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Impact of expert pathology review in skin adnexal carcinoma diagnosis: analysis of 2573 patients from the French CARADERM network. Only one further patient was offered sentinel lymph node biopsy in place of CT staging, which was negative. Porocarcinoma is one of the most frequently occurring cutaneous adnexal carcinomas,[1],[2] and carries an estimated risk of metastasis at presentation ranging from 8.1% to 31%.[3],[4] The 5-year overall survival for porocarcinoma is 68.8%, reducing to 54.3% at 10 years, based on 611 patients with porocarcinoma in US National Cancer Database registry data.[3] Disease-specific death is estimated to be 8-11% in smaller series.[5],[6] Despite this, there is a lack of consensus in relation to diagnosis and management of porocarcinoma,[4],[7] in part due to the relative rarity of this skin cancer. Thirty-two of 75 (42.7%) patients with porocarcinoma underwent computed tomography (CT) staging at presentation; 4 of these 32 (12.5%) had nodal or distant metastases on imaging, of whom 2 were occult presentations with no clinical evidence of metastatic disease (Table 1). [Extracted from the article]

Click here for the corresponding questions to this CME article. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about stomal plugs as a treatment alternative for stomal stenosis.

Competing Interests: Conflicts of interest L.S. is an Associate Editor of Clinical and Experimental Dermatology. The other authors declare no conflicts of interest.

Sarcoidosis occurs much more commonly in cohorts of connective tissue disease (1%) compared to the general population (0.01-0.04%). We present a case of concomitant connective tissue disease and cutaneous sarcoidal granulomas and discuss whether the observed granulomas represent a reactive phenomenon or true sarcoidosis. Click here for the corresponding questions to this CME article., (© 2022 British Association of Dermatologists.)

A 3-tier histopathologic scoring system, the chemotherapy response score (CRS), was previously devised for reporting the histologic response to neoadjuvant chemotherapy in interval debulking surgery specimens of stage IIIc/IV tuboovarian high-grade serous carcinoma. This has been shown to predict the outcome and offer additional information to other methods of assessing the treatment response. In the present study, the reproducibility of this scoring system was assessed by determining the interobserver agreement among reporting pathologists. A total of 5 groups each comprising 3 pathologists with different levels of expertise were selected. The participants underwent an online tutorial on how to apply the CRS system. 40 cases (38 cases in 2 appraiser groups) were scored individually by each of the 15 pathologists. The interobserver reproducibility was calculated using Fleiss' κ, Kendall's coefficient of concordance, and the absolute agreement between (a) individual pathologists within 1 group, (b) with the majority score agreement between all groups, and (c) with all individual scores. The CRS system was found to be highly reproducible among all the pathologists' groups (κ=0.761). The agreement in identifying the group of patients with the best response to chemotherapy was exceptionally high (κ=0.926). We conclude that CRS has a high interobserver reproducibility, especially in identifying the subgroup of patients with the best chemotherapy response, justifying its inclusion in clinical trials and reporting practice.

The low incidence of testicular tumours and the fact that they show an extremely high diversity means that they may be poorly understood. Knowledge of the range of tumours and the differences in treatment available is essential for appropriate management. The advent of cisplatin chemotherapy and the exquisite sensitivity of seminoma to radiotherapy have resulted in excellent cure rates. Nevertheless, research has continued unabated, particularly to understand the molecular basis of germ cell tumours and why certain tumours are recalcitrant to treatment. This overview is an attempt to demystify areas of confusion and highlight areas of current interest in testicular pathology and oncology., (Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Summary: A new scoring system is proposed in order to assist surgeons with the complex analysis associated with non-union surgery. Patients with non-union are rarely easily compared with one another and this has frustrated research in this field. We have therefore attributed values to clinical features based on clinical experience and research evidence, so that patients of similar complexity can be compared with one another. When greater experience with this scoring system has been gained it will be further refined and validated. We propose that surgeons with a sub specialist interest in non-union surgery use this system in reporting results, and that non- specialist surgeons use it to inform their decision to treat the fracture themselves, or refer to a sub specialist.