Browsing by Author "Bruce-Brand, C."

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    Cystic partially differentiated nephroblastoma-like lesion following neoadjuvant chemotherapy for nephroblastoma : a case report and review of the literature
    (Elsevier, 2020) Bruce-Brand, C.; Reyes-Mugica, M.; Van Zyl, A.; Schubert, P. T.
    Cystic partially differentiated nephroblastoma (CPDN) and cystic nephroblastoma are paediatric renal tumours characterised by the presence of a variable combination of primitive epithelium, immature stroma and blastema. Cystic nephroblastoma can be identified by the presence of solid expansile areas of tumour which are absent in CPDN. The distinction can pose diagnostic difficulty pre-operatively and is of paramount importance as their metastatic potential, prognosis and hence therapeutic strategies differ. We present a 2 year old girl, with two right renal masses, diagnosed pre-operatively as synchronous nephroblastoma based on clinical, radiological and cytologic findings. Neo-adjuvant chemotherapy was administered followed by nephrectomy. Two discrete tumours were present, one being an epithelial predominant nephroblastoma and the other a CPDN. The CPDN showed an unusual spectrum of epithelial cells lining the cysts including intestinal type epithelium with goblet cells. This case represents one of three cases described thus far in the literature of concomitant nephroblastoma and CPDN or cystic nephroma (CN) and is the only case in which nephroblastoma occurred synchronously with CPDN. Due to neo-adjuvant therapy being instituted for the nephroblastoma, this case provides unique insights into possible chemotherapy induced changes in a CPDN (usually treated by surgical excision alone). This case highlights several important issues in paediatric cystic renal neoplasms, particularly the distinction between cystic nephroma, CPDN and cystic nephroblastoma. The differential diagnosis of cystic paediatric renal neoplasms is broad and requires appropriate clinical, radiological and histological assessment, often with ancillary immunohistochemical and molecular studies to arrive at a correct diagnosis. Histologic features of chemotherapy effect, although well-described in nephroblastoma, are not well-described in CPDN. Based on our knowledge of possible chemotherapy induced changes in nephroblastoma, such as maturation of epithelial and stromal elements that may be so marked as to mimic mature teratoma, we hypothesize that this case demonstrates such changes within a CPDN.
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    Postmortem lung biopsies from four patients with COVID-19 at a tertiary hospital in Cape Town, South Africa
    (Health & Medical Publishing Group, 2020-10-19) Bruce-Brand, C.; Allwood, B. W.; Koegelenberg, C. F. N.; Lalla, U.; Louw, E.; Diacon, A. H.; Schubert, P. T.
    Background. An outbreak of a novel coronavirus in China in late 2019 has resulted in a global pandemic. The virus (SARS-CoV-2) causes a severe acute respiratory syndrome and had been responsible for >14 000 deaths in South Africa (SA) at the time of writing, 30 August 2020. Autopsies in our setting have not been prioritised owing to the infective risks for staff, resulting in a lack of information on the histopathology of the disease in the SA setting. Postmortem biopsies are relatively quick and easy to perform and reduce the infective risk posed by full autopsies. Objectives. To determine whether postmortem biopsies of lung tissue could be used to determine cause of death in lieu of full autopsies in patients dying from COVID-19. Methods. We performed postmortem biopsies of lung tissue on 4 patients with SARS-CoV-2 confirmed by reverse transcriptase polymerase chain reaction who died in the Tygerberg Hospital (Cape Town, SA) intensive care unit (ICU) in June - July 2020, in order to determine their cause of death. The biopsies were performed in the ICU with the necessary personal protective equipment within 2 hours after death. Clinical information was obtained from the hospital records and the histopathology was reviewed by two consultant histopathologists. Microbiology and electron microscopy were also performed on this tissue. Results. All 4 patients were aged >50 years and had multiple comorbidities. Pulmonary pathology was present in only 3 cases, and the findings were surprisingly heterogeneous. One case demonstrated several findings including diffuse alveolar damage, extensive fibrin thrombi in pulmonary arteries with pulmonary infarction, organising pneumonia and bronchopneumonia. Other findings included type 2 pneumocyte hyperplasia, intra-alveolar macrophages and squamous metaplasia. An organising pneumonia was present in 2 other cases, although these findings were not deemed to be severe enough to be the cause of death. Fibrin thrombi were present in pulmonary arteries of 3 cases. One case showed no significant acute pulmonary pathology. The cause of death could only be determined in 1 case. Conclusions. The pulmonary findings we observed are in keeping with those described in the international literature. However, the pathology was surprisingly heterogeneous between cases, and was only deemed severe enough to be the cause of death in 1 of 4 cases. While lung-targeted, standardised postmortem biopsies may be safe, easy to perform and provide useful insights into the disease, they are not suitable to replace full autopsies in determining cause of death.