- Email: [email protected]
Performance monitoring in transfusion
S82
PATHOLOGY 2012 ABSTRACT SUPPLEMENT
Conclusions: ERG shows a sensitivity of 51.5% and a remarkable specificity of 100% for the diagnosis of prostatic adenocarcinoma versus benign glands. ERG positive PIN is almost always associated with invasive adenocarcinoma in the same core biopsy. Immunohistochemistry for ERG may therefore have significant role in the pathological differential diagnosis of difficult prostate biopsies. CLINICAL UTILITY OF SOLUBLE IL-2 RECEPTOR ALPHA IN HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS Kuang-Chih Hsiao1, Francoise Mechinaud2, Chris Czajko1, Marilyn Clark1, Sharon Choo1 1 Immunology Laboratory, Royal Children’s Hospital, Melbourne, and 2Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, Vic, Australia Haemophagocytic lymphohistiocytosis (HLH) is characterised by lymphocyte and macrophage activation, resulting in fever, hepatosplenomegaly, coagulopathy, cytopenias and other features of inflammation. Diagnosis of HLH can be established when five of eight criteria, one of which is elevated soluble IL2-receptor-alpha (sIL2-Ra), are fulfilled.1 Mortality is high, despite HLH04 chemotherapy, prompting the search for better biomarkers of disease activity. Aims: To assess the utility of sIL2-Ra in diagnosis of patients with suspected HLH and in disease activity monitoring. Method: sIL2-Ra was measured by ELISA (R&D Systems) in stored serum, collected at presentation, from eight patients with known HLH (5 of 7 criteria, excluding sIL2-Ra). In two of the eight patients (Patients A and B), serial sIL2-Ra were measured and compared with serum ferritin and clinical disease activity (CDA), retrospectively assessed by the lead clinician, who was blinded to the sIL2-Ra results. Results: All eight patients had elevated sIL2-Ra levels. Patient A’s sIL2-Ra and ferritin levels correlated with CDA. Serial sIL2-Ra/ ferritin/CDA results were 39518/14987/severe, >50000/6146/ moderate, 13013/2315/mild, 10167/5038/moderate, 8446/2745/ moderate, 5184/1772/inactive. Patient B’s sIL2-Ra levels correlated better with CDA than ferritin levels. Serial sIL2-Ra/ferritin/CDA results were 47021/2948/severe, 18188/1173/moderate, 33870/ 1246/severe, 17147/5277/severe, 9806/20429/severe, 11333/3851/ severe. Conclusion: This study demonstrates the diagnostic sensitivity of sIL2-Ra and its value in complementing traditional disease activity markers in HLH. Reference 1. Henter J-I, Horne A, Arico´ M, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48: 124–31.
PERFORMANCE MONITORING IN TRANSFUSION C. Hughes, N. Herrmann RCPA Transfusion QAP, Qld, Australia Aim: In 2012, the RCPA Transfusion QAP will be introducing a pilot for Performance Monitoring in the General Compatibility module. Method: After each survey, the Transfusion Advisory Committee review laboratory results and points are allocated for each assessable element. This allows participants to be placed into a performance level based on the final score obtained.
