Impact of COVID-19 restrictions on pathology service utilisation.

BACKGROUND: Isolation and social distancing restrictions due to COVID-19 have the potential to impact access to healthcare services. AIMS: To assess the use of pathology services during the COVID-19 pandemic initial restrictions. METHODS: Repeated cross-sectional study of pathology tests utilisation during a baseline time period early in 2020 compared with pre-lockdown and lockdown due to COVID-19 in South Australia. The outcome measure was changed in a number of pathology tests compared to baseline period, particularly change in the number of troponin tests to determine potential impacts of lockdown on urgent care presentations. RESULTS: In the community setting, the ratio of a number of pathology tests pre-lockdown and post-lockdown versus baseline period decreased from 1.02 to 0.53 respectively. The exception was microbiology molecular tests, where the number of tests was more than three times higher in the lockdown period. The number of troponin tests in emergency departments decreased in the lockdown period compared to the baseline time period; however, there was no evidence of an association between tests result (positive vs negative) and time period (odds ratio (OR) 1.09; 95% confidence interval (CI) 0.97-1.22). There was an inverse relationship between age and time period (OR 0.995; 95% CI 0.993-0.997), indicating that fewer troponin tests were conducted in older people during the lockdown compared with the baseline period. CONCLUSION: COVID-19 restrictions had a significant impact on the use of pathology testing in both urgent and non-urgent care settings. Further studies are needed to investigate the effect on health outcomes as a result of the COVID-19 restrictions.

Whole-Genome Sequencing of SARS-CoV-2 from Quarantine Hotel Outbreak.

Hotel quarantine for international travelers has been used to prevent coronavirus disease spread into Australia. A quarantine hotel-associated community outbreak was detected in South Australia. Real-time genomic sequencing enabled rapid confirmation tracking the outbreak to a recently returned traveler and linked 2 cases of infection in travelers at the same facility.

Synchronous malignant phyllodes tumour and invasive lobular carcinoma-case report and review.

Synchronous phyllodes tumour and invasive lobular carcinoma is an extremely rare event. We report these concurrent diagnoses in a patient observed in an ipsilateral breast, suspected due to breast risk factors (family history and lobular carcinoma in situ) and the presence of malignant phyllodes. Screening breast magnetic resonance imaging was able to identify the carcinoma which was occult in other imaging. An understanding of the possibility of dual diagnoses may lead to additional investigations for its identification. Treatment may then be tailored to the individual's pathology.

Hepatocellular carcinoma metastasis to sphenoid wing.

We present a case report where hepatocellular carcinoma metastasis to the sphenoid wing was the initial presentation of an occult primary.

Tendon sheath fibroma of the medial canthal tendon.

Fibromas of the tendon sheath are slow-growing, benign tumors most commonly found on the hands and wrist. A fibroma of the tendon sheath arising from the medial canthal tendon presented as an enlarging nodule that had been present for 40 years. The fibroma was identified by microscopy and immunohistochemistry, and surgical resection appears to have been curative.

Orbital cavernous haemangiomas: immunohistochemical study of proliferative capacity, vascular differentiation and hormonal receptor status.

BACKGROUND/AIMS: Immunohistochemical characterisation of orbital cavernous haemangiomas (CHs) with respect to proliferative capacity, hormone receptor status and vascular differentiation. METHODS: Eleven cases of orbital CHs were reviewed. Immunohistochemical stains for Mib-1, proliferating cell nuclear antigen (PCNA), Bcl-2, estrogen and progesterone receptors (ER & PR), CD31, D2-40, and VEGF were investigated in 11 specimens. RESULTS: Immunohistochemical staining revealed positivity for PCNA in ten of the 11 cases (91%). Bcl-2 was positive in 8 cases (73%). VEGF and PR were each weakly positive in 3 cases. All cases were negative for Mib-1, ER and D2-40. The staining was localized around the endothelium. CONCLUSION: This is the first study to characterise in detail the immunohistochemical features of orbital CHs. The proliferative markers PCNA and Mib-1 show discordant expression in these lesions and the expression of PCNA and Bcl-2 in the absence of Mib-1 is indicative of low proliferative potential. Small subsets of these tumors express PR and VEGF, which may partly explain the proliferative capacity of some orbital CHs.

Characterization of lacrimal sac histology: an immunohistochemical study.

BACKGROUND: A prospective observational study in a university hospital setting to study the immunohistochemical (IHC) characteristics of non-neoplastic human lacrimal sac epithelium. METHODS: Twenty paraffin-embedded specimens of human lacrimal sac were studied using monospecific monoclonal antibodies to 34 beta E12, cell adhesion molecule (CAM 5.2), epithelial membrane antigen (EMA), cytokeratins (CK) 7 and 20, estrogen receptor and progesterone receptor. The distribution and histologic location of IHC staining were examined qualitatively, and the IHC stains scored as positive (+) or negative (-). RESULTS: The haematoxylin-eosin stains were reviewed for tissue morphology. All 20 specimens were positive for 34 beta E12, CAM 5.2, EMA and CK 7 and negative for CK 20, estrogen receptor and progesterone receptor. CONCLUSION: To our knowledge, this is the first study to characterize the IHC properties of human lacrimal sac epithelium. This epithelium appears to possess consistent IHC properties as it stains for 34 beta E12, CAM 5.2, EMA and CK 7 and this information would be potentially useful in differentiating tumours arising in the region of the lacrimal sac.

