Browsing by Author "Schubert, P. T."
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- ItemThe current aetiology of malignant pleural effusion in the Western Cape Province, South Africa(Health & Medical Publishing Group, 2018-04) Koegelenberg, C. F. N.; Bennji, S. M.; Boer, E.; Schubert, P. T.; Shaw, J. A.; Allwood, Brian W.; Irusen, E. M.Background: Malignant pleural effusion (MPE) represents a very common cause of pleural exudates, and is one of the most challenging pleural disorders to manage. This could be attributed to the paucity of high-quality experimental evidence, and inconsistent practice worldwide. South Africa (SA) currently has no data regarding the aetiology of MPE. Objectives: To identify the most common malignancies causing MPE in a population served by a large tertiary hospital in SA, and specifically the relative contribution of mesothelioma. A secondary objective was to evaluate the efficacy of chemical pleurodesis in a subset of patients. Methods: We retrospectively included all known cases of MPE evaluated at our institution over a 3-year period with a tissue diagnosis of MPE. Results: The most common causes of MPE in a total of 274 patients were lung cancer (n=174, 63.5%), breast cancer (n=32, 11.7%), unknown primary (n=22, 11.7%) and mesothelioma (n=27, 9.9%). Talc pleurodesis was performed in 81 of 194 patients (41.8%) referred to our division, and was radiologically successful in 22 of 25 (88.0%) followed up to 3 months. Conclusions: The main cause of MPE in our setting was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE in this population.
- ItemCystic 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.
- ItemAn evaluation of the diagnostic adequacy and immunocytochemistry of manual liquid-based smears in breast aspirates(Medpharm Publications, 2013) Shibemba, A. L.; Wright, C. A.; Bezuidenhout, J.; Schubert, P. T.The aim of this study was to determine if the Syner-Med®/Cell-Solutions® liquid-based cytology (LBC) technique would provide adequate diagnostic material when applied to breast fine-needle aspiration biopsy (FNAB) specimens and to determine its suitability for immunocytochemistry. A prospective study was undertaken of 38 consecutive patients who underwent FNAB of breast masses in the Fine Needle Aspiration Clinic at Tygerberg Hospital, Cape Town, over a period of six months. Conventional smear cytology slides (CSC) were formulated and the material that remained in the needle was used to prepare the LBC Syner-Med®/Cell-Solutions® slides. The CSC and LBC slides were evaluated by two pathologists. The assessed parameters were cellularity, background and representative diagnostic material. Immunocytochemical stains for pancytokeratin (MNF-116) and oestrogen receptor were performed in each case. In 33 cases (87%), LBC compared favourably with CSC. Adequacy rates of 84.2% for CSC and 76.3% for LBC were found. A diagnosis was made in 78.9% of the CSC cases and in 71% of the LBC cases. The LBC slides showed excellent results, with immunocytochemical staining for MNF-116 and oestrogen receptor. The Syner-Med®/Cell-Solutions® LBC fixative and preparation method provides an alternative technique for obtaining well fixed and prepared slides that are suitable for diagnostic cytology and immunocytochemistry.
- ItemThe initial impact of the COVID-19 pandemic on the diagnosis of new cancers at a large pathology laboratory in the public health sector, Western Cape Province, South Africa(Health & Medical Publishing Group, 2021) Van Wyk, A. C.; De Jager, L. J.; Razack, R.; Van Wyk, S. S.; Kleinhans, W.; Simonds, H. M.; Schubert, P. T.Background. The COVID-19 pandemic has disrupted cancer diagnostic services. A decline in the number of new cancers being diagnosed over a relatively short term implies a delay in diagnosis and subsequent treatment. This delay is expected to have a negative effect on cancerrelated morbidity and mortality. The impact of the pandemic on the number of new cancer diagnoses in our setting is unknown. Objectives. To assess the impact of COVID-19 on the number of new cancers diagnosed at our institution in the first 3 months following the implementation of lockdown restrictions, by focusing on common non-cutaneous cancers. Methods. A retrospective laboratory-based audit was performed at a large anatomical pathology laboratory in Western Cape Province, South Africa. The numbers of new diagnoses for six common cancers (breast, prostate, cervix, large bowel, oesophagus and stomach) from 1 April 2020 to 30 June 2020 were compared with the corresponding period in 2019. Results. Histopathological diagnoses for the six cancers combined decreased by 193 (–36.3%), from 532 new cases in the 2019 study period to 339 in the corresponding period in 2020. Substantial declines were seen for prostate (–58.2%), oesophageal (–44.1%), breast (–32.9%), gastric (–32.6%) and colorectal cancer (–29.2%). The smallest decline was seen in cervical cancer (–7%). New breast cancers diagnosed by cytopathology declined by 61.1%. Conclusions. The first wave of the COVID-19 pandemic and the associated response resulted in a substantial decline in the number of new cancer diagnoses, implying a delay in diagnosis. Cancer-related morbidity and mortality is expected to rise as a result, with the greatest increase in mortality expected from breast and colorectal cancer.
- ItemPostmortem 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.
- ItemThe value of histopathology of the placenta in a tertiary referral hospital in South Africa(Health and Medical Publishing Group, 2019) Malusi, Z.; Schubert, P. T.; Theron, G. B.; Wright, C. A.Background. Unexplained intrauterine death (IUD) remains the most common cause of perinatal death in babies of <1 000 g in South Africa (SA). Information from examination of the placenta subsequent to an adverse perinatal outcome is often underutilised and placental histology can contribute to determining the cause of perinatal death and other adverse outcomes in many instances. Objectives. To correlate placental histopathology with the clinical indication for submission and to demonstrate the value of placental histopathology in understanding adverse perinatal outcomes. Methods. We reviewed 2 years’ singleton placental histology reports at a tertiary academic hospital in the Western Cape, SA. All samples were from placentas of >24 weeks’ gestation. Results. The total sample (N=822) comprised 60.9% live-birth placentas and 39.1% IUD placentas. In the IUD group, the cause of death was clinically unexplained in 55.9% of cases. Histopathology identified in this group included chorioamnionitis (CA) (34.5%), maternal vascular malperfusion (32.1%), abruptio placentae (31.5%), delayed villous maturation (17.8%) and toxoplasmosis, other agents, rubella, cytomegalovirus and herpes simplex (TORCH) infections (6.1%), most commonly syphilis. No pathology was found in only 2% of IUD cases. Among live births, preterm labour accounted for 41.9% of placental submissions, of which the cause was unknown in 46.2% of cases. Clinically indicated and histologically defined CA was poorly correlated. Conclusion. This study demonstrates the value of placental histopathology in cases of adverse perinatal outcome.