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Since the beginning of COVID-19 pandemic in late 2019, the symptoms and signs detailed in the medical literature and the media concentrated on the effect of causative virus SARS-COV-2 on the respiratory tract, the coagulopathy associated with severe forms of the disease and the febrile flu like illness in the mild cases. The widespread publicising of the symptoms has been one of the important public health measures in combatting the rapid spread of COVID-19. Less known is the direct or indirect effect of COVID-19 on the skin and underlying soft tissue. Recognising the various cutaneous manifestations may prove a useful tool in early detection and management of COVID-19.

Staging Methods KM curves

Dual stain example

p16 OS KM curves

Scoring Method

Consort diagram

Patient: Male, 48-year-old Final Diagnosis: Intranodal palisaded myofibroblastoma Symptoms: Inguinal lump Medication: — Clinical Procedure: Lumpectomy Specialty: Pathology • Surgery Objective: Rare disease Background: Benign tumors of the lymph nodes are rare and are not usually considered in the differential diagnosis in cases of lymphadenopathy because reactive hyperplasia, lymphoma, and metastatic carcinoma are the most likely causes of enlarged nodes. Intranodal palisaded myofibroblastoma (IPM) is a very rare benign mesenchymal tumor of the lymph nodes most often affecting but not limited to the inguinal region, with up to 92 cases reported in the English literature. The cell of origin is the intranodal differentiated smooth muscle cell or myofibroblast. Although the pathophysiology of IPM remains unclear, theories about viral oncogenesis and mutational changes in the β-catenin gene with subsequent abnormal expression of β-catenin and cyclin D1 have been raised. Case Report: We report a case of IPM in a 48-year-old man who presented with a mass in the left groin, with inconclusive imaging. The typical histologic findings of smooth muscle actin, cyclin D1, and β-catenin positive intranodal spindle cell proliferation with characteristic palisades, amianthoid fibers, collagenous bodies, lack of atypia, and very low mitotic count, together with characteristic profile on ancillary testing, confirmed the diagnosis. In addition to staining with smooth muscle actin, cyclin D1 and β-catenin, immunohistochemical studies showed focal positivity with desmin, a finding previously reported in 2 of the published cases. Surgical excision is usually curative, with a 6% recurrence rate and no reported cases of locally aggressive disease or malignant transformation. Conclusions: Although rare, IPM should be included in the differential diagnosis of isolated lymphadenopathy.

Granuloma annulare (GA) is a granulomatous inflammatory largely cutaneous and less often subcutaneous condition with varied presentations ranging from localized to disseminated forms manifesting as erythematous papules or plaques affecting all ages and primarily involving the extremities. GA may affect other sites such as the face and cases limited to the orbit and ear are exceedingly rare. No consistent causative factor has been identified although there is an established association with diabetes mellitus, autoimmune diseases, infections, malignancies or localized trauma. The chief histological pattern of palisaded or interstitial granulomatous reaction is diagnostic, providing infections such as mycobacterium have been excluded. Standardized treatment is elusive and different modalities including local/intralesional steroids, cryo/photo/laser therapy or oral retinoids/antibiotics have been used with variable response. We report two cases of GA limited to the ear adding to the 13 previously published cases.

Human papilloma virus–positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) represents a distinct subgroup of head and neck cancers associated with clinical outcomes that are not accurately categorized by existing tumor–node–metastasis-based staging methods. Given the significant impact of immune parameters, such as tumor-infiltrating lymphocytes (TIL) in many cancers, we sought to determine if immunophenotyping tumors can improve categorization of HPV+ OPSCCs for prognostic purposes. In a cohort of 190 patients with HPV+ OPSCC, we quantified and determined the localization of CD8+ TILs, as well as PD-L1–expressing tumor cells (TC) and immune cells (IC). The prognostic significance of these parameters on overall survival (OS) was evaluated, and their contribution to existing prognostic models was determined. High CD8+ TIL abundance (≥30% on stromal or intratumoral ICs) was seen in 61.3% patients and was associated with improved OS [HR, 0.4; 95% confidence interval (CI), 0.2–0.9; P = 0.017]. Although the expression of PD-L1 on TC was not prognostic, high expression of PD-L1 on ≥5% of intratumoral ICs was found in 38.5% patients and was significantly associated with improved OS (HR, 0.37; 95% CI, 0.15–0.93; P = 0. 023). Both high intratumoral IC PD-L1 expression and abundant CD8+ TILs in HPV+ OPSCCs identify subgroups of patients with excellent outcomes and provide additional prognostic information beyond existing staging systems. Cancer Immunol Res; 6(3); 295–304. ©2018 AACR.

