The COVID-19 pandemic transformed conventional undergraduate medical education, converting previously in-person clerkships into virtual experiences. In order to allow students to gain exposure to the field of pathology, make connections with pathologists, and provide opportunities for letters of recommendation, the authors quickly developed a Virtual Anatomic Pathology Elective at the University of Minnesota. We succeeded in developing the foundation of a Virtual Anatomic Pathology Elective that allows for the rotation to be accessible not only to our medical students but also to international medical graduates and medical students from different programs. In 1 month, we were able to create a 4-week elective that was available before the start of the 2021 residency application season. We provided students with the closest possible experience to an in-person Anatomic Pathology Elective by developing an introductory week of lectures and assignments that provided structure for the rotation, introduced the field of anatomic pathology, and demonstrated the role of pathologists in health care. Furthermore, students attended virtual resident lectures and grand rounds, participated in virtual sign-out sessions, and presented an interesting case to the faculty at the end of their rotation. The goal was ultimately to customize the curriculum to students’ interests by making the rotation applicable to those applying to pathology as well as to other specialties (eg, general surgery, internal medicine, dermatology). Overall, we were able to design and implement a novel Virtual Anatomic Pathology Elective which we know can be effectively reproduced by other medical schools.

Background: There are few reports of bacteremia caused by Mobiluncus curtisii in the literature. We present a review of the literature in addition to a case study. Method: We describe the case of an 82-year-old patient who underwent gastrointestinal surgery and subsequently presented with dehydration, nausea, and hyperkalemia secondary to diarrhea. Further clinical work included blood cultures, and the patient was started empirically on piperacillin/tazobactam. Results: After five days, the blood culture bottle showed growth of a gram-variable, curved rod-shaped organism. After culture under anaerobic conditions on sheep blood agar, the organism was identified as Mobiluncus curtisii by MALDI-TOF mass spectrometry and enzymatic technology. A review of the literature reveals five additional cases of Mobiluncus curtisii bacteremia. Conclusions: This is the sixth case in the literature describing Mobiluncus species bacteremia. This organism is rarely identified in blood culture and is most often thought of in the context of bacterial vaginosis. However, the reported cases of bacteremia show gastrointestinal symptoms and presumed gastrointestinal source of infection. The pathogenesis of infection of this organism requires further investigation.

Background FMS-like tyrosine kinase-3 (FLT3-ITD) mutations are some of the most common mutations in acute myeloid leukemia (AML), and patient outcomes have improved since the advent of tyrosine kinase inhibitors. First, granulocytic differentiation was described in FLT3-positive AML treated with FLT3 inhibitors, and more recently, monocytic differentiation was reported. Methods Two patients with myelomonocytic cells in their bone marrow were identified during routine follow-up after AML treatment that included FLT3 inhibitors. The bone marrow study was done as standard of care. Results Both patients had FLT3-ITD+ AML and showed an atypical maturing monocytic cell population and a decrease in the leukemic blast cell population after FLT3 inhibitor therapy. Concurrent genetic testing revealed persistent genetic abnormalities. Conclusions These cases illustrate monocytic maturation in FLT3+ AML after FLT3 inhibitor treatment. It is critical for pathologists and clinicians to be aware of the differentiation phenomenon, as these patients have persistent molecular abnormalities despite response to treatment and normalization of blast counts.

At the University of Minnesota, Twin Cities Campus, we have completed our seventh year of an innovative small group learning activity in an undergraduate medical school course. The purpose of the Independent Study Project has been to expose students to the process of making a pathologic diagnosis in a team-based learning format. In the Independent Study Project groups of 3 or 4 students work together to determine a diagnosis on an assigned unknown case, and then compose a 3- to 5-page paper focusing on the disease entity and the basic science underlying the disease. This project emphasizes team-based learning and illustrates the relationship and integration of pathology with clinical medicine. Professionalism is also emphasized with students evaluating and providing feedback to fellow group members. Over time, the format has become more web based with all of the cases available online with digitally scanned microscopic slides and images. Overall, the Independent Study Project has been well received by both faculty members and students.

Objectives JAK2 gene mutation status is included in the 2017 WHO diagnostic criteria of a myeloproliferative neoplasm (MPN) and therefore indicated in the diagnostic workup. Overutilization and inappropriate testing, however, can cause harm and lead to medical errors, and most importantly, it can significantly drive up the costs of patients’ care. Here we report an attempt to evaluate the success rate and the associated costs of JAK2 testing as well as to correlate it with clinical indications and patient presentation. Methods We conducted the analysis of next-generation testing orders/results performed at out institution between 9/2/2015 and 7/13/2018. We reviewed the rate of positive results as well as the type of order submitted to laboratory and compared the costs of individual tests. Results We analyzed 3,474 NGS orders/results performed at our institution. Of those, 1,203 were submitted for JAK2 testing, making this the most commonly ordered NGS test. Out of 1,203 results, there were 820 unique patient specimens and 118 tested positive (15%). The JAK2 testing was primarily ordered as part of the NGS MPN panel, which includes JAK2, CALR, and MPL mutation hotspots (70%), the custom panel (23%), JAK2 single gene (5%), or as part of comprehensive myeloid panel (2%). The mutation detection rate was 15%, 12%, 11%, and 15%, respectively. Conclusion Testing for JAK2 gene mutation status is the most commonly ordered NGS test in our laboratory. The detection rate for pathogenic mutation, irrespective of the type of genetic panel ordered, was 11% to 15%. Our analysis of the JAK2 ordering and reporting suggests that the JAK2 testing may be somewhat overutilized at our institution. An ongoing analysis of clinical indications, patient presentation, and associated costs will help to fully elucidate the true utility of this testing and will be included in the poster presentation.