Aims: The study is aimed to verify Aperio AT2 scanner for reporting on the digital pathology platform (DP) and to validate the cohort of pathologists in the interpretation of DP for routine diagnostic histopathological services in Wales, United Kingdom. Materials, Methods and Results: This was a large multicenter study involving seven hospitals across Wales and unique with 22 (largest number) pathologists participating. 7491 slides from 3001 cases were scanned on Leica Aperio AT2 scanner and reported on digital workstations with Leica software of e-slide manager. A senior pathology fellow compared DP reports with authorized reports on glass slide (GS). A panel of expert pathologists reviewed the discrepant cases under multiheader microscope to establish ground truth. 2745 out of 3001 (91%) cases showed complete concordance between DP and GS reports. Two hundred and fifty-six cases showed discrepancies in diagnosis, of which 170 (5.6%) were deemed of no clinical significance by the review panel. There were 86 (2.9%) clinically significant discrepancies in the diagnosis between DP and GS. The concordance was raised to 97.1% after discounting clinically insignificant discrepancies. Ground truth lay with DP in 28 out of 86 clinically significant discrepancies and with GS in 58 cases. Sensitivity of DP was 98.07% (confidence interval [CI] 97.57–98.56%); for GS was 99.07% (CI 98.72–99.41%). Conclusions: We concluded that Leica Aperio AT2 scanner produces adequate quality of images for routine histopathologic diagnosis. Pathologists were able to diagnose in DP with good concordance as with GS. Strengths and Limitations of this Study: Strengths of this study – This was a prospective blind study. Different pathologists reported digital and glass arms at different times giving an ambience of real-time reporting. There was standardized use of software and hardware across Wales. A strong managerial support from efficiency through the technology group was a key factor for the implementation of the study. Limitations: This study did not include Cytopathology and in situ hybridization slides. Difficulty in achieving surgical pathology practise standardization across the whole country contributed to intra-observer variations.

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Granulomatosis with polyangiitis (GPA) causing liver injury is rare. Where liver biopsies have been taken findings are not always typical and diagnosis can be challenging. Here, we present a case of a 58-year-old male who on admission to hospital was found to have acute liver injury. Diagnosis of liver involvement in GPA is supported by liver histology and the resolution of hepatitis after commencement of immunosuppressive treatment.

BackgroundThe incidence of neoplasms of the appendix is low and accounts for 1% of all cancers. It is often an incidental finding, detected in 0.2 -0.3% of all appendicectomy specimens. PurposeWe studied the incidence of primary lesions of the appendix in a cohort of patients who underwent appendicectomy as part of cytoreductive surgery for gynaecological malignancies. Methods A total of 182 cases were identified from the database of the Department of Histopathology over the course of 6 years (2015-2020). The histopathology reports for these cases were reviewed, and data including patient age, primary gynaecological cancer type, macroscopic abnormality in appendix, presence of a primary lesion of the appendix and its type was collated. ResultsThe median age of the entire cohort was 54 years (range 17-83 years). An appendiceal lesion was identified in 12/182 cases (0.5%), whose median age was 61years (range 48-77 years). The appendiceal pathology included low grade appendiceal neoplasm in 4/12 (33%), well differentiated (grade 1) neuroendocrine tumour in 2/12 (17%), sessile serrated lesion with no dysplasia in 4/12 (33%) and hyperplastic polyp in 2/12 (17%) cases. There was no association with any particular gynaecological cancer type with the presence of appendiceal lesions. A macroscopic abnormality in the form of dilatation of appendix was noted in one of the 12 cases (8%). A tumour nodule was identified grossly in another case whilst metastatic tumour deposits were confirmed microscopically in 4/12 cases (33%). ConclusionAppendicectomy in the course of cytoreductive surgery provides an opportunity to identify occult primary appendiceal lesions, particularly in patients over the age of 45. Appendiceal lesions are most often an incidental finding and given the poor correlation between gross appearance of the appendix and microscopic findings in the majority of these lesions, the entire appendix should be submitted for histological assessment.