No abstract

In the United States, chronic ulcers affect 6.5 million people, with a cost of z$20 million annually. The most common etiology of chronic ulcers in the United States is venous stasis, followed by arterial insufficiency and neuropathic ulcers. Less common causes of chronic ulcers include infection, inflammatory etiologies such as vasculitis and pyoderma gangrenosum, and neoplastic causes. Obtaining skin biopsy and tissue culture can be helpful in diagnosing unusual causes of chronic ulcers; however, there are little data on the diagnostic utility of skin biopsy in rendering a definitive diagnosis of the etiology of chronic ulcers. A retrospective study of all skin ulcers biopsied during a 10-year period at the University of Washington was undertaken. Re-excisions and surgical wounds were excluded. A total of 270 ulcer biopsy specimens were included. In 48% of cases, no specific diagnosis could be rendered histologically. 44.8% of chronic ulcers biopsied were due to atypical causes, with neoplasms (basal cell carcinoma, squamous cell carcinoma, melanoma, and cutaneous T-cell lymphoma) being the most common. Vasculitis and pyoderma gangrenosum each represented 1.5% of rendered diagnoses. Concomitant skin culture was performed in 28.9% of cases, and special stains [acid-fast bacilli, Brown and Brenn (B&B), Grocott's methenamine silver, and periodic acid-Schiff stains] were performed in 34.0%. Although more than half (49 of 78) of tissue cultures were positive, only 6.8% (12 of 175) of special stains on tissue sections were positive. We conclude that although the etiology of many ulcers cannot be determined by routine histology alone, skin biopsy of ulcers remains a critical part of the workup given that when a specific cause can be determined, atypical etiologies, including neoplasms, represent a significant proportion of chronic ulcers. Limitations of our study include referral bias. Our results also confirm the higher diagnostic yield of conventional tissue culture compared with special tissue stain biopsies of skin ulcers.

Background The histopathological diagnosis of MF is challenging, and there is significant overlap with benign inflammatory processes. Clinical features may be relevant in the assessment of skin biopsies. Methods We provided photomicrographs to board‐certified dermatopathologists and one hematopathologist with and without accompanying clinical photographs and assessed accuracy and confidence in diagnosing MF. Results We found that access to clinical photographs improved diagnostic accuracy in both MF and non‐MF (distractors); the degree of improvement was significantly higher in the non‐MF/distractor category. Across all categories, diagnostic confidence level was higher when clinical images were available. Conclusion These findings suggest that clinical images are useful in making an accurate diagnosis of MF, and may be particularly helpful in ruling it out when an inflammatory disorder is clinically suspected.

Context: The novel coronavirus virus severe acute respiratory syndrome coronavirus (SARS-CoV2) causing the coronavirus disease of 2019 (COVID-19) pandemic has resulted in worldwide disruption to the delivery of patient care. The Seattle Washington metropolitan area was one of the first in the United States affected by the pandemic. As a result, the anatomic pathology services at the University of Washington experienced significant changes in operational volumes early in the pandemic. Objective: To assess the impact of COVID-19 and both state and institutional policies implemented to mitigate viral transmission (including institutional policies on non-urgent procedures) on anatomic pathology volumes. Design: Accessioned specimens from January 2020 to June 2020 was evaluated as COVID-19 and institutional policies changed. The data were considered in these contexts: subspecialty, billable CPT codes, and intraoperative consultation. Comparable data were retrieved from 2019 as a historical control. Results: There was a significant reduction in overall accessioned volume (up to 79%) from pre-pandemic levels, during bans on non-urgent procedures when compared to 2020 pre- COVID-19 volumes and historical controls. The gastrointestinal and dermatopathology services were most impacted, while breast and combined head&neck/pulmonary services were least impacted. CPT code 88305, for smaller/biopsy specimens, had a 63% reduction during non-urgent procedure bans. After all bans on procedures were lifted, the overall volume plateaued at 89% of pre-pandemic levels. Conclusions: A significant decrease in specimen volume was most strongly associated with bans on non-urgent procedures. While all departmental areas had a decrease in volume, the extent of change varied across subspecialty and specimen types. Even with removing all bans, service volume did not reach pre-pandemic levels.