2008 Summer Meeting - Leeds - The Pathological Society of Great ...

P171Audit of GP Histopathology Requests for Skin BiopsiesSAkram 1 , L Dunk 1 , S Milkins 21 University Hospitals of Leicester, 2 Kettering General HospitalMost histopathology departments receive numerous primary care skin biopsies.In many cases the lesions biopsied are non-serious in nature. However, some ofthe specimens will contain important/serious diagnoses. Clinical information isimportant for many histopathological diagnoses. The aim of this audit was toassess the information provided by GPs on skin biopsy request forms, todetermine what kinds of lesions GPs are removing and to compare any clinicaldiagnosis provided with the histological diagnosis.We examined 100 primary care skin biopsy request forms received inJanuary 2006 at a district general hospital. GPs were excellent at reporting thesite of the lesion but only 54% gave a description of the lesion. They were verypoor at providing any relevant clinical history and poor at reporting the type ofbiopsy performed. 41% offered a clinical diagnosis, and of these 76% werefound to have given the correct diagnosis. 18 different histological diagnoseswere made, with most being non-serious lesions. Seborrhoeic keratosis was themost commonly diagnosed lesion (29 cases), with intradermal naevus the nextmost frequent diagnosis (17 cases). All other diagnoses were made on 8 or lessoccasions. 5 basal cell carcinomas, 2 squamous cell carcinomas, and 2malignant melanomas were removed by the GPs. The malignant melanomas,squamous cell carcinoms and possibly the basal cell carcinomas should havebeen referred to a dermatologist for removal. We have made a number ofrecommendations that we hope would encourage GPs to provide all therequired clinical information.P173Comparison of Different Waxes for the Construction of TissueMicroarraysCEL Orange, KA Oien1 Division of Cancer Sciences and Molecular Pathology, Faculty ofMedicine, University of Glasgow, UKTissue microarrays (TMAs) are important in pathology research. Theirconstruction and the small size and large number of tissue cores used rendersthem more fragile than whole blocks. The type and quality of wax used to makeTMAs may reduce this fragility. Our aim was to assess different waxes tocompare their performance in TMA production.Ten waxes were tested: Histowax (Cellpath), Blue Ribbon, Histowax(Surgipath), Tissue Tek III, Lambwax, Purewax, VA5, Paraplast, Paraplast X-tra and Precision Cut. Tissue was embedded in each wax to create donor blocksand sectioning performed. Separate recipient blocks were made. TMAs wereconstructed and sections cut and stained. At each step the waxes were assessed,compared and ranked.In the generation, sectioning and staining of whole blocks, most waxesperformed well with only slight cracking. Three waxes showed some tissueseparation when sectioning. When making recipient blocks, waxes ranged infirmness, with some rather brittle or soft. In TMA construction, the most brittlewaxes impaired tissue coring. For TMA sectioning and staining, most waxesperformed well but two were difficult to section.Overall, three waxes performed consistently well, ranking in the top halffor each step assessed, particularly for the TMA-related criteria: Paraplast,Tissue Tek and Lambwax. All three contain polymers, which provide elasticityand are postulated to minimise wax cracking and separation, and are of similarcost. Although the remaining seven waxes were of good quality, we consideredthat Paraplast, Tissue Tek and Lambwax would be particularly suitable forTMA production.P172Visceral Leishmaniasis Presenting in Kaposi's Sarcoma of theSkinDKermani 1 , B Kaur 1 ,FDeroide 1 ,VSwale 1 ,SBhagani 11 Royal Free HospitalA 40 year old man - HIV positive - presented with an 11 month history ofmultiple asymptomatic purple papules, weight loss and night sweats. Histologyof the skin showed features of coexistent Leishmaniasis and Kaposi’s sarcoma.Bone marrow aspirate confirmed visceral Leishmaniasis.There is a high prevalence of visceral leishmaniasis among HIV positivepatients. In parallel with this are reports of the co-existence of leishmaniaparasites in a variety of skin eruptions including Kaposi’s sarcoma,dermatofibroma, psoriasiform dermatitis, tattoo infiltration, dermatomyositisand herpes zoster. In our patient the finding of Leishmania parasites within aKaposi sarcoma enabled a diagnosis of unsuspected visceral Leishmaniasis. Thefact that vascular lesions regressed completely after anti-protozoal therapycould support the idea Kaposi sarcoma might be a reactive condition rather thana true neoplasm.REFERENCESBosch RJ, Rodrigo AB, Sanchez P et al. Presence of Leishmania organisms inspecific and non-specific skin lesions in HIV-infected individuals with visceralleishmaniasis. Int J Dermatol. 2002 Oct;41(10):670-5.1Perrin C, Del Giudice P, Taillan B. Leishmaniasis and Kaposi's sarcoma in anHIV-infected patient.Am J Dermatopathol. 1997 Feb;19(1):101-P174A Virtual Reality Powerwall Compared to the ConventionalLight Microscope: Results of a Pilot StudyDTreanor 1 , N Jordan-Owers 1 ,JHodrien 2 , J Wood 2 , R Ruddle 2 ,PQuirke 21 Pathology and Tumour Biology, Leeds Institute of Molecular Medicine,University of Leeds, 2 School of Computing, University of LeedsBACKGROUND: Previous work presented to the Pathological society showedthat virtual slides are up to 60% less efficient than the conventional lightmicroscope. We sought to develop and test a system to improve the efficiencyof virtual slides.METHODS: A Powerwall is a novel user interface device which allows displayof large high resolution images. It comprises an array of 28 LCD screenscontrolled by an 8 node computer cluster. The resulting image is over 5 by 3metres in size, but has the same resolution as a conventional computer screen.This allows, for example, a whole gastrointestinal biopsy to be seen at once at aresolution which shows every individual cell in detail. Custom-made softwarewas written to render virtual slides on a 50 megapixel virtual reality powerwall.A controlled experiment was performed with 8 pathologist subjects and 4standard tasks to compare the efficiency and acceptability of the two modalities.RESULTS: Users had no previous experience of using a powerwall. Efficiencyand diagnostic confidence were equivalent - mean time to complete diagnostictasks was 86s for the conventional microscope and 88s for the powerwall; selfreporteddiagnostic confidence was over 90% for both modalities.CONCLUSIONS: This pilot study suggests that a powerwall has the potentialto be as efficient as the conventional microscope, and despite the lack offamiliarity of subjects with the system their diagnostic confidence wasmaintained using this new interface.Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme75