ObjectivesTo estimate the proportion of children who die with chronic conditions and examine time trends in childhood deaths involving chronic conditions.DesignRetrospective population-based death cohort study using linked death certificates and hospital discharge records.SettingEngland, Scotland and Wales.ParticipantsAll resident children who died aged 1–18 years between 2001 and 2010.Primary and secondary outcome measuresThe primary outcome was the proportion of children who died with chronic conditions according to age group and type of chronic condition. The secondary outcome was trends over time in mortality rates involving chronic conditions per 100 000 children and trends in the proportion of children who died with chronic conditions.Results65.4% of 23 438 children (95% CI 64.8%, 66.0%) died with chronic conditions, using information from death certificates. This increased to 70.7% (95% CI 70.1% to 71.3%) if hospital records up to 1 year before death were also included and was highest (74.8–79.9% depending on age group) among children aged less than 15 years. Using data from death certificates only led to underascertainment of all types of chronic conditions apart from cancer/blood conditions. Neurological/sensory conditions were most common (present in 38.5%). The rate of children dying with a chronic condition has declined since 2001, whereas the proportion of deaths affected by chronic conditions remained stable.ConclusionsThe majority of children who died had a chronic condition. Neurological/sensory conditions were the most prevalent. Linkage between death certificate and hospital discharge data avoids some of the under-recording of non-cancer conditions on death certificates, and provides a low-cost, population-based method for monitoring chronic conditions in children who die.

BackgroundInjuries are an increasingly important cause of death in children worldwide, yet injury mortality is highly preventable. Determining patterns and trends in child injury mortality can identify groups at particularly high risk. We compare trends in child deaths due to injury in four UK countries, between 1980 and 2010.MethodsWe obtained information from death certificates on all deaths occurring between 1980 and 2010 in children aged 28 days to 18 years and resident in England, Scotland, Wales or Northern Ireland. Injury deaths were defined by an external cause code recorded as the underlying cause of death. Injury mortality rates were analysed by type of injury, country of residence, age group, sex and time period.ResultsChild mortality due to injury has declined in all countries of the UK. England consistently experienced the lowest mortality rate throughout the study period. For children aged 10 to 18 years, differences between countries in mortality rates increased during the study period. Inter-country differences were largest for boys aged 10 to 18 years with mortality rate ratios of 1.38 (95% confidence interval 1.16, 1.64) for Wales, 1.68 (1.48, 1.91) for Scotland and 1.81 (1.50, 2.18) for Northern Ireland compared with England (the baseline) in 2006–10. The decline in mortality due to injury was accounted for by a decline in unintentional injuries. For older children, no declines were observed for deaths caused by self-harm, by assault or from undetermined intent in any UK country.ConclusionWhilst child deaths from injury have declined in all four UK countries, substantial differences in mortality rates remain between countries, particularly for older boys. This group stands to gain most from policy interventions to reduce deaths from injury in children.

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Cutaneous myoepithelial neoplasms are a heterogenous group of neoplasms with mixed tumors typically affecting the head and myoepitheliomas showing a predilection for the extremities. Their malignant counterparts, myoepithelial carcinoma, and malignant mixed tumor are exceptionally rare in the skin, and the morphologic criteria for malignancy are only poorly defined. The aim of the present study was to characterize the clinicopathologic features of myoepithelial neoplasms presenting on acral skin. The clinical and histopathologic features of 11 tumors were recorded, and follow-up was obtained. Immunohistochemistry was performed for S100, SOX10, glial fibrillary acidic protein, keratins, epithelial membrane antigen, p63, p40, smooth muscle actin, desmin, and PLAG1. The tumors mainly affected the feet of adults (range: 26 to 78 y; median: 47 y) with a predilection for the great toe and a male predominance of 1.8:1. Most tumors (91%) displayed a lobular architecture composed of solid and nested growth of epithelioid cells with plasmacytoid features in a myxoid or angiomatous stroma. Scattered cytologic atypia and rare duct differentiation were frequently noted. Three tumors with confluent cytologic atypia, infiltrative growth, and lymphovascular invasion were classified as malignant. By immunohistochemistry, the tumors were positive for S100, SOX10, keratins AE1/AE3, CK5/6 and CK7, and PLAG1. Local recurrence and bilateral pulmonary metastasis were observed in a patient presenting with a histopathologically benign-appearing tumor. Two patients with malignant tumors experienced local recurrences, and 1 developed metastasis to soft tissue, lung, and mediastinal lymph nodes. All patients are currently alive, all but 1 with no evidence of disease after a median follow-up interval of 96 months (range: 2 to 360 mo). In conclusion, acral myoepithelial neoplasms show distinctive and reproducible histopathologic and immunohistochemical features. They are best regarded as a distinctive subset of mixed tumors with features reminiscent of their salivary gland counterparts. While most tumors pursue a benign disease course, histopathologic features appear to be a poor indicator of prognosis.

Aims Trichoblastic carcinomas (malignant trichoblastomas) are rare and poorly documented neoplasms characterised by malignant transformation of a pre‐existing benign trichoblastoma, and are subdivided histologically into low‐grade and high‐grade tumours. Whereas morphologically low‐grade trichoblastic carcinomas show indolent behaviour, morphologically high‐grade trichoblastic carcinomas have been associated with a poor prognosis, but little is known about their true biological potential. The aim of this study was to better define the clinicopathological features and outcomes of morphologically high‐grade trichoblastic carcinomas. Methods and results Four high‐grade trichoblastic carcinomas were retrieved from departmental files, and the clinical and histopathological features and follow‐up were recorded. The tumours presented as nodules on the scalps, necks and shoulders of adults (median age, 40 years; range, 30–55 years) with a female predominance of 3:1. Three patients had a longstanding history with recent change. Histologically, three tumours were characterised by an expansile cellular nodule composed of sheets of pleomorphic epithelioid cells with brisk mitotic activity and necrosis arising in a background of a benign trichoblastoma. One tumour showed a more gradual transition from a benign trichoepithelioma to an undifferentiated carcinoma with infiltrative growth and perineural infiltration. All patients were alive with no evidence of recurrence or metastasis following complete excision after a median follow‐up of 96 months (range, 30–180 months). Conclusions The correct diagnosis of high‐grade trichoblastic carcinoma relies on adequate sampling and recognition of the benign trichoblastic precursor lesion, i.e. trichoblastoma or trichoepithelioma. Despite the concerning histological features of the malignant component, the tumours appear to be less aggressive than previously thought.