Pathology Information System Research Articles

Metastatic tumours to the parotid: A 20-year single institutional experience with an emphasis on 14 unusual presentations

The parotid gland is a rare site for distant metastasis. We aim to provide an overview of metastatic tumours to the parotid over the past 20 years, focusing on clinicopathological analysis of 14 rare diagnoses. To the best of our knowledge, we are the first group to present the most up-to-date and largest case series on unusual metastases to the parotid. A total of 93 metastatic cases were identified from 2004 to 2023, on the pathology information system at North West London Pathology, with squamous cell carcinoma (n = 45, 48.4 %) as the most common primary, followed by malignant melanoma (n = 29, 31.2 %) and Merkel cell carcinoma (n = 4, 4.3 %). We came across 14 rare tumours that had metastasised to the parotid, including metastatic adenocarcinoma from kidney (n = 3, 3.2 %), lung (n = 3, 3.2 %) and breast (n = 1, 1.1 %), olfactory neuroblastoma (n = 3, 3.2 %), soft tissue sarcoma (n = 2, 2.2 %), small cell carcinoma (n = 1, 1,1 %) and hidradenocarcinoma (n = 1, 1.1 %). Half of all secondary neoplastic lesions (50.5 %) were found in intra-parotid nodes, while the other half (49.5 %) were found in parotid parenchyma. Our study offers valuable insights into the various tumour types that can metastasise to the parotid across a wide age range. It underscores the necessity of maintaining a broad differential diagnosis. Keeping an open mind regarding the potential primary sources of the tumour is imperative for accurate diagnosis and effective treatment planning.

CLINICOHISTOPATHOLOGICAL STUDY OF TESTICULAR TUMOURS IN DR. HASAN SADIKIN GENERAL HOSPITAL BANDUNG

Objective: The purpose of this research was to describe the clinical and histopathological characteristics of testicular tumours at Hasan Sadikin General Hospital (RSHS) between 2017-2021. Material & Methods: This research was a cross-sectional descriptive study examining the clinical and histopathological profiles of testicular tumours. The secondary data sources included medical records from the Department of Urology, Anatomic Pathology, Medical Records, and Hospital Information System (SIRS). The collected data covered age, ethnicity, clinical symptoms, site, stage, annual prevalence rate, and analyzed using Microsoft Excel. Results: There were 42 patients who had primary testicular tumour. The highest prevalence of testicular tumours at RSHS was in 2019 consist of 12(29%) patients and the lowest in 2020 were 6(14%) patients. Most patients were >35 years old amounting 19(45%) patients, Sundanese ethnicity were 29(69%) patients, and testicular enlargement revealed in 27(64%) patients. Majority patients were in stage 0/IB 36(86%) patients and occurred in unilateral testis which 34(80%) patients, with 3(7%) patients metastasized. The most common histopathological type was seminoma 18(43%) cases followed by prepubertal-type yolk sac tumour 9(21%) patients. Seminomas, and the fibroma-thecoma group were mostly in patients over 35 years old, while prepubertal-type yolk sac tumour was more commonly in children under 15 years old. Conclusion: Prevalence of testicular tumours increased from 2017 to 2019, then started to decrease in 2020. Histopathologically, seminoma was the most common type. These tumours were most commonly found in older individuals (>35 YO) and unilateral, diagnosed in stage 0/IB, and were mostly presented with enlargement of testis. Keywords: Testicular tumours, clinical features, histopathology

Invasion risk of cutaneous squamous cell carcinoma in situ by histological subtype: a retrospective cohort study

AimsCutaneous squamous cell carcinoma in situ (SCCis) can be classified histopathologically into four subtypes: full-thickness (FT), hypertrophic actinic keratosis (HAK), Bowenoid, and acantholytic types. 3%–5% of SCCis lesions progress to...

Cervicovaginal Papanicolaou tests in transgender men: Cytomorphologic alterations, interpretation considerations, and clinical implications.

