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Sclerosing haemangiomas should be considered in the differential diagnosis of cystic pulmonary masses. They may also present histologically as combined tumours and metastasize to mediastinal nodes, indicating an, albeit low, malignant potential. TTF-1 is a valuable antibody in identifying the presence of a sclerosing haemangioma when typical features are absent.

Nuclear grading system for epithelioid malignant pleural mesothelioma (MPM) has been proposed but 2 it remains uncertain if they could be applied in a biopsy-heavy setting. Using the proposed system, we 3 conducted an independent, external validation study using 563 consecutive cases of epithelioid MPM 4 diagnosed at our institution between 2003 and 2017, of which 87% of patients underwent biopsies 5 only. The median number of sites sampled was 1, with median maximum tissue dimension of 17mm 6 (Biopsy) and 150mm (Resection). The median overall survival (OS) was 14.7 months. The 7 frequencies of Grade I, II and III tumors were 31% (132/563), 52% (292/563) and 17% (94/563). 8Grade I tumors were associated with the most favorable median OS (24.7 months) followed by grade 9 II (12.7 months) and III (7.2 months). 2-tier nuclear grade separated tumors into low grade (19.3 10 months) and high grade (8.9 months). In multivariate analysis, 3-tier nuclear grade, 2-tier nuclear 11 grade and mitosis-necrosis score predicted OS independent of age, procedural type, solid-predominant 12 growth pattern, necrosis and atypical mitosis (all p<0.001 except 2-tier nuclear grade, p=0.001). In the 13 scenario of a single site biopsy with tissue dimension less than or equal to 10mm, none but age 14 (p=0.002) were independently predictive. Our data also suggested sampling 3 sites or a maximum 15 tissue dimension of at least 20mm from a single site is optimal for nuclear grade assessment. In 16 conclusion our study confirmed the utility of nuclear grade in epithelioid MPM using a biopsy-heavy 17 cohort provided the tissue sample met minimum dimensional criteria.

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Background: SARS-CoV-2 has challenged health service provision worldwide. This work evaluates safe surgical pathways and standard operating procedures implemented in the high volume, global city of London during the first wave of SARS-CoV-2 infection. We also assess the safety of minimally invasive surgery(MIS) for anatomical lung resection. Methods: This multicentre cohort study was conducted across all London thoracic surgical units, covering a catchment area of approximately 14.8 Million. A Pan-London Collaborative was created for data sharing and dissemination of protocols. All patients undergoing anatomical lung resection 1st March-1st June 2020 were included. Primary outcomes were SARS-CoV-2 infection, access to minimally invasive surgery, post-operative complication, length of intensive care and hospital stay (LOS), and death during follow up. Findings: 352 patients underwent anatomical lung resection with a median age of 69 (IQR: 35À86) years. Self-isolation and pre-operative screening were implemented following the UK national lockdown. Pre-operative SARS-CoV-2 swabs were performed in 63.1% and CT imaging in 54.8%. 61.7% of cases were performed minimally invasively (MIS), compared to 59.9% pre pandemic. Median LOS was 6 days with a 30-day survival of 98.3% (comparable to a median LOS of 6 days and 30-day survival of 98.4% pre-pandemic). Significant complications developed in 7.3% of patients (Clavien-Dindo Grade 3À4) and 12 there were re-admissions(3.4%). Seven patients(2.0%) were diagnosed with SARS-CoV-2 infection, two of whom died (28.5%). Interpretation: SARS-CoV-2 infection significantly increases morbidity and mortality in patients undergoing elective anatomical pulmonary resection. However, surgery can be safely undertaken via open and MIS approaches at the peak of a viral pandemic if precautionary measures are implemented. High volume surgery should continue during further viral peaks to minimise health service burden and potential harm to cancer patients. Funding: This work did not receive funding.