Abstract Background In the wake of social distancing, many institutions resorted to using varying levels of digital education modalities and virtual tours for education or recruitment. The virtual reality (VR) simulations use partial immersion through a digital learning environment to foster a perceived lived experience for an intended outcome. Integrating simulation and interactive media fits within gamification with has shown effectiveness to increase learner engagement and retention. Objective This study aimed to enhance medical education by integrating 360° VR tours into the clinical pathology curriculum and to evaluate the effectiveness of VR compared to traditional didactic methods, primarily in regards to interactivity and with a secondary outcome of retention. Methods Seven 360° VR tours were developed for pathology laboratories at a large academic medical center. Two (Microbiology and Transfusion Services) were selected for further enhancement and integration into the curriculum of remote learning courses. A controlled crossover study was conducted with 171 medical students (83% MS4) from April 2021 to April 2023. The students were randomly assigned to participate in either VR or PowerPoint (PP) presentations. Surveys on a 5-point Likert scale and learning assessments were used to measure understanding, interactivity, relevance, engagement, and knowledge retention. Results 15 course cohorts contained 171 enrolled students. Approximately 14% of students (n = 23) stated a primary career interest in pathology at the outset of the rotation, and 6 students (3.5%) later became residents in the institution’s pathology department. 16 students were unable to participate in the proctored activity due to scheduling conflicts. 155 students were randomized into the experimental comparison of the VR and PP tour formats. With a response rate exceeding 90%, VR participants rated interactivity significantly higher than PP participants (average 4.48 vs. 3.48, p < 0.001). VR participants also demonstrated higher engagement scores (average 4.21 vs. 3.92, p = 0.004), although average assessment scores were slightly lower for VR participants than for PP participants (6.2 vs. 6.5, p = 0.1). In-depth textual analysis highlighted themes of enhanced engagement and interactivity, although some students reported challenges with VR navigation. Conclusions The integration of 360° VR tours into the clinical pathology curriculum enhances interactivity and learner engagement, presenting a scalable solution for remote learning. This modality is especially suited for educational activities where the location and environment are critical experiential components. While VR tours did not substantially improve short-term knowledge retention compared to traditional methods, they significantly increased student engagement, an essential component for effective learning. Limitations such as navigation difficulties and technological barriers underscore the need for iterative improvements in VR experiences. These findings support the continued use of VR tours as a supplementary educational tool, complementing traditional curricula to provide a more immersive and interactive educational experience.

Abstract Introduction/Objective Connective tissue disorders affect multiple organ systems and manifest a wide range of complications, including autoimmune hemolytic anemia (AIHA) and hemophagocytic lymphohistiocytosis (HLH). While hemolytic anemias induce erythroid hyperplasia to compensate for peripheral red blood cell destruction, this response may be curtailed when erythroid precursors are themselves targeted. Methods/Case Report A 35-year-old female with mixed connective tissue disease (MCTD), including features of scleroderma and lupus, presented with fingertip autoamputations due to Raynaud’s phenomenon. Her clinical course was complicated by abdominal pain, transaminitis, a sudden drop in hemoglobin, and clinical and laboratory findings of AIHA and HLH. Despite laboratory evidence of AIHA, she exhibited a transient reticulocytopenia. Concern for HLH prompted a bone marrow biopsy which revealed a normocellular marrow, markedly decreased and left-shifted erythroid precursors, myeloid-to-erythroid ratio of 21.9, no hemophagocytes, and negative Parvovirus staining. Peripheral blood Parvovirus B19 PCR was negative. A single dose of tocilizumab for suspected HLH resulted in clinical improvement and reticulocyte recovery. Results NA Conclusion The unexpected erythroid hypoplasia may reflect multiple overlapping etiologies, including MCTD-associated autoantibody-mediated stem-cell injury, HLH-related hemophagocytosis, or cytokine-induced marrow suppression. This case highlights the importance of multidisciplinary collaboration in managing complex autoimmune conditions. Recognition of the unusual presentations is critical for timely diagnosis and therapy.