Pathology (2012), 44(S1)
From the survey levels, a cumulative performance level (CPL) is calculated. Performance levels are weighted and the CPL is calculated from the sum of individual survey performance levels divided by the last six surveys regardless of year/cycle. Performance levels: Reference 100, loss of 0 points, weighting ¼ 1; Reference 99, loss of 1–19 points (minor errors), weighting ¼ 2; Operational, loss of 20–49 points (minor errors), weighting ¼ 3; Review, loss of 50–99 points (1 critical error) weighting ¼ 4; Unsatisfactory, loss of >100 points (2 or more critical errors) weighting ¼ 5. Exceptions: Unsatisfactory survey performance level defaults to unsatisfactory CPL; Review survey performance level defaults to review CPL; 3rd consecutive Reference 100 survey performance level resets the CPL to Reference 100. Conclusions/outcomes: Participants results falling outside the criteria will be referred to the Advisory Committee for review. A letter of notification and committee report will be issued to the participant, supervisor(s) and Director of Pathology as below. Criteria for letter of notification: Letter 1: two critical errors – letter and report sent to participant and supervisor(s); Letter 2: three critical errors – letter and report sent to participant and supervisor(s); Letter 3: four critical errors – letter and report sent to participant, supervisor(s) and Director of Pathology. OVARIAN SERTOLI-LEYDIG CELL TUMOUR OF INTERMEDIATE-DIFFERENTIATION WITH HETEROLOGOUS ELEMENTS COMPRISING OF SEROMUCINOUS EPITHELIAL LINED CYSTS AND IMMATURE NEURAL TISSUE: AN UNUSUAL NEOPLASM Doris Ip Hee Wai, Simon Nazaretian The Royal Women’s Hospital Anatomical Pathology, Melbourne, Vic, Australia Ovarian Sertoli-Leydig cell tumour (SLCT) is a rare sex cord stromal tumour. Some SLCT, usually of intermediate or poor differentiation show heterologous elements such as gastrointestinal type epithelium, immature cartilage or skeletal muscle. However, SLCT with serous epithelium and immature neural tissue as heterologous elements have not been documented. We describe a rare ovarian SLCT with heterologous elements in a 25-year-old woman with post-partum abdominal swelling and pain. Heterologous elements included cystic locules lined by a benign epithelium of serous and mucinous cells and a small foci of immature neural tissue. SCLT with heterologous mucinous elements should be distinguished from pure mucinous cystic ovarian tumours which may appear similar macroscopically and present with virilising symptoms. Heterologous elements may present in a variable proportion from microscopic foci to predominant tumour masking the SLCT. This case highlights the importance of extensive sampling because of common and overlapping morphological features with other ovarian tumours. MUC2 STAINING IS NOT USEFUL TO PREDICT SUBSEQUENT DEVELOPMENT OF INTESTINAL METAPLASIA IN OESOPHAGEAL BIOPSIES P. Irandoost, L. Siosson, A. Clarkson, A. J. Gill Royal North Shore Hospital, Sydney, NSW, Australia Aims: It has recently been postulated that goblet cells in the oesophagus eventually develop from a field of metaplastic
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited. Copyright
PATHOLOGY 2012 ABSTRACT SUPPLEMENT
Conclusions: ERG shows a sensitivity of 51.5% and a remarkable specificity of 100% for the diagnosis of prostatic adenocarcinoma versus benign glands. ERG positive PIN is almost always associated with invasive adenocarcinoma in the same core biopsy. Immunohistochemistry for ERG may therefore have significant role in the pathological differential diagnosis of difficult prostate biopsies. CLINICAL UTILITY OF SOLUBLE IL-2 RECEPTOR ALPHA IN HAEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS Kuang-Chih Hsiao1, Francoise Mechinaud2, Chris Czajko1, Marilyn Clark1, Sharon Choo1 1 Immunology Laboratory, Royal Children’s Hospital, Melbourne, and 2Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, Vic, Australia Haemophagocytic lymphohistiocytosis (HLH) is characterised by lymphocyte and macrophage activation, resulting in fever, hepatosplenomegaly, coagulopathy, cytopenias and other features of inflammation. Diagnosis of HLH can be established when five of eight criteria, one of which is elevated soluble IL2-receptor-alpha (sIL2-Ra), are fulfilled.1 Mortality is high, despite HLH04 chemotherapy, prompting the search for better biomarkers of disease activity. Aims: To assess the utility of sIL2-Ra in diagnosis of patients with suspected HLH and in disease activity monitoring. Method: sIL2-Ra was measured by ELISA (R&D Systems) in stored serum, collected at presentation, from eight patients with known HLH (5 of 7 criteria, excluding sIL2-Ra). In two of the eight patients (Patients A and B), serial sIL2-Ra were measured and compared with serum ferritin and clinical disease activity (CDA), retrospectively assessed by the lead clinician, who was blinded to the sIL2-Ra results. Results: All eight patients had elevated sIL2-Ra levels. Patient A’s sIL2-Ra and ferritin levels correlated with CDA. Serial sIL2-Ra/ ferritin/CDA results were 39518/14987/severe, >50000/6146/ moderate, 13013/2315/mild, 10167/5038/moderate, 8446/2745/ moderate, 5184/1772/inactive. Patient B’s sIL2-Ra levels correlated better with CDA than ferritin levels. Serial sIL2-Ra/ferritin/CDA results were 47021/2948/severe, 18188/1173/moderate, 33870/ 1246/severe, 17147/5277/severe, 9806/20429/severe, 11333/3851/ severe. Conclusion: This study demonstrates the diagnostic sensitivity of sIL2-Ra and its value in complementing traditional disease activity markers in HLH. Reference 1. Henter J-I, Horne A, Arico´ M, et al. HLH-2004: Diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis. Pediatr Blood Cancer 2007; 48: 124–31.
