residency program. Residents scored higher on the readiness assurance tests when working in teams, demonstrating the effectiveness of team learning and achievement. In addition, the Accreditation Council for Graduate Medical Education competencies of professionalism and interpersonal and communication skills were further enhanced by incorporating TBL into pathology residency training.

Metastatic meningioma extending into the left atrium through the pulmonary vein.

Left atrial extension of pulmonary tumors through the pulmonary vein is most often associated with primary malignancies and is rarely associated with metastatic disease. We present the first, to our knowledge, reported case of a patient with a history of intracranial meningioma resections presenting with metastatic meningioma to the right lower lobe with extension into the left atrium through the pulmonary vein.