Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future

Background

This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases.

Materials and methods

A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019.

Results

Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples.

Conclusions

The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe.

•

Biosafety measures used in the first wave of the COVID-19 crisis were heterogeneous in 53 European pathology laboratories.

•

A dramatic decrease of the workload in pathology laboratories was noted.

•

No case of healthcare workers contaminated with SARS-CoV-2 associated with samples handling was identified.

[Intramural intestinal hematoma--a complication of the oral anticoagulant therapy]

AIM

The presentation of a rare complication of oral anticoagulant treatment involving abdominal surgery.

MATERIAL AND METHOD

A 59 years old patient who received oral anticoagulant treatment with Warfarine for repeated episodes of thrombosis of the lower limbs, suddenly develops an occlusive abdominal simptoms, which did not submit under conservative treatment. Biologically the clotting times were modified and the abdominal CT showed lesions of the first jejunal loop.

RESULTS

During surgery an amount of blood was found in abdominal cavity and a large haematoma of the first jejunal loop which required resection. The postoperative evolution was simple with discharge in the 12th day, surgically cured.

CONCLUSIONS

1. Intramural intestinal haematoma is a rare, but possible complication of the oral anticoagulant treatment. 2. Precise diagnosis is possible, avoiding unnecessary surgical intervention because the complication is treatable using conservative therapy. 3. Surgical intervention is required in case of a sudden onset, imprecise diagnosis and unfavorable evolution which could point associated intraabdominal lesions.

[Intestinal stromal tumors, rare cause of lower gastrointestinal bleeding. Case report]

Gastrointestinal stromal tumors represent a heterogeneous group of mesenchymal tumors that can develop throughout the gastrointestinal tract. We present the clinical case of a patient with such malignancies occurred in the proximal jejunum and clinically manifested by a severe digestive hemorrhage with hemorrhagic shock and severe posthemorrhagic anemia. Pre-operative diagnosis was possible only through the Entero-MRI. The evolution was favorable after surgical extirpation. It's being discussed particular aspects of this lesion's entity and post-operative optimal attitude in this case.

Granular cell tumor of the penis shaft: case report and literature review

INTRODUCTION

Granular cell tumors (GCT) are uncommon soft tissue neoplasms of presumed neural origin that rarely involve the male external genitalia. Penile lesions are distinctly uncommon with less than 20 cases reported till now.

OBJECTIVE

In the present paper we describe the clinicopathological and immunohistochemical findings in a case of GCT of the penis shaft in a 31-years-old man.

RESULTS AND CONCLUSIONS

On physical examination the patient was found to have a small ovoid mass, 20 x 10 mm in diameter, at the left postero-lateral area of the penis' base. The mass was firm on palpation with no fixation on the neighboring tissues. The lesion was completely excised under loco-regional anesthesia. The surgical specimen was an ovoid, gray-white, elastic mass, of 10 x 5 mm. Microscopically, the tumor was moderately cellular and was composed of polygonal-shaped cells with abundant granular eosinophilic cytoplasm. Tumor cells were disposed in nests, cords, and trabeculae and showed perineural invasion. The tumor presented bland cytological features with only focal slight nucleo-megaly. Mitotic activity was undetectable. The tumor cells showed diffuse immunohistochemical expression for S100 protein. At 6 month after surgery the patient was free of persistent/recurrent disease or metastatic spread of the tumor. We discuss the clinical, histo-immunohistochemical and therapeutical features of this unusual penile tumor, the single one encountered in the Department of Pathology from Timisoara County Hospital and, to our knowledge, the only one reported in the Romanian medical literature.

[An unusual splenic tumor. Littoral cell angioma]

Littoral cell angioma is a rare splenic tumor which develops from specialised endothelial cells of the splenic red pulp. Numerous papers published since 1991 when the tumor was firstly described till now were focused on the radiologic characteristics of the lesion. This paper presents the clinical, imaging and morpho-immunohistochemical features of a littoral cell angioma diagnosed in a 51 year - old woman, to our knowledge, the first documented case in the Romanian medical literature. The lesion might be suspected on the basis of the clinical and imaging signs, but the diagnosis of certitude is provided by the gross and microscopic examination supplemented with immunohistochemical methods.

Immunohistochemical expression of prostate specific antigen (PSA) in benign and malignant tumors of the prostate

The immunohistochemical (IHC) expression of PSA in tissue fragments has been analysed in 25 patients with benign prostatic hypertrophy (BPH) and in 50 patients with prostatic carcinoma. The fragments were obtained by transurethral resection and transvesical adenomectomy. Morphology was studied by hematoxylin-eosin and Gömöri's trichrome staining. For immunohistochemical study anti-PSA monoclonal antibodies (DAKO, EPOS) were used. In BPH cases a positive reaction in the cytoplasm of secretory luminal cells was noticed; the reaction was negative in basal and urothelial cells, in foci of squamous metaplasia and in the cells of mucous gland metaplasia. All the classic types of prostatic carcinoma, regardless of the degree of differentiation showed positive reaction with various intensity and distribution. A positive focal reaction was noticed in two ductal carcinomas of endometrioid type. The reaction was negative in transitional, epidermoid and small cell carcinoma. Though less useful in differentiating benign from malignant lesions, this method may contribute to the differential diagnosis of particular forms of prostatic tumors.

Prognostic significance of neuroendocrine differentiation in carcinoma of the prostate

Biopsies taken by core-needle biopsy and/or transurethral resection to 68 patients with prostatic neoplasia stage III and IV, were studied morphohistochemically. Morphological observations showed high incidence of mixed histopathological forms. The Churukian-Schenk and Garvey silver impregnations were used in order to identify associated neuroendocrine differentiations. Three cases presented monomorphic small cell proliferation which contained numerous argyrophilic cytoplasmic granulations. The prognosis in these cases was poor--the patients died because of neoplastic extension within 5 to 9 months following diagnosis. Neuroendocrine cells were identified in 15 cases, 6 of which presented a malignant pattern. Taking into consideration the hormonal resistance of malignant cells with argyrophilic granulations, the necessity of chemotherapy associated to hormonotherapy is discussed.

Clinical evaluation of four tumor markers in malignant and benign pleural effusions

Total sialic acid (TSA), lipid-bound sialic acid (LSA), ferritin and carcinoembryonic antigen (CEA) were evaluated in 55 patients with malignant pleural effusions and in 32 patients with benign (exudative) pleural effusions. No significant differences were found in the pleural fluid TSA, LSA and ferritin levels between malignant and benign conditions. CEA levels in malignant effusions were significantly higher than those in benign effusions (43.13 +/- 72.8 ng/ml versus 2.6 +/- 5.56 ng/ml, p less than 0.01). At a cut-off level of 5 ng/ml, 60% of the patients with cancer showed elevated pleural fluid CEA levels. The specificity and diagnostic accuracy of CEA in distinguishing malignant from benign pleural exudates were both very high (91% and 71% respectively). Therefore, of the four markers investigated, only CEA could be a valuable tool in the detection of pleural malignancy.

Five tumor markers in lung cancer: significance of total and "lipid"-bound sialic acid

Total sialic acid (TSA) and "lipid-bound" sialic acid (LSA) were evaluated in comparison to carcinoembryonic antigen (CEA) and ferritin and neuron specific enolase (NSE) in 152 untreated patients with primary lung cancer, 107 benign pulmonary disease patients and 207 notmal controls. The mean concentrations of TSA, LSA and CEA in lung cancer patients, were significantly higher than in benign and normal controls (p less than 0.001), while the mean ferritin and NSE levels were significantly higher than in normal controls only (p less than 0.001). At the designated cut-off serum levels, sensitivities of the five markers for lung cancer were in decreasing order: TSA 86.5% (greater than 80 mg/dL), LSA 77% (greater than 20 mg/dL), CEA 46.4% (greater than 5 ng/mL), ferritin 36% (greater than 300 ng/mL) and NSE 34.5% (greater than 12.5 ng/mL). Using the benign pulmonary values as negative controls the specificity of each marker was as follows: CEA 88%, ferritin 72%, NSE 58%, TSA 44% and LSA 44%. In small cell lung cancer (SCLC) patients, NSE mean concentrations and sensitivity were significantly higher than in non-small lung cancer (NSCLC) patients (9.63 +/- 4.4 versus 23.54 +/- 16.9, p less than 0.001 and 74% versus 21.4% respectively). While in NSCLC patients only CEA levels correlated well with the stage of the disease, in SCLC patients concentrations of TSA, LSA and ferritin were significantly higher in extensive than in limited disease stages. These preliminary data suggest that, although TSA and LSA are highly sensitive markers in lung cancer, their specificity is low.