Day 1 :
Keynote Forum
Zahra Maleki
The Johns Hopkins Hospital, USA
Keynote: Milan Salivary Gland Reporting System: Highlights and Classification Schemes
Biography:
Zahra Maleki is an assistant professor of pathology at the Johns Hopkins University School of Medicine. Her areas of clinical expertise include surgical pathology and cytopathology. Her priority as a clinician and pathologist is to serve the patients by performing both fine needle aspirations and on site evaluations of specimen adequacy, and providing an accurate, timely diagnosis. She teaches and mentors fellows, residents, and students at the Johns Hopkins School of Medicine. She received her medical degree from Shaheed Beheshti University of Medical Sciences and completed a residency in anatomic and clinical pathology at the Virginia Commonwealth University School of Medicine. She performed her first fellowship at the Virginia Commonwealth University School of Medicine in pathology and a second fellowship in cytopathology at the University of Miami.
Abstract:
Salivary gland lesions are relatively uncommon and Fine needle aspiration (FNA) is routinely performed to evaluate these lesions. Although it is possible to reach a definitive diagnosis in some cases, there are a considerable number of remaining problematic cases. The issues precluding a definitive diagnosis on aspirated material of salivary gland lesions are as follows: scant cellularity, poorly preserved cells, cellular heterogeneity, squamous metaplasia, variable ratio of the cells and the matrix, uncommon presentation of common entities and finally rare neoplasms. Therefore, rendering a definitive diagnosis on aspirated material can be a diagnostic challenge. Moreover, the clinicians and surgeons heavily rely on diagnosis of salivary gland FNAs for their patient care and management. Milan salivary gland reporting system is introduced to provide a classification scheme for salivary gland FNA to improve the reporting diagnosis of salivary gland FNA cases. This workshop will review Milan system and its application on routine daily practices for pathologists.
Keynote Forum
Qing Kay Li
The Johns Hopkins Medical Institutions
Keynote: Accurate sub-classification of lung cancer using small biopsy samples based on updated WHO and IASLC criteria.
Time : 10:10 AM
Biography:
Dr. Li is an associate professor of pathology and oncology at the Johns Hopkins Medical Institutions. Her areas of clinical expertise include surgical pathology, cytopathology, and oncological pathology. She is also a faculty and PI at Johns Hopkins Biomarker Discovery Center. Dr. Li serves as editorial board members for several journals; committee members of the American Society of Cytopathology, Papanicolaou Society of Cytopathology, NIH/NCI cancer working groups; study sections of government agents and private organizations. She has more than 100 publications, including several book chapters and books.
Abstract:
The new 2015 edition of the WHO classification and recommendations of IASLC (International Association of Study of Lung Cancer) emphasize the importance of accurate subclassification of lung cancers for targeted therapy. Lung cancer is a heterogeneous group of neoplasms and accurate diagnosis and sub-classification on small biopsies can be challenging. Recent systematic reviews and meta-analyses have shown that interobserver disagreement rates on the subclassification of non–small cell lung cancer (NSCLC) are approximately 10-20% in resected specimens and 20-30% in small biopsy specimen without immunohistochemical (IHC) stains. The morphological heterogeneity of the lung cancer is also correlated with certain molecular alterations. Therefore, it is necessary to introduce newly updated guidelines of WHO and IASLC into our daily practice to improve the accuracy of subclassification of lung cancer for targeted therapy, particularly in small biopsy specimens.
- Cancer Cytopathology | Comparative Pathology | Head & Neck Pathology | Renal Pathology | Hematopathology | Surgical Pathology | Clinical Pathology | Diagnostic Pathology | Oncopathology | Reproductive Pathology | Neuropathology
Session Introduction
Malti Kumari Maurya
King George’s Medical University, India
Title: Clinicopathological evaluation of abnormal uterine bleeding (AUB) and its correlation with biochemical hormone profile in perimenopausal women
Biography:
Malti Kumari Maurya has completed her MD Pathology from King George’s Medical University (KGMU), Lucknow, India in 2008.Then join as lecturer in 2009 in the same department and promoted to Associate professor in 2015.She is actively participating in both teaching undergraduate and post graduate students along with research work attended national international CME. Her field of interest is gynec pathology. Onco path, oral and Gall bladder tumour. She has published more than 20 papers in reputed journals and serving as reviewer in 3-4 journals.