The transgender population faces unique psychosocial and physical obstacles to cervical cancer screening. Additionally, most individuals undergo masculinizing testosterone hormone therapy, and the physiologic changes can cause cytomorphologic alterations that may mimic lesions. Although the literatureon cervicovaginal cytology is growing in this patient population, it is still limited. The pathology information system was queried for all Papanicolaou (Pap) tests from transgender men from January 2013 to February 2023. The original diagnostic categories were catalogued. Cases were reviewed to evaluate the cytomorphologic alterations. Clinical data were also sought, including whether the sample was self-collected. Two comparison groups were established: one was a postpartum atrophic group and the other was an all-comer group. A total of 51 cases from 43 individuals were identified, with a mean age of 31 years. Approximately a third of cases (18 of 51; 35%) were self-collected. The abnormal rate was low, with 5.9% of cases rendered atypical squamous cells of undetermined significance on original review and no lesions identified. The Pap unsatisfactory rate according to original reports was 3.9%. This increased to 13.7% when the cases were rereviewed, which was significantly higher than the all-comer comparison group. The unsatisfactory rate did not correlate with self-collection. Atrophy was a prevalent cytomorphologic alteration, with the vast majority of cases (92%) showing at least mild atrophy. Small blue cells and transitional cell metaplasia were seen in many cases (53% and 43%, respectively). There are clinical and morphologic considerations that are distinct to the transgender patient population. Laboratory personnel and diagnosticians need to be aware of these in order to optimize patient care.

Abstract 3167: The need for structured pathology data in matching human subjects to cancer clinical trial criteria: A methodological approach

Abstract Introduction: Identification of human subjects who qualify for a cancer trial can be challenging, particularly given narrow time frames for enrollment and highly specific criteria for eligibility. We sought to identify patients on a timely basis by matching trial criteria to data present in both the Pathology and clinical information systems. In a separate abstract submitted to the AACR meeting, we described the enrollment outcomes of our effort for two clinical trials. In this companion abstract, we describe the query methods that we employed. Methods: Method #1 involved querying structured data fields in the EMR, using dashboards or SQL queries of relational databases. Method #2 utilized natural language processing (NLP) queries of narrative text in pathology reports. We assessed the useability of each query approach, on a near-real-time basis, against eligibility criteria for open clinical trials at our institution. Results: We examined the first 25 open clinical trials for treatment of solid tumors listed publicly on our institutional website. For each trial, eligibility and query criteria were compiled by two reviewers (DC,YZ); discrepancies between reviewers were resolved by a third reviewer (NY). We found that of the 33 trials examined: 26 trials (79%) could be successfully analyzed by NLP in the pathology report. 2 trials (6%) required SQL query of discrete data fields in clinical databases. 2 trials (6%) required both methods to be used together. 3 trials (9%) required data elements outside the scope of either method. The data fields provided by NLP were: tumor morphology; tumor stage; specimen margin; and tumor receptor status. The data fields provided by SQL were: ICD 10 codes, CPT codes, Chemotherapy, and quantitative lab results. The data fields not accessible by either approach were: tumor resectability and risk calculation. Conclusion: There is no single method that is best for all trials, and availability of a broad set of tools is needed to craft a fitting query for each trial. However, 26 of 33 trials (79%) required NLP to parse eligibility criteria from narrative pathology reports. Cancer clinical trials enrollment may be substantially enhanced by NLP extraction of structured data from pathology reports as part of a near-real-time workflow for identifying eligible Human Subjects. Citation Format: Nalan Yurtsever, Yonah Ziemba, Daniel A. King, Dylan J. Cooper, Sergio Garza, Cheryl B. Schleicher, Sharon S. Fox, James M. Crawford, Joseph Herman. The need for structured pathology data in matching human subjects to cancer clinical trial criteria: A methodological approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3167.

Nonsquamous Malignancies of Vagina and Vulva: 23-Year Experience at a Tertiary Center in the United Kingdom.

