Evolution of anatomic pathology workload from 2011 to 2019 assessed in a regional hospital laboratory via 574,093 pathology reports.

Objective: Quantify changes in workload in relation to the anatomic pathologist workforce.

Methods: In house pathology reports for cytology and surgical specimens from a regional hospital laboratory over a nine- year period (2011-2019) were analyzed, using custom computer code. Report length for the diagnosis+microscopic+synoptic report, number of blocks, billing classification (L86x codes), billings, national workload model (L4E 2018), regional workload model (W2Q), case count, and pathologist workforce in full-time equivalents (FTEs) were quantified.

A Challenging Case of Mammary Analogue Secretory Carcinoma: Case Study with Ultrastructural and Cytogenetic Correlation.

Mammary analogue secretory carcinoma (MASC) is a rare salivary gland tumor analogous to secretory carcinoma of the breast. The diagnosis of MASC can be challenging due to substantial morphologic and immunohistochemical similarities with other salivary gland tumors. The differential diagnosis of MASC is broad and includes intraductal carcinoma, acinic cell carcinoma, and adenocarcinoma, not otherwise specified.

Immunohistochemistry Use by Diagnostic Category and Pathologist in 4477 Prostate Core Biopsy Sets Assessed at Two Hospitals.

Background: Immunohistochemistry (IHC) use in prostate cores is not routinely determined and its value assessed.

Methods: Pathology reports for cases accessioned 2011 to 2017 at two hospitals were retrieved. IHC orders by pathologist and hospital were extracted with a custom program and tabulated.

Next Generation Quality: Assessing the Physician in Clinical History Completeness and Diagnostic Interpretations Using Funnel Plots and Normalized Deviations Plots in 3,854 Prostate Biopsies.

Background: Observational data and funnel plots are routinely used outside of pathology to understand trends and improve performance.

Objective: Extract diagnostic rate (DR) information from free text surgical pathology reports with synoptic elements and assess whether inter-rater variation and clinical history completeness information useful for continuous quality improvement (CQI) can be obtained.

Methods: All in-house prostate biopsies in a 6-year period at two large teaching hospitals were extracted and then diagnostically categorized using string matching, fuzzy string matching, and hierarchical pruning.

Endocrine Mucin-Producing Sweat Gland Carcinoma, a Histological Challenge.

Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is a rare adnexal tumor of the skin with low-grade cytological features and neuroendocrine differentiation. It has a predilection for the skin of the eyelid, but has also been reported in the face and rarely extra-facial locations. The tumor is seen more frequently in women and on average affects the elderly.

A Case of Patch Stage of Kaposi's Sarcoma and Discussion of the Differential Diagnosis.

A 55 year old HIV positive male had a skin lesion biopsy which showed atypical vascular proliferation within the superficial and deep dermis with mild atypia of lining endothelial cells. A sparse lymphoplasmacytic infiltrate surrounding the irregular vascular channels was noted. Immunohistochemistry highlighted the atypical blood vessels with the vascular markers CD31, CD34 and Factor VIII.

Amelanotic Melanoma Presenting with Plasmacytoid Morphology and BRAF V600 Mutation.

Plasmacytoid melanoma is an unusual variant of malignant melanoma. The plasmacytoid morphology can be found in a variety of other malignancies including carcinomas, plasma cell neoplasms, lymphoproliferative disorders, and sarcomas. The authors report a rare case of plasmacytoid amelanotic malignant melanoma in a 78-year-old man presenting with an enlarging palpable, erythematous mass on his left posterior shoulder.

Cutaneous collagenous vasculopathy: a new case series with clinicopathologic and ultrastructural correlation, literature review, and insight into the pathogenesis.

Cutaneous collagenous vasculopathy (CCV) is a rare distinct idiopathic microangiopathy of the superficial cutaneous vasculature. Seven new cases are reported (6 females and 1 male) ranging in age from 42 to 85 years, with some showing unusual clinical and histopathological findings. All presented with macular telangiectases starting on the lower extremities and spreading progressively in 5 cases and were suspected to have generalized essential telangiectasia.

Cutaneous lymphadenoma: a rare case and brief review of a diagnostic pitfall.

We report a case of cutaneous lymphadenoma on the posterior left ear of a 67-year-old woman. Although it is benign, recognition of cutaneous lymphadenoma is important as it presents a diagnostic pitfall to the unsuspecting dermatologist and general surgical pathologist, who may readily misdiagnose the lesion because it is not only very rare, but also clinically and histologically resembles the far more common and locally destructive basal cell carcinoma.