Abstract:
Introduction: Perimenopausal women faces menstrual problems inform of cycle irregularity in form of variation in both length and heaviness of bleeding episodes. Follicular development during this phase is erratic, leading to estrogen level variability. Thus, detailed characterization of sex hormones dynamics during the perimenopause is important for understanding its potential implications for reproductive cancers and other health outcomes.
Objective: To evaluate the clinical features and histopathological findings in abnormal uterine bleeding and correlate with hormone profile in perimenopausal women.
Materials and method: A total of 156 endometrial curettage samples of perimenopausal women age group (40-50 years) which were undergone D&C for AUB were collected and processed and classified according WHO criteria. 2-3 ml serum was collected between day 2 to day 4th of period and LH, FSH, Estradiol and progesterone hormone analysis was done by chemiluminescent microparticle immunoassay.
Result: The predominant pattern of endometrium among benign category was proliferative 46(30.6%) and disordered proliferative phase endometrium 40(26.6%) followed by secretory 12(8%) and mixed endometrium 11(7.3%). In premalignant group, 33 (22%) had hyperplasia without atypia and 2 (1.3%) had atypical hyperplasia. Patients with benign endometrial lesions (102) and hyperplasia (33) presented with heavy menstrual bleed 91% and 94% respectively while all (3) patient of malignant lesions complaint intermenstrual bleeding (100%). (p= 0.001). No statistically significant correlation was found between hormone levels and endometrial histological pattern.
Conclusion: In perimenopausal women, intermenstrual bleeding may represent an alarming symptom of endometrial malignancy. Histopathological pattern of endometrium and clinicopathological factors can predict further management and outcome.
Rashmi Kushwaha
King George’s Medical University, India
Title: Hemostatic profile in patients of Myeloproliferative Neoplasms- 5 year experience from a tertiary care centre in North India.
Time :
Biography:
Rashmi Kushwaha completed MD Pathology at the age of 29 years from Rajiv Gandhi University of Health Sciences, Karnataka, India. At present she is working as Additional Professor, Lymphoma-Leukemia Lab, Department of Pathology, King George’s Medical University, Lucknow, India. She has been working in above lab since 10 years. She has 28 scientific paper publications in indexed journals and 2 research projects. She has delivered 9 guest lectures in various conferences. She is trained in Flowcytometric immunophenotyping, Platelet aggregation studies and coagulation workup.
Abstract:
Background: Patients of myeloproliferative neoplasm (MPN) commonly present with abnormalities in coagulation tests that are consistent with hypercoagulable state. Some individuals with MPN exhibit a pattern of exclusive bleeding or thrombotic events, many others have both bleeding and thrombosis.
Objectives: To assess the hemostatic defects and platelet functions in patients of MPN.
Methods: Five year prospective study done at a tertiary care centre in North India. All recently diagnosed cases of MPN along with 50 age and sex matched controls were included.
Patients on antiplatelet drugs, antimyeloproliferative treatment, vitamin K agonists or antagonists, OCP’s, Platelet count <1,00, 000/μl, high grade fever, liver disease, pregnancy were excluded.
All the patients underwent screening investigations like CBC, peripheral smear evaluation, Bleeding time , Prothrombin time , Activated Partial Thromboplastin Time , Protein C and S measurement, aggregation with ADP 5μM (CHRONOLOG 700).