PERFORMANCE MONITORING IN TRANSFUSION C. Hughes, N. Herrmann RCPA Transfusion QAP, Qld, Australia Aim: In 2012, the RCPA Transfusion QAP will be introducing a pilot for Performance Monitoring in the General Compatibility module. Method: After each survey, the Transfusion Advisory Committee review laboratory results and points are allocated for each assessable element. This allows participants to be placed into a performance level based on the final score obtained.
Pathology (2012), 44(S1)
From the survey levels, a cumulative performance level (CPL) is calculated. Performance levels are weighted and the CPL is calculated from the sum of individual survey performance levels divided by the last six surveys regardless of year/cycle. Performance levels: Reference 100, loss of 0 points, weighting ¼ 1; Reference 99, loss of 1–19 points (minor errors), weighting ¼ 2; Operational, loss of 20–49 points (minor errors), weighting ¼ 3; Review, loss of 50–99 points (1 critical error) weighting ¼ 4; Unsatisfactory, loss of >100 points (2 or more critical errors) weighting ¼ 5. Exceptions: Unsatisfactory survey performance level defaults to unsatisfactory CPL; Review survey performance level defaults to review CPL; 3rd consecutive Reference 100 survey performance level resets the CPL to Reference 100. Conclusions/outcomes: Participants results falling outside the criteria will be referred to the Advisory Committee for review. A letter of notification and committee report will be issued to the participant, supervisor(s) and Director of Pathology as below. Criteria for letter of notification: Letter 1: two critical errors – letter and report sent to participant and supervisor(s); Letter 2: three critical errors – letter and report sent to participant and supervisor(s); Letter 3: four critical errors – letter and report sent to participant, supervisor(s) and Director of Pathology. OVARIAN SERTOLI-LEYDIG CELL TUMOUR OF INTERMEDIATE-DIFFERENTIATION WITH HETEROLOGOUS ELEMENTS COMPRISING OF SEROMUCINOUS EPITHELIAL LINED CYSTS AND IMMATURE NEURAL TISSUE: AN UNUSUAL NEOPLASM Doris Ip Hee Wai, Simon Nazaretian The Royal Women’s Hospital Anatomical Pathology, Melbourne, Vic, Australia Ovarian Sertoli-Leydig cell tumour (SLCT) is a rare sex cord stromal tumour. Some SLCT, usually of intermediate or poor differentiation show heterologous elements such as gastrointestinal type epithelium, immature cartilage or skeletal muscle. However, SLCT with serous epithelium and immature neural tissue as heterologous elements have not been documented. We describe a rare ovarian SLCT with heterologous elements in a 25-year-old woman with post-partum abdominal swelling and pain. Heterologous elements included cystic locules lined by a benign epithelium of serous and mucinous cells and a small foci of immature neural tissue. SCLT with heterologous mucinous elements should be distinguished from pure mucinous cystic ovarian tumours which may appear similar macroscopically and present with virilising symptoms. Heterologous elements may present in a variable proportion from microscopic foci to predominant tumour masking the SLCT. This case highlights the importance of extensive sampling because of common and overlapping morphological features with other ovarian tumours. MUC2 STAINING IS NOT USEFUL TO PREDICT SUBSEQUENT DEVELOPMENT OF INTESTINAL METAPLASIA IN OESOPHAGEAL BIOPSIES P. Irandoost, L. Siosson, A. Clarkson, A. J. Gill Royal North Shore Hospital, Sydney, NSW, Australia Aims: It has recently been postulated that goblet cells in the oesophagus eventually develop from a field of metaplastic
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited. Copyright