Abstract Introduction/Objective Malaria and Toxoplasmosis are two parasitic infectious diseases with great endemicity in Sub- Saharan Africa. Although shared risk factors and immune modulation may exacerbate the co-infection to a greater extent, yet local epidemiological data remain limited. Malaria is an acute and chronic disease caused by protozoan parasites of the genus Plasmodium, and transmitted principally through the bite of infected female Anopheles mosquitoes. Toxoplasmosis, a disease caused by intracellular protozoa, Toxoplasma gondii, which is one of the world’s most common parasitic infections. The purpose of this study was to evaluate the prevalence of Plasmodium falciparum and Toxoplasma gondii co-infection, sero-prevalence of Toxoplasma gondii IgG and IgM among the febrile patients and determine associated risk factors. Methods/Case Report A cross sectional study of 184 febrile patients aged 1-75 years was carried out in three hospitals located at Osogbo. Malaria parasite was detected using thick blood film examination of venous blood, while Toxoplasma gondii IgG and IgM antibodies were detected via ELISA. Detailed questionnaires were administered to gather demographic data and information on exposure to possible risk factors. Analysis of data was carried out using SPSS v 20, Chi-square test (p < 0.05) was performed to determine significant associations. Results Out of 184 participants enrolled in this study, 134(72.8%) were positive for malaria which included 4 pregnant women. Whereas, 57(31%) participants were anti-T. gondii IgG positive, only 25(13.6%) participants were anti-T. gondii IgM positive. Meanwhile 50(27.2%) participants had co-infection of toxoplasmosis and malaria, predominantly in children aged 1–10 years. Relevant associations were found with malaria parasite infection in non-users of an insecticide-treated net (p = 0.000) and those living in water logged areas (p = 0.005). Stray cat exposure was associated with Toxoplasma gondii sero-positivity (p = 0.002). Conclusion This study showed a considerable prevalence of co-infection of toxoplasmosis and malaria, and significantly high overall prevalence of toxoplasmosis, and malaria. The age group 1-10 years was identified as risk group for both infections, and the study revealed high prevalence of both infections in the study population. The risk group as shown by this study for co-infections could be suggestive of congenital transmission of toxoplasmosis, care-free attitude to life of children of this age range. Also, the study supports the fact that malaria is still a threat to children in Nigeria as adult might have developed a higher immunity to malaria as a result of repeated infections. High rate of co-infection necessitate need for screening and preventive strategies that are integrated. It is recommended to screen for toxoplasmosis in febrile patients, especially among children. With targeted health education on specific improved hygiene and vector control in endemic areas.

Abstract Introduction/Objective Tumors of the appendix are rare, often presenting as appendicitis, with most being benign and managed with appendectomy. Invasive mucinous adenocarcinoma (IMA) accounts for only 0.2%–0.3% of appendectomy specimens. We present a diagnostically challenging case of IMA arising from a sessile serrated lesion (SSL) with high-grade dysplasia. Methods/Case Report A 78-year-old woman presented with chronic right lower quadrant pain. Imaging revealed a retrocecal appendix with irregular thickening and a dilated lumen (1.8 cm), raising concern for a neoplastic process. While initial microscopy suggested low-grade or high-grade appendiceal mucinous neoplasm (LAMN or HAMN), careful histologic examination confirmed IMA, showing destructive invasion with malignant glands and tumor cell strips in mucin pools. The preserved lamina propria and submucosa helped exclude LAMN and HAMN, which typically show mural disruption and pushing invasion. The tumor invaded the serosa, forming serosal nodules (pT4a stage). It arose from a background SSL with high-grade dysplasia. Although histologically distinct, SSLs, LAMNs, and HAMNs can appear similar due to shared molecular features, such as KRAS mutations, particularly in Eastern populations. Results NA Conclusion This case emphasizes the need for careful histologic assessment to distinguish IMA from other mucinous tumors, as preserved submucosa and destructive invasion are key to accurate diagnosis and management.

Abstract Introduction/Objective Primary seminal vesicle tumors, especially benign cystadenomas, are extremely rare with under 25 reported cases. Often asymptomatic, they may mimic malignancy due to nonspecific symptoms, complex imaging, and ambiguous histology. We report a rare 5 kg seminal vesicle cystadenoma, highlighting the diagnostic challenges posed by overlapping immunohistochemical features. Methods/Case Report A 67-year-old male presented with a 31.3 × 21.2 × 10.5 cm pelvic mass compressing nearby structures. Resection revealed a hemorrhagic unilocular cyst. Histology showed bland cuboidal epithelium without atypia and non-hypercellular stroma. Immunohistochemistry was positive for CK7, CK19, CD10, PAX-8, and negative for prostatic and intestinal markers. Stromal cells expressed ER, PR, desmin, and caldesmon, supporting a diagnosis of seminal vesicle cystadenoma. Results N/A Conclusion The combination of nonspecific symptoms, atypical imaging, massive tumor burden, and ambiguous immunohistochemical profiles can obscure identification of the origin and nature of this lesion. Awareness of this rare tumor type and its histologic features can prevent misdiagnosis and overtreatment.