The differential diagnosis of localised amelanotic limbal lesions: a review of 162 consecutive excisions.

AIMS: To report the distribution of histopathological diagnoses in patients who underwent excision of localised limbal lesions that were clinically suspected to be squamous neoplasia (intra-epithelial neoplasia or squamous cell carcinoma). METHODS: 162 consecutive patients of a single ocular oncologist underwent an excisional biopsy between 1998 and 2009 for suspected squamous neoplasia. Histopathological reports were retrospectively reviewed. RESULTS: The population comprised 122 males and 40 females. The mean age was 63.4±15.8 (range: 27-90). 138 (85.2%) lesions were identified as intraepithelial neoplasia (CIN), of which 34 (21.0%) were CIN I, 32 (19.8%) were CIN II and 72 (44.4%) were CIN III or squamous cell carcinoma in situ. In seven (4.3%) cases, the lesion was invasive squamous cell carcinoma. In two (1.2%) cases, the lesion was amelanotic malignant melanoma. In 16 (9.9%) cases, histopathology revealed a benign entity including lesions described as squamous papilloma, solar elastosis and epithelial hyperplasia, keratosis or reactive atypia. CONCLUSIONS: In this population, for an experienced ocular oncologist, the misdiagnosis of localised limbal squamous neoplasia occurred in 10.5% of cases, with 5.5% of cases being malignant. This study highlights the importance of acquiring a clinical diagnosis before administering a topical chemotherapeutic agent.

Quantitative and qualitative research data and their relevance to policy and practice.

Tom Dodd explores the nature of the relationship between qualitative and quantitative data in research, and reflects on how these methods can affect policy.

Malignant peripheral nerve sheath tumour metastatic to the orbit.

PURPOSE: To present a case of malignant peripheral nerve sheath tumour (MPNST) metastatic to the orbit. METHOD/RESULTS: The authors describe a 29-year-old woman with disseminated MPNST who presented with acute right orbital inflammation. Computerized tomography revealed a superolateral mass with a central radiolucent area. At biopsy, the mass was primarily subperiosteal and histology showed a spindle cell, S100-positive MPNST consistent with the primary tumour. CONCLUSION: This is the second reported case of MPNST metastatic to the orbit and illustrates that an inflammatory presentation is possible in this aggressive malignancy.

Cervical cancer: effect of glandular cell type on prognosis, treatment, and survival.

OBJECTIVE: To investigate survivals from cervical cancer, with special reference to effects of glandular histology and its influence on prognostic characteristics and management decisions. METHODS: Data on cervical cancers, diagnosed in 1984-2000, were obtained from the gynecologic oncology registry of hospitals of the University of Adelaide. Comparisons were made of disease-specific survival, age at diagnosis, diagnostic period, stage, grade, and primary course of treatment. RESULTS: The study included 544 squamous cell carcinomas, 43 adenosquamous carcinomas, five clear cell cancers, 136 other adenocarcinomas, and 19 cancers of "other" histological type. Overall survival was 72.2% at 5 years from diagnosis, decreasing to 67.5% at 15 years. Survival was lower for older ages, higher grades, and higher International Federation of Gynecology and Obstetrics stages, although equivalent for stages IIA and IIB. Unadjusted survivals varied by histological type (P =.001), with lower survivals suggested for adenosquamous and clear cell lesions and "other" histological types than for squamous cell carcinomas and other adenocarcinomas. After adjusting for age, stage, grade, and diagnostic period, adenocarcinomas had a higher case fatality than squamous cell lesions (relative risk 2.08, 95% confidence limit 1.35, 3.21), whereas the elevation in relative risk was lower and not statistically significant for a combined adenosquamous and clear cell category at 1.25 (0.69, 2.24). For stage II, both adenocarcinomas and the adenosquamous and clear cell group had lower survivals than squamous cell cancers. CONCLUSION: Relative to squamous cell carcinomas, adenocarcinomas and potentially adenosquamous cancers are becoming more common. This has implications for screening, treatment, and prognosis.

Orbital lipomatous haemangiopericytoma: an unusual variant.

Haemangiopericytoma (HPC) of the orbit is a rare tumour occurring in all age groups and presenting with slowly progressive proptosis, ocular motility impairment and visual loss. Although most are benign tumours that are resectable at diagnosis, one-third of these tumours demonstrate malignant features and recur locally or metastasize, usually with a fatal outcome. In 1995, a morphologically unique variant, termed lipomatous haemangiopericytoma (L-HPC), was described. Only one case has been reported previously arising in the orbit. In this paper, a case is reported of L-HPC occurring in the orbit and consider the prognostic implications of this HPC variant.