Cryptococcosis presenting as upper limb cellulitis and ulceration: a case series.

We report four cases of cryptococcosis presenting as upper limb cellulitis or ulceration, or both. Three of the four patients were on long-term prednisolone therapy at the time of presentation. In each case, the diagnosis of cryptococcosis was established by a biopsy of the skin. Only one of the four patients had conclusive evidence of disseminated disease. Our cases highlight the importance of skin biopsy in immunosuppressed individuals presenting with cellulitis, particularly when the cellulitis occurs in an atypical location and when the clinical condition fails to respond to standard antibacterial therapy.

Analysis of preanalytical nonconformance in a medium-sized private pathology laboratory.

OBJECTIVES: To determine the frequency of preanalytical nonconformance in a medium-sized private pathology laboratory. METHODS: A retrospective audit was performed at Southern IML Pathology in Wollongong and Nowra, Australia, to identify incidences of nonconformance over a 12-month period from October 2012 to September 2013. Data were obtained using an in-house nonconformance reporting system and from the quarterly Royal College of Pathologists of Australasia Key Incident Monitoring and Management System. RESULTS: There were 584,012 patient episodes tested and 2,726,597 tests performed at Southern IML Pathology during the study period. Of the 11,266 incidences of nonconformance during the study period, 3,613 (32%) were from collection, 2,164 (19%) were from the specimen reception area, and 2,242 (20%) were from data entry. In total, 3,045 (27%) incidences required a re-collection. A total of 10,972 patients had an incidence of preanalytical nonconformance, which is 1.9% of patients who had tests performed during the study period. CONCLUSIONS: This is one of few studies of preanalytical nonconformance in a medium-sized private laboratory setting. Monitoring nonconformance for a pathology laboratory is essential to determine areas where further improvements can be made.

Hyperplastic polyp of the duodenum: a report of 9 cases with immunohistochemical and molecular findings.

Benign serrated polyps are commonly found in the colorectum but have rarely been described in other parts of the gastrointestinal tract. We report a series of 9 serrated polyps arising in the duodenum with clinicopathologic features, immunohistochemical expression profile of mucins (MUC2, MUC5AC, MUC6), and molecular analysis for BRAF and KRAS. The polyps were diagnosed as incidental endoscopy findings in 9 different patients, comprising 3 male and 6 female patients, with a mean age of 52.2 years (range, 21-72 years). The second part of the duodenum was the most common site (n = 5), followed by the ampulla (n = 1) and the distal duodenum (n = 1), with the location of the 2 remaining polyps unspecified. Other upper gastrointestinal tract pathology features included Barrett esophagus for 5 patients, Helicobacter gastritis for 1 patient, and mild chronic gastritis for 1 patient. The histologic appearance of the polyps was similar to microvesicular hyperplastic polyp in the colorectum. Immunostaining for mucins showed MUC6 expression in the crypt bases of all polyps, MUC5AC expression in 8 cases (89%), and mucin 2 expression in 6 cases (67%). Molecular testing was successful in 6 polyps, showing BRAF mutation (V600E) in 2 polyps, KRAS mutation in 2 polyps, and no mutation for either gene in 2 polyps. Colonoscopy reports were available for 6 patients, of whom 4 were diagnosed with hyperplastic polyps or sessile serrated polyps in the colorectum. However, no patient met the criteria for serrated polyposis. Although probably rare and of uncertain malignant potential, hyperplastic polyp should be considered in the differential diagnosis of benign duodenal polyp.