Abstract Introduction/Objective The BRAF VE1 immunohistochemical (IHC) stain can recognize BRAF V600E-mutant proteins and coincidently highlights cilia due to cross-reactivity of the antibody with epitopes in axonemal dyneins. This phenomenon has not been extensively studied. Our aim was to therefore investigate the utility of BRAF IHC staining in pulmonary tissue. Methods/Case Report Archival cases where BRAF IHC was performed on pulmonary tissue were retrieved. Clinical and pathological findings were recorded and IHC slides reviewed. Results BRAF IHC was available for 49 thoracic specimens including 26 biopsies, 22 surgical resections and 1 cytopathology cell block case. BRAF staining highlighted cilia at the apical surface of bronchial cells in 39 cases (80%). Cytoplasmic or nuclear staining was considered abnormal, with artifactual staining seen in 18 cases (e.g. histiocytes, mucin). Unexpected, non-apical staining in 10 slides occurred with adenocarcinoma (3 of 14 adenocarcinomas in the cohort), thoracic sialadenoma papilliferum, atypical adenomatous hyperplasia, benign cartilage, and vessels. BRAF failed to stain two entirely benign cases (one with scar tissue). Conclusion BRAF IHC is an underutilized ancillary tool in thoracic pathology. By highlighting the presence of cilia, BRAF has potential in most cases to distinguish benign from malignant pulmonary tissue.

Abstract Introduction/Objective Rising healthcare costs necessitate efficient resource utilization in trauma care. This study assesses the cost-effectiveness of liquid plasma compared to fresh frozen plasma in massive transfusion protocols. Methods/Case Report A quantitative analysis was performed on 1,077 plasma units ordered over two years, focusing on procurement costs, waste metrics, and overall financial impact on the healthcare system. Results The transition to liquid plasma resulted in a 30% reduction in overall plasma procurement costs, decreasing from $5,000 in Year One to $3,500 in Year Two (p < 0.01). The total estimated savings from reduced plasma waste amounted to $150,000 over the study period. Additionally, the average cost per patient for massive transfusions decreased from $1,200 to $800, reflecting a significant financial benefit. The study also highlighted that the increased efficiency in transfusion practices led to a reduction in the average length of hospital stay by 1.5 days. Conclusion Liquid plasma is not only clinically effective but also cost-efficient, highlighting its potential to improve financial outcomes in trauma care. These findings advocate for the adoption of liquid plasma in massive transfusion protocols to enhance both clinical and economic outcomes in emergency medicine.

Abstract Accurate identification of donor-specific antibodies (DSA) plays a critical role in assessing immunological risk for solid organ transplantation, with high-resolution HLA typing being a key component of this process. Short-read next-generation sequencing (NGS) offers two-field high-resolution (2F-HR) HLA typing, but its application in deceased donors is often impractical due to time constraints. As a result, most tissue typing laboratories use faster, lower-resolution methods like real-time PCR (qPCR), though qPCR provides limited gene coverage, which may lead to ambiguous results due to the inability to fully exclude certain HLA alleles. This study aimed to evaluate the concordance between two-field HLA alleles identified through qPCR and those determined using NGS. Additionally, we examined the impact of potential allele discrepancies on DSA assignment during pre-transplant assessments. A retrospective analysis was conducted on 67 deceased donors at our center between January and September 2024. Donor HLA typing was initially performed using qPCR by the organ procurement organization’s HLA laboratory, followed by high-resolution NGS typing in our center’s laboratory. DSA detection, both pre- and post-transplant, utilized Luminex-based single antigen bead assays. The study found a 94.7% concordance between qPCR and NGS results, with the highest agreement observed for HLA-DPB1 (98.2%), HLA-DQB1 (93.4%), and HLA-DRB1 (97%). However, the lowest concordance (90.2%) was seen for HLA-DRB*3/4/5. All discordant alleles were further analyzed for their potential impact on DSA assignments in virtual crossmatch (VXM) evaluations, which assess immunologic compatibility between a recipient’s alloantibody profile and the donor’s histocompatibility antigens. The analysis demonstrated negligible effects on DSA assignments. While HLA-DPA1 and DQA1 exhibited the highest incidence of discordant allele assignments represented on the bead panel, no waitlisted recipient displayed antibodies against either the qPCR or NGS-discordant alleles. In conclusion, these results confirm that while qPCR generally aligns well with NGS for high-resolution HLA typing, certain loci present challenges in accurate allele assignment. Further, the impact of HLA typing discrepancies on DSA identification in VXM assessments was insignificant, supporting qPCR as a reliable and efficient tool for HLA typing in deceased donor transplants. Future directions of this research include expanding the study to include a larger cohort of deceased donors from multiple centers to validate the findings and assess their applicability across various populations. Additionally, the study will explore whether discordant alleles affect eplet mismatches (molecular mismatch) and influence post-transplant outcomes, such as rejection rates and graft survival.

