discordance between IHC and ISH (single probe silver ISH, SISH; or dual probe fluorescence ISH, FISH). Of the 1,701 HER2 IHC 0 test results retrieved, 99.2% were HER2 SISH negative, 0.8% equivocal, and no SISH positive cases were identified. Of the IHC 0 and SISH equivocal cases, all were subsequently shown to be HER2 negative by further FISH testing. Of the 881 IHC 1+ test results, 96.7% were SISH negative, 3.0% equivocal, and 0.3% were positive. The majority of IHC 1+ cases with equivocal or positive SISH were ultimately shown to be HER2 negative by FISH. The IHC 1+ cases that were subsequently shown to be HER2 amplified by FISH were reviewed and some exhibited either tumour heterogeneity or were in the neoadjuvant setting. Our review supports the current recommendation against reflexive ISH testing of IHC 0 and 1+ cases, and referral for further testing in cases of tumour heterogeneity.

Background: Ablative fractional CO 2 laser (AFCL) has been reported to be safe and effective to use for preventing hand photoaging in a recent pilot study. Objectives: This study aimed to evaluate the efficacy of AFCL in improvement of hand photoaging in 25 patients. Patients and Methods: A prospective, before-after, single blind study was conducted in 25 patients who presented for desired treatment of hand photoaging. Patients received three treatments sessions with AFCL. Results: All enrolled patients were female and received three treatment sessions. There was no incidence of significant adverse effects such as scarring, prolonged erythema sever edema, post inflammatory pigmentary changes, or infection. Mean improvement one month after three treatments was 48.3% (95% CI, 42.6 -53.9) for skin wrinkling, 53.3% (95% CI, 47.9 -58.8) for skin pigmentation, 46.9% (95% CI, 41.4 -52.2) for skin texture, and 54.9% (95% CI, 49.3 -60.5) for overall cosmetic outcome (all P < 0.05). Conclusions: AFCL can be used safely and effectively in the treatment of hand photoaging.

Congenital toxoplasmosis is a disease caused by Toxoplasma gondii, an obligate intracellular parasite, which is transmitted via the placenta from mother to fetus. The risk of fetal infection increases with advancing gestation, while the risk of severe fetal disease decreases with gestation. Infection may result in miscarriage, preterm labour or stillbirth. Manifestations in the fetus vary and can include serious and progressive motor, hearing, visual and cognitive issues. Here we report a case of congenital toxoplasmosis detected in the placenta of a preterm infant. The diagnosis of Toxoplasma placentitis was based on the presence of a characteristic true Toxoplasma cyst in the chorionic plate, associated with non-specific features of low grade chronic villitis with multinucleated giant cells, chronic chorioamnionitis and chronic deciduitis. The sensitivity of diagnosis of toxoplasmosis on placental examination is generally low (91% in symptomatic cases). However, given the characteristic morphology of the Toxoplasma cyst and the clinical history of severe fetal brain abnormalities on antenatal imaging, the features were considered in keeping with Toxoplasma placentitis. The histology findings were communicated to the Neonatal Intensive Care Unit. Toxoplasma PCR was subsequently performed on blood and CSF samples from the baby, confirming the diagnosis of congenital toxoplasmosis.

Congenital is a disease caused by Toxoplasma gondii, an obligate intracellular parasite, which is transmitted via the placenta from mother to fetus. The risk of fetal infection increases with advancing gestation, while the risk of severe fetal disease decreases with gestation. Infection may result in miscarriage, preterm labour or stillbirth. Manifestations in the fetus vary and can include serious and progressive motor, hearing, visual and cognitive issues. Here we report a case of congenital toxoplasmosis detected in the placenta of a preterm infant. The diagnosis of Toxoplasma placentitis was based on the presence of a characteristic true Toxoplasma cyst in the chorionic plate, associated with non-specific features of low grade chronic villitis with multinucleated giant cells, chronic chorioamnionitis and chronic deciduitis. The sensitivity of diagnosis of toxoplasmosis on placental examination is generally low (91% in symptomatic cases). However, given the characteristic morphology of the Toxoplasma cyst and the clinical history of severe fetal brain abnormalities on antenatal imaging, the features were considered in keeping with Toxoplasma placentitis. The histology findings were communicated to the Neonatal Intensive Care Unit. Toxoplasma PCR was subsequently performed on blood and CSF samples from the baby, confirming the diagnosis of congenital toxoplasmosis.