Introduction. Soft tissue tumour pathology is a highly specialised area of surgical pathology, but soft tissue neoplasms can occur at virtually all sites and are therefore encountered by a wide population of surgical pathologists. Potential sarcomas require referral to specialist centres for review by pathologists who see a large number of soft tissue lesions and where appropriate ancillary investigations can be performed. We have previously assessed the types of diagnostic discrepancies between referring and final diagnosis for soft tissue lesions referred to our tertiary centre. We now reaudit this 6 years later, assessing changes in discrepancy patterns, particularly in relation to the now widespread use of ancillary molecular diagnostic techniques which were not prevalent in our original study. Materials and Methods. We compared the sarcoma unit's histopathology reports with referring reports on 348 specimens from 286 patients with suspected or proven soft tissue tumours in a one-year period. Results. Diagnostic agreement was seen in 250 cases (71.8%), with 57 (16.4%) major and 41 (11.8%) minor discrepancies. There were 23 cases of benign/malignant discrepancies (23.5% of all discrepancies). 50 ancillary molecular tests were performed, 33 for aiding diagnosis and 17 mutational analyses for gastrointestinal stromal tumour to guide therapy. Findings from ancillary techniques contributed to 3 major and 4 minor discrepancies. While the results were broadly similar to those of the previous study, there was an increase in frequency of major discrepancies. Conclusion. Six years following our previous study and notably now in an era of widespread ancillary molecular diagnosis, the overall discrepancy rate between referral and tertiary centre diagnosis remains similar, but there is an increase in frequency of major discrepancies likely to alter patient management. A possible reason for the increase in major discrepancies is the increasing lack of exposure to soft tissue cases in nonspecialist centres in a time of subspecialisation. The findings support the national guidelines in which all suspected soft tissue tumour pathology specimens should be referred to a specialist sarcoma unit.
We found that while essential information was always included in reports, more specific details contributing to better quality reports such as more detailed macroscopic descriptions and a higher proportion of clinical summaries with radiological correlation were included in 2011 than 2006, despite increasing workload. Specimen handling, particularly of core biopsies, was also improved, reflecting the increasing need to conserve the maximum amount of patient material for molecular investigations.
Objectives: The incidence and severity of multiple myeloma (MM) differ among ethnic groups. The purpose of this study was to determine the incidence, demographics, clinical presentation and outcome of multiple myeloma (MM) in Bermuda.
Methods:The study involved a review of patients diagnosed with haematological malignancy including MM using hospital records retrieved from Bermuda Hospital Board database, between January, 2010 and December, 2014. Demographic, clinical and laboratory data on patients with MM were collected and analysed.Results: Haematological malignancy accounted for 7% (144/2009) of all cancers and MM accounted for 23% (33/144) of all hematologic malignancies with an incidence of 10.2/100,000 population per year (based on Bermuda population of 64,237 in 2010). The male: female ratio was 1:2.3 with a mean age at diagnosis of 68 years. The common clinical presentations at the time of diagnosis were anaemia (26/33, 78.8%), followed by bone pain involving the lower back and hip (15/33, 45.5%), hypercalcaemia (14/33, 42.4%), neoplastic systemic symptoms (13/33, 39%) and renal insufficiency (12/33, 36.4%). The majority of patients (23/33, 69.7%) were diagnosed at stages 2 and 3 of the disease and 91.3% (21/23) of these patients were from Black ethnic groups. All patients (15/15, 100%) with adverse genetic factors were Black and the majority (10/15, 66.6%) were female.
Conclusion:The incidence of MM in Bermuda is higher than that reported from the United Kingdom and the United States and the condition is more common in women. The age at diagnosis and clinical presentation and prognosis of MM in Bermuda are comparable with reports from the Western world. Further studies to address the survival of patients with MM in Bermuda receiving different treatment options should be considered.
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