Abstract Introduction/Objective Orbital metastases from breast carcinoma are rare and often present diagnostic challenges due to their clinical resemblance to benign conditions such as orbital cellulitis. Breast cancer is the most common primary tumor to metastasize to the orbit, yet these events remain infrequent and easily misdiagnosed, especially in patients presenting without visual symptoms. Recognizing this presentation is critical in cancer survivors to prevent delays in appropriate treatment. Methods/Case Report This is a case study of a 69-year-old woman previously diagnosed with estrogen and progesterone receptor-positive, HER2-negative invasive ductal carcinoma of the right breast, treated by radical mastectomy in 2022. She presented in August 2024 with progressive left periorbital swelling and discomfort since April 2024. Despite empirical antibiotic therapy for presumed orbital cellulitis, her symptoms persisted. A full-thickness eyelid biopsy was performed. Tissue sections were stained with hematoxylin and eosin (H&E), followed by immunohistochemistry using CK7, GATA-3, and E-cadherin antibodies. Results Histologic examination revealed a single-file arrangement of neoplastic cells. Immunostaining was positive for CK7 and GATA-3, with weak E-cadherin expression and loss of intercellular adhesion, confirming metastatic lobular carcinoma of breast origin. Conclusion This case emphasizes the importance of considering metastatic disease in atypical orbital presentations in breast cancer survivors. Timely biopsy and immunohistochemical analysis are essential for accurate diagnosis and management.

Abstract Introduction/Objective Nonalcoholic fatty liver disease (NAFLD) spans from simple steatosis to severe liver injury, with the inflammatory phase known as nonalcoholic steatohepatitis (NASH). NASH can progress to cirrhosis and may require a liver transplant to prevent mortality. NAFLD affects approximately 25% of the global population, with the highest prevalence observed in the Middle East, where rates reach about 31.79%. NASH, a severe form of NAFLD, involves various cell types—epithelial, progenitor, hepatic stellate, endothelial, and inflammatory cells—that contribute to its progression. Early identification and targeted treatment of NAFLD/NASH are crucial for reducing morbidity and mortality. However, aside from imaging methods like MRI elastography, there are no reliable minimally invasive diagnostic tools for accurate diagnosis and stratification. Methods/Case Report Liver cancer stem cell (LCSC) subpopulations exhibit resistance to chemotherapy and are linked to metastatic hepatocellular carcinoma (HCC). This phenomenon is frequently observed in patients infected with the hepatitis C virus (HCV), particularly those who also struggle with obesity or alcohol abuse. However, there is a need for further exploration into the role of LCSC stemness biomarkers and signaling pathways for the early identification and targeted treatment of NAFLD/NASH. Results Mesenchymal stem cells (MSCs) are well-known for their remarkable self-renewal capabilities, exceptional compatibility with biological tissues, and low tendency to provoke immune responses. These distinctive characteristics position them as a pioneering therapeutic option for liver diseases, presenting promising opportunities for innovative solutions in regenerative medicine. In this study, we employed cell-based therapies utilizing extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) (MSC-EVs). These cell-free vehicles exhibit low immunogenicity and were utilized to modulate the stem cell-related molecular markers of the LCSC subpopulation, which are linked to the initiation and progression of NAFLD. Furthermore, we engineered EVs loaded with miRNA-34a, a tumor suppressor specifically targeting the CD133+/CD90+ LCSC subpopulation, which were isolated via FACS from HCC animal models developed with or without NAFLD. This approach was found to affect several stemness biomarkers, including Notch1, Notch4, Nanog, p-S6 kinase, β-catenin, and Stat3, in both in vitro and in vivo settings. These results suggest that engineered EVs loaded with miRNA-34a may represent a promising MSC-based therapeutic strategy for treating NAFLD/NASH. These results suggest that engineered EVs loaded with miRNA-34a may represent a promising MSC-based therapeutic strategy for treating NAFLD/NASH. Conclusion Our data conclude that engineered EVs loaded with miRNA-34a may play a vital role in the therapeutic strategy for treating NAFLD/NASH.