Result: 50 cases were included. There was an occult prothrombotic state, suggested by significantly ( p<0.001) reduced levels of Protein C, Protein S. But no patient presented with frank thrombosis. 8 out of 50 patients had hemorrhagic manifestations ranging from subdural hematoma to pin point petechial hemorrhages. Patients of CML-CP, ET, PV, PMF, MPNNOS
showed significantly reduced maximal aggregation with 5μM ADP (p<0.001). MPV also showed a statistically significant increase in these patients.
Conclusion: Thrombohaemorrhagic complications significantly affect the morbidity and mortality of MPN patients. Timely diagnosis of hemostatic abnormalities can decrease the morbidity in these patients.
George Mihail MAN
Physical Education and Informatics, University of Pitesti, Romania
Title: Irradiation effects on colon cancer cells autophagy process
Biography:
George Mihail MAN is currently serving as a Faculty of Sciences at Department of Medical Assistance and Physical Therapy, Physical Education and Informatics, University of Pitesti, Romania. He is having more than 25 publications in reputed journals.
Abstract:
Aim: A quantitative assessment of LC3 expression of autophagy process, in cells from tumoral colorectal tissues was compared from patients with or without preoperative radiotherapy.
Materials and Methods: 50 patients that underwent surgery for colorectal adenocarcinoma, of which 11 received preoperative radiotherapy, were biopsied. After being included in paraffin and sectionated, the tumoral tissue samples were immunomarked for LC3 expression. The influence of preoperative radioterapy was revelated comparing LC3 percentage on 10 randomly selected microscopy fields (with 40× objective) from malignant tissue samples of each patient, assessed with dedicated software. The resulting data were assessed and compared with a statistical apparatus.
Results: The LC3 percentage is different from person to person and the higher it is in normal epithelium, the higher will be in tumoral epithelium of the same person. LC3 was overexpressed in tumoral tissue as compared with normal one. The LC3 expression levels are decreasing from tumoral non-irradiated epithelia to tumoral irradiated epithelia. LC3 expression in tumoral cells is granular, with particular perinuclear disposal and often “annular” pattern.
Conclusions: The study of cancer cells autophagy allows for a more accurate molecular targeted anticancer approach of radiation therapy. Using a quantitative assessment of LC3 protein expression on tumoral colorectal tissues we determined the influence of preoperative radiotherapy on tumoral cells autophagy process. The autophagy process proved to be upregulated in the tumoral cells, with a particular morphological expression, namely the presence of cytoplasmic coarse granules disposed in an “annular” pattern. Preoperative radiotherapy is downregulating the autophagy process both in normal and tumoral tissue but to a lesser extent in the latter.
Lotte Mulder
American Society for Clinical Pathology, USA
Title: Understanding Lab Results Empowers Patients
Biography:
Lotte Mulder earned her Master’s of Education from the Harvard Graduate School of Education in 2013, where she focused on Leadership and Group Development. Professionally, Lotte comes from a background in experiential leadership, working in Africa, Latin America, Asia, and the U.S. There she worked to increase leadership skills through cultural immersion, service learning and refugee issues, and cross-cultural interpretation.
At ASCP, Lotte directs the ASCP Leadership Institute and has built ASCP’s first patient ambassador program, Patients Champions. This program empowers patients through bringing awareness and understanding of the laboratory. She is currently working toward a PhD in Organizational Leadership.
Abstract:
The general public is not aware of the role of pathology and does not understand the resources available to them. To address this issue, ASCP created the an ambassador program called Patient Champions. This program raises awareness of the vital role the medical laboratory plays in patient care through real-life stories of patients. Patient Champions empower new patients to ask the right questions and understand their diagnoses by sharing their stories.Arming patients with knowledge about the lab will empower and support them when going through health care challenges and struggles. This session provides resources awareness and understanding of the laboratory and how patients can use that knowledge to understand their diagnosis and treatment.
This session is a case-based discussion about understanding breast cancer diagnoses and now to empower patients and their caregivers. A Patient Champion and/or representative will be part of the panel to discuss the impact of pathology and what we can do to improve patient care from the patient’s standpoint.