Under 10% of gynaecological cancers are diagnosed in the vulva and vagina, mostly squamous cell carcinomas. Melanoma, Paget disease, basal cell carcinomas, and other cancers can present with vulval/vaginal symptoms. The pathology information system of a tertiary referral center for vulvo-vaginal cancers was searched for cancers of the vulva and vagina from 1996 to 2019. Squamous carcinomas were excluded, and the remaining entities were catalogued. A total of 221 nonsquamous cancers were found, including 135 vaginal and 86 vulval cases. One hundred eight cases of metastatic carcinomas from the endometrium, cervix, ovary, bowel, bladder, kidney, and breast formed the largest category. Basal cell carcinomas constituted the second largest category. Others included melanomas, Paget disease, and adenoid cystic carcinomas. Primary adenocarcinomas included porocarcinoma, mammary type carcinoma, enteric type carcinoma, clear cell carcinoma, Bartholin gland adenocarcinoma and malignant transformation of hidradenoma papilliferum. The vulva and vagina can harbor a wide range of nonsquamous malignancies. The most challenging of these are adenocarcinomas which can be metastatic from other sites. The dominance of metastatic carcinomas in this series is likely to reflect consultation practice of specialist pathologists.

Changes in Surgical Pathology Case Volume and Amendment Rates During the COVID-19 Pandemic

ObjectivesSurgical pathology volume decreased during the peak of the coronavirus disease 2019 (COVID-19) pandemic. We looked at the 4 months with the greatest reduction in surgical pathology volume during the COVID-19 pandemic and compared them with those same months in 2019 to determine changes in specimen volume. We compared the amendment rates during those periods and types of amendments issued (identification [ID], report defect [RD], diagnostic information [DI]).MethodsAll pathology reports between March to June 2019 and March to June 2020 were extracted from the pathology information system. All amendments issued were extracted over the same period and then subclassified by two pathologists.ResultsThere was a 52.1% reduction in surgical pathology volume between the 4-month periods in 2019 and 2020 (P = .04). The amendment rate was 0.9% in 2019 compared with 1.4% in 2020, representing a 65.5% increase in amendments overall. There was a 53.3% reduction in amendments issued for ID, a 3.8% reduction in RD, and a 23.2% increase in amendments issued for DI. The change in amendments was not statistically significant.ConclusionsThese findings suggest that a reduction in workload would not improve error rates. The circumstances of the pandemic highlight the many factors contributing to error rates in surgical pathology.

A Study on the Automatic Control System for Quality Assurance of Clinical Pathology Examination Applying Machine Learning Technology

The object of research is a study on a machine learning-based integrated quality control system to provide accurate test results quickly by improving the accuracy of test results and improving the utilization rate of test equipment by analyzing clinical pathology Examination data. As for the development method for research, IEC 62304, the international standard for medical S/W life cycle used in medical software development, was applied, and the S/W life cycle rule was applied to all processors by integrating agile methodology. Random Forest, XGboost (extreme Gradient Boosting), LightGBM (Light Gradient Boosting Machine), and DNN (Deep Neural Networks) to improve Rule Check accuracy to predict abnormality of inspection results, and to monitor abnormal results in real time by rule check calculation method technique was applied. In addition, to improve user convenience, automatic control and user interface technology using a dashboard function applied with machine learning technology, and automatic interlocking interface technology for various heterogeneous inspection devices were applied. Validation and verification were conducted through a qualified testing body (TTA) to ensure reliability. The following results were found through this study. As a result of implementing a module that applied big data-based machine learning technology to the algorithm used for quality control judgment of the first knowledge-based expert system, it was possible to implement a module with more than 95% accuracy. there was. Second, in order to determine whether a real-time alarm function was provided, the development module was linked to the clinical pathology information system and as a result of the experiment, it was found that it was operating normally. In addition, reliability was secured through certification by an accredited certification body. Third, as a communication support method for the interface of the inspection equipment, stability and various technologies were secured through a number of communication tests and certification tests such as RS232C, TCP/IP, and Serial HL7. Fourth, through multiple database tests (Oracle, MSSQL, MySQL, MS Access, etc.), cost savings were secured by resolving duplicate investment by providing database neutrality and interface with other systems. Fifth, utility and user satisfaction were enhanced by providing program functions for outputting the result report in various formats and configuring the UI settings, and the UI settings were modularized to reduce the program development costs and allow the modules to be reused. Through the results of research, small and medium hospitals can improve the reliability of inspection results through the machine learning-based quality control module, and through real-time monitoring of the inspection equipment, it is possible to quickly determine whether there is a failure and improve the operation rate of the inspection equipment. In addition, by providing a module that can be linked with the existing information system, it was made easy to link, and the convenience of the user was improved by providing various UI environments. As a result, it can be expected that the hospital's competitiveness and medical service will be improved by resolving the difficulties of quality control that small and medium-sized hospitals had and providing prompt and accurate test results.