Primary cutaneous versus salivary gland origin mucoepidermoid carcinoma.

Mucoepidermoid carcinoma (MEC) is a malignant glandular epithelial neoplasm that most commonly arises in the major salivary glands. Primary cutaneous MEC is very rare. There is a particular diagnostic challenge in determining the primary site of MEC when it is found in skin overlying the parotid gland.

Cutaneous collagenous vasculopathy associated with intravascular occlusive fibrin thrombi.

Cutaneous collagenous vasculopathy (CCV) is a rare cutaneous microangiopathy that clinically resembles generalized essential telangiectasia with only 12 cases reported to date. The perivascular fibrosis is thought to be due to production of abnormal collagen by veil cells in the outer vessel walls as a result of unknown factors. This report is of an 84-year-old male with progressive telangiectasia.

Lymphoepithelioma-like carcinoma of the skin: case report and approach to surgical pathology sign out.

Lymphoepithelioma-like carcinoma of the skin (LELCS) is a rare and poorly differentiated variant of squamous cell carcinoma. The lesion is histologically identical to undifferentiated nasopharyngeal carcinoma (lymphoepithelioma), but with Epstein-Barr virus involvement documented rarely. The first case of LELCS was described in 1988 by Swanson et al.

Radiology-pathology conference: neutrophilic fasciitis and panniculitis of the feet (Sweet's syndrome).

Sweet's syndrome is characterised by pyrexia, cutaneous lesions, neutrophilia and an infiltrate of mature neutrophils in the dermis. While extracutaneous disease is not uncommon, neutrophilic fasciitis has rarely been described. We report the imaging appearances with clinical and histological correlation of a case of drug-induced neutrophilic fasciitis in a 56-year-old man.

CD99 expression in Merkel cell carcinoma: a case series with an unusual paranuclear dot-like staining pattern.

Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine cancer of the skin. The utility of CD99 (MIC-2) in the diagnosis of MCC has been previously studied, with reported rates of expression ranging from 13 to 55%. When specified, a membranous or cytoplasmic staining pattern was considered significant.

Cutaneous presentation of post-renal transplant lymphoproliferative disorder: a series of four cases.

We report detailed histological and molecular characteristics of four post transplant lymphoproliferative disorders (PTLD) presenting in the skin of renal transplant patients, and their clinical outcome. Three had B-cell lymphomas (cases 1-3), and one had a T-cell lymphoma (case 4). All B-cell lymphomas showed Epstein-Barr virus (EBV) by immunohistochemistry (IHC) or in situ hybridization (ISH).

Skin thickening in a hemodialysis patient: a case of nephrogenic fibrosing dermopathy.

Background: Nephrogenic fibrosing dermopathy (NFD), a rare fibrosing condition of the skin, occurs in patients with renal failure. Worldwide, 215 cases have been reported, but none of them are from Canada.

Case Report: A 71-year-old woman with hypertensive vasculopathy and renal failure, hypothyroidism, deep vein thrombosis, and a previous abdominal aneurysm repair presented with the rapid development of indurated skin over her arms and legs.

Sebaceoma of the external ear canal: an unusual location. Case report and review of the literature.

Sebaceous neoplasms of the external ear canal are extremely rare. Only two cases of sebaceous neoplasms have been reported in the English literature, a sebaceous carcinoma and a sebaceous adenoma. We report a case of sebaceoma of the external ear canal.

Primitive nonneural granular cell tumor (so-called atypical polypoid granular cell tumor). Report of 2 cases with immunohistochemical and ultrastructural correlation.

Primitive nonneural granular cell tumors (so-called atypical cutaneous granular cell tumors) were first described in 1991, followed by few case reports, and 2 recent larger series. We report here 2 additional cases in 2 women aged 73 and 74, who presented with 0.6- and 0.

Miliarial gout (a new entity).

Background: Tophaceous gout typically presents as a subcutaneous, nodular collection of monosodium urate crystals sharply circumscribed from surrounding tissues. Although intradermal cutaneous manifestations of gout have been described, no reported cases of miliarial gout remain.

Objective: We describe the first known presentation of miliarial gout and list other uncommon cutaneous manifestations of gouty tophi.

An unusual cause of refractive chronic bilateral leg ulceration.

Background: Ulceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg.