ECP 2022 Abstract Book

Virchows Archiv (2022) 481 (Suppl 1):S1–S364 13 fluid samples from 432 patients. Clinical, pathological, and microbiological data were extracted from medical records and correlated with sequencing results. Results: Taxa from the order Mucorales could be detected in 11/432 patients. 7 of these 11 patients were male, and the median age was 54 years (range 5-74 years). All 11 patients had severe comorbidities (9 with hematological cancers and 2 with other can- cers; 1 had additionally COVID-19). Specimen sites included lung (6x), upper respiratory tract (2x), myocardium (2x), and soft tissue (1x). The most commonly detected Mucor species was Rhizopus microsporus (5x), followed by Lichtheimia corymbifera (2x), Rhiz- opus oryzae (1x), Actinomucor elegans (1x), Rhizomucor pusillus (1x), and Rhizomucor miehei (1x). Microbiological culture was performed in 7 cases, always yielding negative results. Conclusion: The rising incidence of mucormycosis in patients with COVID-19 has raised awareness of this rare but lethal fungal infection. Due to the fast-progressing clinical course of mucormycosis, early diagnosis is key. Our study demonstrates that ITS sequencing is a reliable tool in diagnosing this devastating disease with a much higher sensitivity than microbiological culture. Thus, especially when combined with histopathology, ITS sequencing enables a rapid and accurate diagnosis of mucormycosis, with important implications for clinical practice. OFP-04-012 Comprehensive analysis of bronchoalveolar lavage in severe COVID-19 patients G. Olteanu*, E. Baldasso, F. Lunardi, F. Fortarezza, F. Pezzuto, A. Kilitci, L. Moracci, V. Tauro, L. Vedovelli, C. Del Vecchio, A. Boscolo, P. Navalesi, F. Calabrese *Spitalul Clinic de Boli Infec ț ioase ș i Pneumoftiziologie Dr.Victor Babe ș Timi ș oara, Romania Background & objectives: A few and inconclusive data are reported about the broad analysis of bronchoalveolar lavage (BAL), a demonstrated safe procedure in COVID-19 patients. We aim to report the comprehensive cytological, microbiological, and molec- ular analysis of BAL from critically ill COVID-19 patients. Methods: BAL fluid was obtained from 12 COVID-19 patients admitted in the intensive care unit in the second wave (February 2021 - May 2021). BAL from lung transplant recipients (n=12), and lung donors (n=12), represented the ‘fragile’ and ‘healthy’ control groups, respectively. Cytological analysis, microbiologi- cal investigation (culture and molecular determination), and wide cytokine expression analysis using Real-Time PCR were performed. Results: SARS-CoV-2 (mainly A variant) was positive only in severe COVID-19 patients. Microbiological analysis showed bacterial coinfections with K. pneumoniae, P. aeruginosa, and S. aureus in COVID-19 and transplant patients. Fungal coinfec- tions were found only in COVID-19 patients (C. albicans and A. fumigatus). Molecular analysis identified the viral coexistence of Epstein Barr virus, Cytomegalovirus, and Herpes simplex virus type-1 in both COVID-19 and lung transplant groups; lung donors were negative for all microorganisms. The molecular cytokine profile in the COVID-19 group was remarkable for a low expression of interferon-gamma (IFN-γ), and significantly overexpression of interleukins (IL) IL-1β, and IL-9. Conclusion: The full comprehensive analysis of BAL is crucial to specifically detect frequent coinfections in patients with severe COVID19 pneumonia. IL-1β, and IL-9 overexpression could represent a possible therapeutic target. Although confirmation is required on larger case series, the obtained results underline a complex and overall different inflammatory profile in COVID-19 BAL in comparison to blood or upper airways as reported in the literature. OFP-05 | Joint Oral Free Paper Session Uropathology / Nephropathology OFP-05-001 Outcomes according to consensus molecular subtypes of urothelial carcinoma after neoadjuvant chemotherapy in the GETUG-AFU V05 VESPER trial Y. Allory*, C. S. Groeneveld, V. Harter, C. Krucker, V. Dixon, A. de Reynies, S. Culine, C. Pfister, F. Radvanyi *Institut Curie, Pathology department, Saint-Cloud, France Background & objectives: The molecular subtypes of urothelial carcinoma may impact the outcomes after neoadjuvant chemotherapy in muscle invasive bladder cancer. Our aim was to assess the 3-year progression free survival according to the consensus molecular subtypes within the prospective Vesper clinical trial. Methods: 493 patients received dd-MVAC or GC after randomi- zation in the VESPER trial (NCT01812369). This ancillary study was restricted to neoadjuvant treated patients. To take into account intra-tumoural heterogeneity, we performed 3’ mRNA sequenc- ing of distinct tumour areas when morphology and/or multiplexed GATA3 Cytokeratin 5/6 TUBB2a immunostaining highlighted distinct pattern. Consensus molecular subtype was determined for each area from transcriptomic profile. Results: Out of 296 cases, 97 with heterogeneous immunostain- ing were selected for multiple sampling. For 251 cases, one single subtype was detected per tumour (i.e. pure): 37 luminal papillary, 60 luminal unstable, 17 luminal non specified, 53 stroma-rich, 81 basal/squamous and 3 neuroendocrine-like. 45 cases were mixed with 2 or more subtypes (27 with basal/squamous component). Pathological response was not different between pure subtypes but was decreased for mixed cases (OR adjusted for randomization arm: 0.43, 95% CI 0.19-0.96, p=0.040). Compared with luminal and stroma rich, the 3yr PFS was decreased for basal/squamous, either pure or admixed with another subtype (HR adjusted for ran- domization arm: 2.16, 95% CI 1.46-3.20, p<1e-3). Conclusion: In the VESPER trial, the basal/squamous molecular subtype (pure or mixed) is associated with a decreased 3 yr PFS after neoadjuvant chemotherapy. Further studies will investigate the molecular basis associated with this adverse feature and explore new systemic treatments for the basal/squamous subtype. Funding: French governmental grant (Institut National du Cancer) OFP-05-002 Clinicopathologic and molecular spectrum of testicular sex- cord stromal tumours not amenable to specific histopathologic subclassification S. Siegmund*, H. Tsai, I. Tran, Y. Yang, V. Vasudevaraja, M. Snud- erl, K. Cornejo, M. Idrees, K. Al-Obaidy, K. Collins, J. Gordetsky, S. Wobker, K. Trpkov, A. Yilmaz, G. Quiroga-Garza, W. Anderson, M. Hirsch, C. Magi-Galluzzi, A. Acosta *Department of Pathology, Brigham and Women’s Hospital; Department of Pathology, Harvard Medical School, Boston, MA, USA Background & objectives: Testicular neoplasms of sex-cord or stromal derivation that cannot be definitively classified into a spe- cific tumour subtype are designated "unclassified sex-cord stromal tumours" (USCSTs). Given the rarity of USCSTs, their clinico- pathologic and molecular features remain largely unexplored. Methods: This study evaluated a multi-institutional series of tes- ticular USCSTs to better define the spectrum of tumours comprised in this diagnostic category. Twenty-six USCSTs from 25 patients S18