A pathology order interface based on the transmission of texts obtained from pathology requisitions and just-in-time construction of HL7 messages

BackgroundA pathology order interface using Health Level 7 standards (HL7) generally has an HL7 client program that gathers information from the clinical electronic medical record system, packages the information in the form of HL7 message, and sends the message using secure communication protocols to an HL7 interface engine located on the pathology side. We describe an alternative approach that transmits the texts obtained from requisitions, with subsequent just-in-time construction of HL7 messages. Materials and methodsThe order interface is between a dermatology clinic EMR and pathology information system. A text acquisition and processing program runs in the background in desktop computers in dermatology clinic so that a copy of pathology requisition text is obtained each time when the clinic prints a pathology requisition. Discrete elements of the data are extracted from this text, prepended to the text and saved on a shared drive within the dermatology office intranet. This text file is then transferred to pathology intranet using secure File Transfer Protocol (sFTP). Once received, an HL7 message construction program extracts the discrete data elements to construct an HL7 message. The HL7 message is then forwarded to an HL7 interface engine and entered into the pathology information system as an order. ResultsUsing an actual case as an example, the content and format of the information flowing through different steps of the interface are demonstrated. ConclusionsThe construction of such an interface does not involve the clinic EMR vendor, thus avoiding its associated cost and potential delay. This interface has advantages over our other order interfaces constructed using the conventional approach in that it does not require a change of order process and it avoids duplicate orders.

Emergency medicine: past, present, and future challenges

Emergency medicine: past, present, and future challenges

Molecular findings in bone marrow samples of myeloid sarcoma

Abstract Introduction/Objective Myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia. There are very few studies regarding molecular findings in myeloid sarcoma or their associated myeloid leukemia Methods/Case Report We evaluated cases of myeloid sarcoma with concurrent or prior bone marrow studies diagnosed as acute myeloid leukemia, from 2014 to 2021. We searched our Anatomic pathology information system for the terms ‘myeloid sarcoma’ or ‘leukemia cutis’. Out of 58 cases of myeloid sarcoma, ten had next generation sequencing studies (FoundationOne Heme) performed on bone marrow aspirate. Results-There were 7 male and 3 female patients. Age range was from 1-79 yrs. Myeloid sarcoma involved the skin (n=7) or soft tissue (n=3). Most common mutated genes were KMT2A/MLL (n=4, all translocations/fusions) followed by AXL1 (n=3), TP53 (n=3), NRAS (n=2), TET2 (n=2) and CEPBA (n=2). KMT2A fusion partners were MLLT1/ENL (n=1), MLLT3 (n=1), and MLLT10/AF10 (n=2). In all except for one case that harbored KMT2A/MLL fusions, karyotype also showed translocation of KMT2A. Only one case had both an AXL stop codon and a KMT2A translocation, otherwise AXL1/CEBPA mutated cases and KMT2A/MLL mutated cases were mutually exclusive. Other mutated genes were PHF6, BRCA2, DNMT3A, NPM1, RAD21, CBL, KMD6A, and NF1; each found in one case. Results (if a Case Study enter NA) Our result support the notion of higher risk of myeloid sarcoma in KMT2A and TP53 mutated AMLs. Except for absence of spliceosomes mutation, the incidence of mutated genes and functional categories in our series is concordance with two previously published studies. Conclusion Our result support the notion of higher risk of myeloid sarcoma in KMT2A and TP53 mutated AMLs. Except for absence of spliceosomes mutation, the incidence of mutated genes and functional categories in our series is concordance with two previously published studies.

