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Cytopathology ; 33(1): 23-38, 2022 01.
Article in English | MEDLINE | ID: covidwho-1799272


Lung cancer is a leading cause of cancer mortality worldwide but recent years have seen a rapidly rising proportion of cases of advanced non-small cell carcinoma amenable to increasingly targeted therapy, initially based on the differential response to systemic treatment of tumours of squamous or glandular differentiation. In two-thirds of the cases, where patients present with advanced disease, both primary pathological diagnosis and biomarker testing is based on small biopsies and cytopathological specimens. The framework of this article is an overview of the technical aspect of each stage of the specimen pathway with emphasis on maximising potential for success when using small cytology samples. It brings together the current literature addressing pre-analytical and analytical aspects of specimen acquisition, performing rapid onsite evaluation, and undertaking diagnostic and predictive testing using immunocytochemistry and molecular platforms. The advantages and drawbacks of performing analysis on cell block and non-cell block specimen preparations is discussed.

Carcinoma, Non-Small-Cell Lung , Carcinoma , Lung Neoplasms , Biomarkers, Tumor/metabolism , Carcinoma/pathology , Carcinoma, Non-Small-Cell Lung/pathology , Humans , Lung/pathology , Lung Neoplasms/pathology
Chest ; 160(6): e645-e650, 2021 12.
Article in English | MEDLINE | ID: covidwho-1544869


CASE PRESENTATION: A 30-year-old man with a history of childhood asthma, a 15-pack-year smoking history, and methamphetamine abuse was intubated and started on mechanical ventilation because of acute hypoxic respiratory failure after experiencing progressive dyspnea and a nonproductive cough over the previous year. During the previous 3 months, he had multiple clinic visits, with chest radiographs showing diffuse, bilateral, reticulonodular opacities and small bilateral pleural effusions and was treated for community-acquired pneumonia. Testing for COVID pneumonia was negative, and he failed to respond to antimicrobial therapy. Physical examination on admission showed diffuse fine crackles bilaterally on lung auscultation. Admission laboratory test results were unremarkable.

Adenocarcinoma/diagnosis , Carcinoma/diagnosis , Lung Neoplasms/diagnosis , Lymphangitis/diagnosis , Adenocarcinoma/pathology , Adrenal Gland Neoplasms/secondary , Adult , Biomarkers, Tumor/analysis , Carcinoma/pathology , Diagnosis, Differential , Dyspnea , Fatal Outcome , Humans , Lung Neoplasms/pathology , Lymphangitis/pathology , Lymphatic Metastasis , Male , Neoplasm Invasiveness , Tomography, X-Ray Computed
ORL J Otorhinolaryngol Relat Spec ; 83(1): 47-51, 2021.
Article in English | MEDLINE | ID: covidwho-817876


The novel coronavirus (SARS-CoV-2) pandemic has influenced the timeliness of care for patients with both common and rare conditions, particularly those affecting high-risk operative sites such as the upper aerodigestive tract. Sinonasal undifferentiated carcinoma (SNUC) represents a rare malignancy of the sinonasal tract, a unique subset of which has never been previously reported in the otolaryngology literature and is characterized by inactivation of the SMARCB (INI-1) tumor suppressor gene. This subtype exhibits a particularly poor prognosis and is characterized pathologically by its rhabdoid appearance. Here we present the case of an individual who was diagnosed with a sinonasal mass during the SARS-CoV-2 pandemic, which was ultimately found to be SMARCB (INI-1)-deficient sinonasal carcinoma. Advanced imaging was deferred in the interest of limiting the patient's exposure to the virus, and expedited operative management was performed which facilitated prompt referral for adjuvant chemoradiation. The SARS-CoV-2 pandemic presents unique challenges, but the work-up of high-risk lesions must be prioritized; this continues to be paramount as SARS-CoV-2 resurges in many cities across the USA.

COVID-19/epidemiology , Carcinoma/diagnosis , Carcinoma/surgery , Maxillary Sinus Neoplasms/diagnosis , Maxillary Sinus Neoplasms/surgery , Biopsy , Carcinoma/pathology , Chemoradiotherapy, Adjuvant , Diagnosis, Differential , Endoscopy , Female , Humans , Maxillary Sinus Neoplasms/pathology , Middle Aged , SARS-CoV-2 , Tomography, X-Ray Computed