Research Articles (Anatomical Pathology)

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    Endobronchial masses encountered on fine-needle aspiration biopsy : a focus on unusual entities
    (2020-04-24) Aldera, Alessandro P.; Schubert, Pawel T.
    Fine-needle aspiration biopsy (FNAB) is a useful technique in the evaluation of central lung tumors which is commonly encountered in clinical cytology practice. Some of these tumors may show endobronchial, polypoid growth which is readily apparent to the endoscopist. Pulmonary salivary gland-type tumors and carcinoid tumors are overall uncommon in the lung, but these tumors tend to occur centrally and show endobronchial involvement. The prognosis of these tumors is generally better than that of small cell or non-small cell carcinomas of the lung and more conservative surgical resection is often indicated. The identification of salient cytological features and a high index of suspicion when considering the differential diagnosis of a central lung tumor is essential to accurate diagnosis. This review focuses on cytological clues as well as ancillary techniques that may be useful to the practicing cytopathologist.
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    Effusion cytology of a mucinous borderline ovarian tumour : Pitfall or controversy? a case report with insight into the newly proposed international system for reporting serous fluid cytology
    (Wiley, 2021-11) Razack, Rubina; Mohosho, Mokoena Martins; Barnardt, Pieter; Schubert, Pawel Tomasz
    A case report of effusion cytology of a mucinous neoplasm is illustrated. The authors share their insight into adapting the newly proposed international system for reporting serous fluid cytology.
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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.
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    The 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.
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    Unusual presentation of atrial myxoma : a case report and review of the literature
    (International Scientific Information, 2021) Jaravaza, Diana Rufaro; Lalla, Usha; Zaharie, Stefan Dan; De Jager, Louis Johann
    BACKGROUND: Although rare, atrial myxoma is the most common benign cardiac tumor. The recognized triad of presenting symptoms relates to constitutional, embolic, and obstructive effects produced by the tumor. However, the presentation may be non-specific and mimic other diseases, confounding diagnosis. CASE REPORT: A middle-aged woman presented with wheezing and shortness of breath. With a strong background smoking history, the initial impression was that of acute bronchospasm. She however deteriorated rapidly, with decreased consciousness and cardiac arrest requiring resuscitation. Despite intensive care management, she died within 1 day of admission. Autopsy revealed a previously undiagnosed left atrial myxoma with coronary and systemic embolization. CONCLUSIONS: This case highlights an unusual presentation of atrial myxoma, resulting in fatal simultaneous embolization to the coronary and cerebral arteries. This simultaneous embolic presentation is not common, but the potential consequences are serious. This report also demonstrates that the presentation of a left-sided atrial myxoma with cardiac asthma can mimic respiratory disease and confound diagnosis. In adult patients without a history of chronic respiratory disease, the possibility of cardiac asthma should always be entertained. Furthermore, the importance of considering atrial myxoma as a cause for cardiac asthma is emphasized. The use of transthoracic echocardiogram in aiding the rapid diagnosis of atrial myxoma is recommended. Finally, the continued acknowledgement of the important contribution the academic autopsy makes in complementing and improving clinical practice remains imperative.