Assessing the Prognostic Significance of Tumor-Infiltrating Lymphocytes in Patients With Melanoma Using Pathologic Features Identified by Natural Language Processing

Although tumor-infiltrating lymphocytes (TILs) are an important histopathologic characteristic reflecting host immune response in patients with melanoma, their prognostic value remains controversial. Because manual review of medical records is labor intensive, a survival analysis using a large patient cohort with comprehensive clinical and histopathologic characteristics is lacking. To assess the prognostic significance of TILs among patients with cutaneous melanoma using a large cohort established through natural language processing (NLP) algorithms. This retrospective cohort study analyzed the medical records of 14 436 patients with cutaneous melanoma at Brigham and Women's Hospital between June 1, 2004, and December 31, 2019. Patients were followed up to death or censored at their last clinical visit. The primary outcome was overall survival (OS). Survival analysis was conducted using Kaplan-Meier curves, the log-rank test, and Cox proportional hazards regression analysis. A total of 14 436 patients with cutaneous melanoma were identified in the institution's pathology information system. Using NLP, we established a study cohort of 2624 patients (1462 men [55.7%]; median age, 61 years [interquartile range, 50-72 years]) who had vertical growth phase melanoma with TIL status scored. Absent TILs were identified in 434 patients (16.5%), nonbrisk TILs in 1916 patients (73.0%), and brisk TILs in 274 patients (10.4%). The 5-year survival rate was 71.0% (95% CI, 65.5%-76.9%) among patients with an absence of TILs, 73.8% (95% CI, 71.1%-76.5%) among patients with nonbrisk TILs, and 85.2% (95% CI, 80.0%-90.7%) among patients with brisk TILs. Brisk TILs were significantly associated with improved OS (adjusted hazard ratio, 0.63; 95% CI, 0.42-0.95; P = .03; 14.2% OS advantage at 5 years), and nonbrisk TILs were not associated with improved OS (adjusted hazard ratio, 0.87; 95% CI, 0.68-1.11; P = .25), compared with the absence of TILs. This study provides evidence based on a large patient cohort from a single institution that suggests that brisk TILs represent an independent prognostic factor for OS among patients with primary cutaneous melanoma. The study also suggests that NLP is a highly efficient tool to facilitate large-scale analyses that involve free-text clinical data.

Esophagitis Dissecans Superficialis in Children.

Esophagitis dissecans superficialis (EDS) is a desquamative disorder of the superficial esophageal epithelium with variable clinical characteristics. Endoscopically, there is an appearance of superficial peeling of sheets of epithelium. Histologically there is 2-toned epithelium with coagulative necrosis of the superficial epithelium. Currently, there is paucity of data regarding this condition in children. A 10-year retrospective search of the pathology information system was performed for cases with a pathologic diagnosis of EDS in a tertiary care pediatric center. Demographic data, clinical history, endoscopic findings, and histopathologic reports were reviewed. Thirteen patients (9 girls; ages 3-18 years), were identified with histologic findings of EDS. Esophageal food impaction, dysphagia, vomiting, and abdominal pain were the most common presenting symptoms. Sixty-nine percentage of the patients had underlying comorbidities and 76% were on at least 1 medication chronically. Eosinophilic esophagitis (23%), inflammatory bowel disease (23%), and gastroesophageal reflux disease (GERD) (15%) were the most common associated diagnoses. Of the 13 patients, 5 had repeat endoscopies showing complete resolution of EDS with no complications. EDS is an under-recognized entity that endoscopists should be familiar with. In our series, the most prevalent associations were with food impaction and eosinophilic esophagitis (EoE). Contact injury and/or inflammation may precede the development of EDS. Pediatric EDS appears to be an incidental finding without significant morbidity or mortality.

FP07.14 Implementation of a Lung Biopsy Histology Protocol Supports Successful Cancer Biomarker Testing

