When used together SS18-SSX fusion-specific and SSX C-terminus immunohistochemistry are highly specific and sensitive for the diagnosis of synovial sarcoma and can replace FISH or molecular testing in most cases Aims: Synovial sarcoma is defined by recurrent t (X;18)(p11;q11) translocations creating SS18-SSX1, SS18-SSX2 or SS18-SSX4 fusions. Recently, a novel rabbit monoclonal antibody designed to identify these fusions (SS18-SSX, clone E9X9V) was proposed to be highly specific (100%), but not completely sensitive (95%) for this diagnosis. Another antibody designed to identify the C-terminal end of SSX (SSX_CT, clone E5A2C) was proposed to be highly sensitive (100%), but not completely specific (96%). We sought to validate these antibodies in an independent cohort. Methods and results: We performed immunohistochemistry for SS18-SSX and SSX_CT on 39 synovial sarcoma samples from 25 patients with confirmed gene rearrangements. Thirty-four (87%) and 36 (92%) were positive for SS18-SSX and SSX_CT, respectively. Falsenegative staining was associated with suboptimally handled small biopsies and decalcified specimens, even when staining was diffuse and strong in subsequent optimally processed excisions and non-decalcified areas. None of 580 non-synovial sarcoma tumours (76 whole sections, 504 TMA samples) were positive for SS18-SSX (100% specificity), whereas 39 (93% specificity) were positive for SSX_CT. Conclusions: SS18-SSX fusion-specific IHC is 87-95% sensitive for the diagnosis of synovial sarcoma and highly (perhaps perfectly) specific. Therefore, positive SS18-SSX staining definitively confirms the diagnosis of synovial sarcoma. SSX_CT is less specific (93-96%) but highly sensitive (92%, but approaching 100% when suboptimally processed biopsies and decalcified specimens are excluded). Negative SSX_CT staining may therefore have an ancillary role as a rule-out test for synovial sarcoma. We caution that both antibodies are prone to false-negative staining in decalcified specimens.

Aims Myxoid liposarcoma (MLPS) is characterised by DNA damage‐inducible transcript 3 (DDIT3) gene rearrangements, confirmation of which is commonly used diagnostically. Recently, DDIT3 immunohistochemistry (IHC) has been reported to be highly sensitive and, when strict criteria are employed, specific for the diagnosis of MLPS. The aim of this study was to independently investigate DDIT3 IHC as a diagnostic marker for MLPS. Methods and results DDIT3 IHC was performed on 52 MLPS and on 152 mimics on whole sections, and on 515 non‐MLPS sarcomas in tissue microarray format. Only one MLPS (which had undergone acid‐based decalcification) was completely negative. With inclusion of this case if any nuclear expression is considered to indicate positivity, the overall sensitivity of DDIT3 is 98% (51 of 52 cases) and the specificity is 94% (633 of 667 non‐MLPS cases are negative). If a cut‐off of >10% of neoplastic cells is required for positivity, then the sensitivity remains 98% (51/52) and the specificity is 98.5% (657 of 667 non‐MLPS cases are negative). If a cut‐off of >50% of cells is required for positivity, then the sensitivity is 96% (50 of 52 cases) but the specificity improves to 100%. Conclusions Diffuse nuclear DDIT3 expression occurs in the overwhelming majority of MLPSs, and can be used to confirm the diagnosis in most cases without the need for molecular testing. A complete absence of expression argues strongly against MLPS, and almost completely excludes this diagnosis, particularly if there is consideration of technical factors such as decalcification. The significance of focal DDIT3 expression should be interpreted in the morphological and clinical context, although most tumours showing only focal expression are not MLPS.

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Background: Oral health emergency department (ED) visits are increasing nationally. This increase in ED admissions is an indicator that preventative dental and oral healthcare practices are not being utilized. Methods: Data was obtained from the Meadville Medical Center. Fourteen ICD-9 codes for dental and oral health admissions over 10 years were categorized and analyzed. Data was graphed to illustrate trends over time and the chi-square test of independence was used to determine associations between admissions types and demographic characteristics. Results: ED admissions for dental and oral health issues were most common among individuals age 19-38 years. Most individuals admitted to the ED for these concerns paid with private medical insurance or were uninsured. The categorization of ICD-9 codes allowed us to see that ED use for structural and soft-issues decreased at the end of the decade under study. However, admissions for infections and dental caries increased over time. Conclusions: The opening of a free dental clinic in 2011 might be associated with the decrease in overall admissions for dental and oral health concerns as well as soft tissue and structural admissions. The increase in ED admissions for dental caries and infections illustrates that more affordable and preventative dental and oral health care and education are need.

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