Human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV

Aim: To carry out a nationwide study of KRAS testing in metastatic colorectal cancer as reported by nine major molecular pathology service providers in Australia, including mutation frequencies and turnaround times that might impact on patient care. Methods: Participating laboratories contributed information on KRAS mutation frequencies, including the G13D mutation type, as well as turnaround times for tumor block retrieval and testing. Results: The KRAS mutation frequency observed by nine different test sites for a total of 3688 metastatic colorectal cancers ranged from 34.4% to 40.7%, with an average across all sites of 38.8%. The average frequency of the G13D mutation type among all cases was 8.0%. The median turnaround time was 17 days (range 0-191), with 20% of cases requiring more than 4 weeks for a KRAS test result. The major contributor to long turnaround times was the time taken to retrieve archived blocks of primary tumor, particularly from sources external to the test site. Conclusion: The frequency of KRAS mutations in metastatic colorectal cancer reported by the major Australian test sites is very similar to that reported by other large overseas studies. More widespread introduction of routine testing at the time of initial diagnosis should eliminate the long turnaround times currently being experienced in a significant proportion of cases. Future expansion of testing to include other KRAS and NRAS mutation hotspots may spur the introduction of next-generation sequencing platforms.

Background Giant luteinized follicle cyst is a recently recognized cause of ovarian enlargement during pregnancy and the puerperium. Only rare cases of this clinical condition have been reported in the literature, and the cytologic features have not been previously described. Case A 34-year-old, pregnant woman presented at 10 weeks' gestation with a large, right ovarian cyst. Clinical management was initially conservative, but four weeks later the patient presented with acute abdominal pain. At laparotomy, the ovarian cyst was aspirated and a cystectomy performed. On cytologic examination, the presence of a luteinized follicle cyst of pregnancy was suggested. Subsequent histologic examination confirmed the diagnosis. Conclusion This case illustrates the clinicopathologic features of a luteinized follicle cyst of pregnancy with special emphasis on the cytologic characteristics. The cytologic features are sufficient to establish the diagnosis in conjunction with the ultrasonographic appearance.

This study aimed at investigating which source of social support (supervisors, colleagues, friends, spouse, family) would be most effective in reducing burnout among school counsellors. A sample of 90 counsellors (47 males and 43 females) completed Burnout and Source of Social Support questionnaires. Pearson correlation coefficients and ANOVA were employed to analyze data. Results revealed significant positive correlations between family support, colleague support, and personal accomplishment. Demographic variables: sex, age, marital status, and counselling experience were not significantly related to any of the three burnout dimensions. Results were interpreted and implications for counselling were suggested.

To carry out a nationwide study of KRAS testing in metastatic colorectal cancer as reported by nine major molecular pathology service providers in Australia, including mutation frequencies and turnaround times that might impact on patient care.Participating laboratories contributed information on KRAS mutation frequencies, including the G13D mutation type, as well as turnaround times for tumor block retrieval and testing.The KRAS mutation frequency observed by nine different test sites for a total of 3688 metastatic colorectal cancers ranged from 34.4% to 40.7%, with an average across all sites of 38.8%. The average frequency of the G13D mutation type among all cases was 8.0%. The median turnaround time was 17 days (range 0-191), with 20% of cases requiring more than 4 weeks for a KRAS test result. The major contributor to long turnaround times was the time taken to retrieve archived blocks of primary tumor, particularly from sources external to the test site.The frequency of KRAS mutations in metastatic colorectal cancer reported by the major Australian test sites is very similar to that reported by other large overseas studies. More widespread introduction of routine testing at the time of initial diagnosis should eliminate the long turnaround times currently being experienced in a significant proportion of cases. Future expansion of testing to include other KRAS and NRAS mutation hotspots may spur the introduction of next-generation sequencing platforms.

Introduction and background Mature cystic teratoma is the most common ovarian germ cell neoplasm and childhood ovarian tumour. Malignant change in a mature cystic teratoma is rare. Most common malignancy arising in a teratoma is squamous cell carcinoma. Only 32 cases of a malignant melanoma arising in a mature cystic teratoma have been reported in the world literature to date. Clinical presentation A 37-year-old female presented with a recent history of lower back pain. X-ray showed a tooth like structure in the right ovary. Ultrasound revealed features of a dermoid cyst. She underwent surgical excision of the dermoid cyst. Methods, Macroscopic and microscopic features: Macroscopy A 50 mm cyst, containing greasy yellow material and hair shafts. Two nodules noted within the cyst wall, a 35×26×26 mm fatty nodule centred by a misshapen tooth and an intramural 16×10mm pigmented nodule. Microscopy A mixture of skin and skin appendages, conjunctival lining, fibroadipose tissue and mature neural elements. The pigmented nodule consisted of a whorled proliferation of melanocytes exhibiting pronounced cellular pigmentation and moderate cyto-logical atypia. The final diagnosis was malignant melanoma arising in a mature cystic teratoma confirmed by S100, HMB45, Melan A, Perl’s stain, Schmorl’s stains. Peritoneal washings cytology no malignant cells. Discussion This is a rare change in a relatively common benign entity that can be easily overlooked. It emphasises how distinction between a benign or borderline melanocytic proliferation and a malignant melanoma can be challenging. The importance of adequate sampling and use of immunohistochemistry techniques is revealed. Moreover, previous data supports a role for chemotherapy. This case has had the best outcome reported in the literature despite no additional chemotherapy.