Non-small cell lung cancer (NSCLC) management increasingly relies on biomarker testing, which presents a logistical challenge for utilization of lung biopsy specimens beyond routine diagnosis. Appropriate allocation of tissue from small biopsies is critical in order to permit for accurate histologic diagnosis while preserving tissue for ancillary studies such as PD-L1 testing and next generation sequencing (NGS). International surveys show that satisfaction with molecular testing is less than ideal, driven in part by inadequacy of formalin-fixed paraffin embedded (FFPE) tumor tissue for biomarker testing in over a quarter of clinical cases by some reports. We developed a histology protocol (LUNGCOR) that generates multiple unstained FFPE slides up front in order to increase tissue yields for pathologic diagnosis and ancillary testing. We examined the efficacy of this protocol in regards to molecular testing success rates. Biopsy samples (e.g. transbronchial or fine needle biopsies) were flagged for the LUNGCOR protocol based on a clinical indication of "lung mass" or need for genomics. Proceduralists were requested to prospectively specify when samples were obtained for the purposes of biomarker testing. Per protocol, after embedding, 2 H&E slides with 18 intervening 4-micron unstained FFPE slides were prepared and reserved for immunohistochemistry or molecular studies. We performed a retrospective review of consecutive LUNGCOR specimens within the pathology information system and electronic medical record to determine the usage patterns for the unstained slides and success rates of molecular testing. This analysis is restricted to the first 2 years (2015-2016) following protocol initiation. 300 specimens were designated for the LUNGCOR protocol in this time period. Of these specimens, 84% resulted in a malignant diagnosis and 175 (58%) were non-squamous NSCLC. Of these, 87 (50%) of NSCLC underwent molecular profiling of some kind, either in house NGS, single gene PCR assays, or send-out NGS. For cases undergoing in house next generation sequencing (447-gene panel), 61 of 69 (88%) cases generated complete genotyping for all required and emerging biomarkers for targeted therapy. Sequencing failures were most commonly due to inadequate tumor content in the biopsy specimen, rather than inadequate size of the overall sample. Generation of unstained slides during upfront histologic processing of known or suspected NSCLC increases availability of tissue for molecular testing and reduces risk of sample inadequacy due to specimen loss during routine handling steps, such as "refacing" the block. This straightforward process improvement can improve the yield of invasive biopsies for essential biomarker testing and contribute to improved patient outcomes.

Semantically Interoperable Oncology Information System - Oncology 4.0

Realizing the possibilities of eHealth will depend on the capacity to share information across time and space. Multiple actors, systems, machines, and organizations must seamlessly and unambiguously communicate. Therefore, we created a semantically interoperable oncology information system (Oncology 4.0). The objective of the Oncology 4.0 project was to validate the technology framework for oncology information management. We developed a system around four loosely coupled modules: shared meta-thesaurus, dynamic form creator, Fast Healthcare Interoperability Resources (FHIR) RestFull Application Programming Interface, and semantic engine. To validate the technology, we have created a cohort of synthetic head and neck cancer patients. We have described a single patient with 1432 data points, which represents clinical, pathological, genomic, treatment, and workflow data. The data collection instruments, forms, documents, and interfaces were created while respecting the FHIR framework. We have assigned random values to each variable while respecting data from the literature (median and standard deviation for a continuous variable, frequencies of occurrence for categorical variables). To test the real-world scenario, we changed the document structure in 10% of the patient, we have exchange synthetic patient data with the radio-oncology treatment planning system (ROTPS), and we have exchange data with a pathology information system (PIS). We have successfully created 10.000 in-silico head and neck cancer patients. Every data point was accessible through the FHIR interface and defined within shared thesaurus entry. We have achieved bi-directional intra-institutional data exchange with ROTPS and inter-institutional data exchange with PIS. We were capable to dynamically change the content of the clinical documentation without endangering the underlying database model. We have overcome significant technical barriers and demonstrated semantical interoperability between disparate healthcare systems. Further steps will include solving problems on the political and functional interoperability level.

Emerging clinical role of pivmecillinam in the treatment of urinary tract infections caused by Extended Spectrum βeta-lactamase (ESBL) producing Enterobacteriaceae.

