Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Cytodiagnosis of Castleman′s disease: A diagnostic challenge

Castleman′s disease (CD) is an uncommon cause of solitary or multiple lymphadenopathy, which may be a target for fine-needle aspiration (FNA). Because of its rarity and lack of adequate literature available on its cytomorphological findings, the condition is misdiagnosed or missed out during routine FNA reporting. The presence of small lymphocytes and plasma cells with large atypical binucleate follicular dendritic cells resembling Reed-Sternberg cells may raise a suspicion of Hodgkin lymphoma (HL). Here, we report the cytodiagnosis and pitfalls in the diagnosis of CD in three cases. FNA smears were reviewed and pitfalls in the diagnosis analyzed and correlated with histopathological findings

Usefulness and significance of morphological criteria with regard to Gleason grade in the diagnosis of adenocarcinoma prostate

Objectives: 1. To study Gleason grade and sum. 2. To study the morphological criteria and their significance. 3. To correlate morphological features with Gleason pattern. Materials and Methods: We studied 411 prostatic specimens, 342 benign and 69 neoplastic cases which were received over a period of two years duration at our Institution. The neoplastic cases were further categorized for occurence of the important morphological criteria with regard to Gleason Grade. Results: Out of the 69 cases of adenocarcinoma prostate, 3 cases were well differentiated adenocarcinoma (Gleason sum 2-4), 35 cases were moderately differentiated adenocarcinoma (Gleason sum 5-7) and 31 cases were poorly differentiated adenocarcinoma (Gleason Sum 8-10). Nucleomegaly was seen in 73%, prominent nucleoli in 60.8%, amphophilic cytoplasm in 19%, intraluminal crystalloids in 62%, collagen micronodules in 36%, chronic inflammation in 64%, perineural invasion in 91%, tumour infiltration was seen in 76%, retraction clefting in 66% cases and necrosis in 49% of the cases. Conclusion: Perineural invasion, Infiltrative pattern and Necrosis have significant correlation with higher Gleason Sum. Morphologically nucleomegaly, nucleolar changes, amphophilic cytoplasm and collagenous micronodules are important additional features which help in clinching the diagnosis

Primary umbilical endometriosis - Diagnosis by fine needle aspiration

Primary (spontaneous) umbilical endometriosis is very rare with an estimated incidence of 0.5-1% of all patients with endometrial ectopia. Endometriosis is a common gynecological condition, the pelvis being the most common site of the disease. Extrapelvic site is less common and even more difficult to diagnose due to the extreme variability in presentation. A 38-year-old woman presented with a blackish nodule over the umbilicus of 3 years duration. Fine needle aspiration cytology of the lesion showed cells in clusters and sheets with background of scant stromal fragment, hemosiderin laden macrophages and RBCs, leading to a suggestion of umbilical endometriosis. Histopathological examination of the excised lesion confirmed the same

A clinicohematological evaluation of pancytopenia in a tertiary care hospital in South India

Objective: The aim of this study is to study the incidence of the underlying etiology of pancytopenia presenting at our institution with a clinical and hematological correlation. Materials and Methods: A prospective study of 12 months′ duration was carried out, which included patients of all age groups. Of the 60 patients presenting with pancytopenia, bone marrow aspiration and biopsy were done on 30 cases, after taking an informed consent. Patients who had received previous blood transfusion and were on chemo- and radiotherapy were excluded. A detailed clinical examination of all cases was carried out. Results: The most common etiology of pancytopenia in our study was normoblastic erythroid hyperplasia (30%), followed by megaloblastic anemia (20%). This was followed by acute myeloid leukemia (13.3%) and closely by micronormoblastic erythroid maturation (10%) and miscellaneous etiologies. Conclusion: The varied causes of pancytopenia can be attributed to the geographic area, genetic differences, stringency of diagnostic criteria, and differences in the methodology used. There are varying trends in its clinical pattern, treatment modalities, and outcomes. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Thus, identification of the correct cause will help in implementing the appropriate therapy

Influence of dengue endemicity on malaria identification by automated hematology analyzer – Beckman Coulter LH750: A hospital-based cross-sectional study

Aim: Automated hematology analyzers have been used to develop indices and algorithms for diagnosing malaria. We believe that the practical utility of such indices depends on the infection profile in the community since the type of infection determines the hematological parameters and consequently their power to discriminate malaria. Our region is endemic for malaria and dengue. Our aim was to verify the utility of the published malaria factor (MF) in our setting. Materials and Methods: Anticoagulated blood from clinically suspected cases of malaria and dengue were analyzed. The standard deviation and mean (M) values of all the leukocytes were obtained and the MF was calculated. Results: The MF showed a sensitivity and specificity of 75% and 55.1% in identifying malaria at a cutoff of 4.2 when the control group (CG) included dengue-positive (DP) patients and a sensitivity and specificity of 93.4% and 65.2% when the CG did not include DP cases. Using another set of parameters, we developed a Malaria Discriminant Index which showed a sensitivity and specificity of 94.4% and 73.9% in identifying malaria in the absence of dengue at a cutoff of 1.19 and a sensitivity and specificity of 85.5% and 61.7% at a cut off of 1.26 when dengue patients were included in the CG. Conclusion: This study emphasizes the need to verify the utility of indices/factors developed in regions not having similar endemic profiles before utilizing them in the clinical setting as other infections can influence the discriminant capacity