Extended Spectrum βeta-lactamase (ESBL)-producing Enterobacteriaceae causing urinary tract infections (UTIs) appear resistant to many common oral agents. There is a growing need to discover new antibiotics to combat with emerging antibiotic resistance problem. Until the discovery of new antimicrobials, we can bring back forgotten antibiotics to our clinical formulary. Pivmecillinam (prodrug of mecillinam), an oral antimicrobial agent is effective against ESBL producing organisms. We analysed the sensitivity rates of ESBL-producing Enterobacteriaceae from urine samples to mecillinam and to document if pivmecillinam is a suitable alternative option in the treatment of UTI. This retrospective study was conducted from September 2015 to September 2017. Data were collected from the pathology information system. Antimicrobial sensitivity testing on ESBL-producing Enterobacteriaceae isolates was carried out by disc diffusion method in accordance with The European Committee on Antimicrobial Susceptibility Testing. A total of 986 ESBL-producing Enterobacteriaceae were tested for mecillinam during the study period. Of 986 organisms, Escherichia coli was the most common organism (889); followed by Klebsiella species (71) and others Enterobacteriaceae (26). Mecillinam sensitivity was found in 96% Escherichia coli (855/889 isolates), 83% Klebsiella species (59/71 isolates) and 88% other Enterobacteriaceae (23/26 isolates). Overall 95% (935/986 isolates) of ESBL-producing urinary isolates were sensitive to mecillinam. Pivmecillinam appears to be suitable option to treat ESBL-producing Enterobacteriaceae causing uncomplicated UTI. Our results showed low resistance rate to mecillinam. We recommend the use of pivmecillinam in uncomplicated UTIs because of ESBL-producing Enterobacteriaceae. More studies on in vitro activity of mecillinam against ESBL producing organism and its use and clinical outcome should be tried in future.

Benign disease prone to be misdiagnosed as malignant pulmonary nodules: Minute meningothelioid nodules.

BackgroundThe lung is one of the most common target organs for malignant tumor metastasis. The existence of lung metastasis may have a decisive effect on the choice of treatment regimen. Minute pulmonary meningothelial‐like nodules (MPMNs) usually present as ground‐glass opacity or solid nodules, mimicking the imaging findings of malignant pulmonary nodules. This study summarizes the clinical, radiological, and pathological features of MPMNs to distinguish them from malignant pulmonary nodules.MethodsThe Guangdong Lung Cancer Institute Pathology Information System was searched using the key words “minute meningothelioid nodules” and “lung.” Patients who underwent pulmonary resection from 23 February 2009 to 31 May 2017 were included in the study. The 11th edition of Rosai and Ackerman's Surgical Pathology was used to confirm the diagnosis. The clinical, imaging, and pathological characteristics of MPMNs were recorded.ResultsTwelve patients had MPMNs. MPMNs were associated with cancerous or precancerous lesions (10/12), female gender (11/12), and non‐smokers (11/12). Four patients were misdiagnosed with malignant pulmonary nodules before surgery. Positron emission tomography‐computed tomography revealed an increased maximum standardized uptake value in one patient. Immunohistochemistry identified eight specimens positive for vimentin, EMA, and PR and negative for TTF‐1 and CK.ConclusionsMPMNs tend to coexist with malignant tumors, mimicking the imaging findings of malignant pulmonary nodules, thus resulting in misdiagnosis. Dynamic monitoring or an invasive examination may help to distinguish MPMNs from malignant lesions.

Computational Algorithms that Effectively Reduce Report Defects in Surgical Pathology

Background: Pathology report defects refer to errors in the pathology reports, such as transcription/voice recognition errors and incorrect nondiagnostic information. Examples of the latter include incorrect gender, incorrect submitting physician, incorrect description of tissue blocks submitted, report formatting issues, and so on. Over the past 5 years, we have implemented computational algorithms to identify and correct these report defects. Materials and Methods: Report texts, tissue blocks submitted, and other relevant information are retrieved from the pathology information system database. Two complementary algorithms are used to identify the voice recognition errors by parsing the gross description texts to either (i) identify previously encountered error patterns or (ii) flag sentences containing previously-unused two-word sequences (bigrams). A third algorithm based on identifying conflicting information from two different sources is used to identify tissue block designation errors in the gross description; the information on actual block submission is compared with the block designation information parsed from the gross description text. Results: The computational algorithms identify voice recognition errors in approximately 8%–10% of the cases and block designation errors in approximately 0.5%—1% of all the cases. Conclusions: The algorithms described here have been effective in reducing pathology report defects. In addition to detecting voice recognition and block designation errors, these algorithms have also be used to detect other report defects, such as wrong gender, wrong provider, special stains or immunostains performed but not reported, and so on.

Mucormycosis Among Children with Hematological Malignancies Is Associated with High-Risk Acute Lymphoblastic Leukemia and Is Often Salvageable

Mucormycosis has emerged as an increasingly important infection in patients with hematological malignancies, and is associated with considerable morbidity and mortality. However, contemporary data concerning epidemiology and outcome in children is lacking. Here we report a nationwide multicenter study of mucormycosis among children with hematological malignancies.Between the years 2004-2017, 1136 Israeli children aged ≤18 years with acute leukemias (acute lymphoblastic leukemia (ALL)-941; acute myeloid leukemia (AML)-195) were prospectively enrolled on a centralized clinical registry. Fungal infections, including mucormycosis, were prospectively and retrospectively captured. In addition, all 7 pediatric hematology centers were required to search hospital medical records, microbiology databases, and pathology information systems for cases of mucormycosis. Following central revision, 39 cases of mucormycosis were identified.Patient characteristics: Median age at mucor diagnosis: 13.5 years. Underlying diseases: ALL-27, AML-9, other-3. In 24 patients mucormycosis occurred during frontline therapy of their disease, and in 15 patients at relapse. Known risk factors included stem cell transplantation (SCT)-13 (33%), severe neutropenia-33 (85%) and corticosteroids-26 (67%). Among 20 patients on frontline ALL therapy, mucormycosis was diagnosed during induction in 13 cases, reinduction-6 cases, consolidation-1 case. Twenty-five patients with mucormycosis were enrolled on the national acute leukemia registry (not included: other malignancies, non-Israeli patients, relapsed leukemia with primary diagnosis preceding registry initiation, secondary AML). An analysis of registry cases demonstrated that the incidence of mucormycosis did not significantly increase during the study period. There was no seasonal clustering. Mucormycosis was significantly more common among patients ≥10 years old (4% vs 1%, p=0.004). Among patients on frontline treatment, mucormycosis was significantly more common in high-risk (HR) ALL patients (6%) than in non-HR (1%) or AML (1%) patients (p=0.001).Mucormycosis: Patterns of infection included sinusitis/sino-orbital-16 (41%), rhinocerebral-8 (21%), pulmonary-3 (8%), mandibular -4 (10%), gastrointestinal-1, cutaneous-1, otomastoiditis-1, disseminated-6 (15%). The majority (46%) were caused by Rhizopus spp. EORTC criteria: proven-30, probable-7, possible-2 (pathognomonic radiological findings and molecular diagnosis).Treatment: Nineteen patients were treated with amphotericin B formulations only and 19 received combined antifungal treatment. Nine patients received step-down treatment with posaconazole/ isavuconazole. In addition, 33 patients underwent surgical interventions, 26 underwent 2 procedures or more (range 2-14). Median time from presentation to antifungal treatment-3 days.Outcome: Twenty-one patients died, 15 of mucormycosis, 3 of other toxicities, 3 of leukemia. Factors significantly associated with mortality from mucormycosis were preceding SCT (p=0.01), less than 2 surgical interventions (p=0.0003) and relapsed disease (p=0.006). Eight-year OS of the whole cohort, those on frontline therapy and relapsed patients was 42% (±21%), 70%(±13%), 13%(±66%), respectively. Eight-year cumulative incidence of death from mucormycosis (CIDM) in those subgroups was 40%(±8), 21%(±8), 67% (±13), respectively.To our knowledge, this is the largest population-based study of mucormycosis in children with hematological malignancies. Our study demonstrates that mucormycosis is an age-dependent toxicity, significantly more common in patients ≥10 years of age. A striking finding was the high incidence of mucormycosis among patients on frontline high-risk ALL therapy, a fact which may reflect the increasing intensity of childhood ALL treatment. In a cohort of 24 patients who developed mucormycosis on frontline therapy, including 2 patients with AML and 13 with HR-ALL, 8y-OS was 70% and 8y-CIDM was 21%.The majority of patients in this cohort were salvageable through control of underlying disease, rapid instigation of antifungal treatment, and surgical debridement procedures, albeit in some cases at a price of mutilation and long-term sequelae. Future research should focus on the complex interactions between fungi and host, and on developing novel therapeutic strategies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Late Breaking Abstracts.

Late Breaking Abstracts.