Ceren Canbey Goret
Sancaktepe Research and Education Hospital, Istanbul, Turkey
Title: Review and local experience for evaluating pancreatic tissue specimens
Biography:
Ceren Canbey Goret was born in Turkey in the year 1983. She had graduated from medical school in 2007 and completed my residency training in clinical pathology in 2013. She worked for two years as a staff pathologist at Istanbul Haydarpasa Numune training / research hospital, and for two years as an assistant professor pathologist Canakkale Onsekiz Mart University Hospital. Currently she is working at Health Science University, Sancaktepe training / research hospital as a staff pathologist since 2017.
Abstract:
Background: Pancreaticoduodenectomy (Whipple) and distal pancreatectomy (DP) operations are the preferred methods for indications ranging from benign inflammatory conditions to malignant neoplasia. Pathological examination of both Whipple and distal pancreatectomy materials requires special attention to correctly evaluate many important prognostic factors. In this study, we aimed to present the pathology results of 41 Whipple and distal pancreatectomy materials evaluated retrospectively over a 6-year period.
Method: A total of 41 Whipple procedure and distal pancreatectomy materials, both benign and malignant, which were evaluated in the Istanbul Ekin Private Pathology Laboratory between January 2010 and January 2016 were included in the study.
Results: Out of the 41 cases, 10 (24.4%) showed DP and 31 (75.6%) showed Whipple; 22 (53.6%) of the cases were male and 19 (46.4%) were female, and the mean age was 59.8 years. Six (14.6%) cases were benign and 35 (85.4%) were malignant. Of the 35 malignant cases, 15 were female and 20 were male; the mean age was 60.44 years. In terms of localization, 6 (17.1%) of the tumors were localized to the ampulla, 7 (20%) to the pancreas distal, 2 (5.7%) to the duodenum, and 20 (57.2%) to the pancreas head.
Conclusion: In pancreatic carcinoma cases that are treated with either Whipple or DP, macroscopy should be assessed pathologically, and the entire piece should be diligently sampled. By doing so, parameters fundamentally affecting the survey, such as tumor type and lymph node status, will be evaluated more accurately. In addition, rate of resection in benign lesions can be slightly reduced by performing FNAB with ERCP or EUS to the masses detected by imaging in the preoperative period.
Key words: Whipple procedure, Distal pancreatectomy, Pancreas pathology
Biography:
Shivani Sharma is graduate from Maulana Azad medical college, New Delhi in 2009. Completed Diploma in Clinical Pathology from Indira Gandhi Medical College, Shimla, Himachal Pradesh in 2012. Pursued Diplomate in National Board from Medanta-The Medicity, Gurgaon, Haryana(2013-2015). Also, cleared the first part of FRCPath, Royal College of London in March 2015. Has been awarded the Shiv Ram Vidyawanti Kakkar memorial award, Gold medal in E.N.T in 2007, and Gold medal for the best student in Diploma in Clinical Pathology, in 2012 by Himachal Pradesh University. Has about more than 14 papers published in various reputed journals.
Abstract:
Histiocytic and dendritic cell neoplasms (HDCN) are rare disorders of lymph node and soft tissue. These neoplasms include histiocytic sarcoma (HS), Langerhans cell histiocytosis (LCH), follicular dendritic cell sarcoma (FDCS), interdigitating cell sarcoma (IDCS), indeterminate cell sarcoma (INDCS), and fibroblastic reticular cell tumor (FRCT). These neoplasms are often misdiagnosed as carcinoma, neuroendocrine tumors and other Non Hodgkin lymphomas.We sought to establish a correlation between the histomorphologic features and immunohistochemical results of these neoplasms and analyse the diagnostic pitfalls. This is a retrospective observational study including 17 cases of HDCN collected over a period of three years.
Formalin fixed paraffin embedded tissue underwent routine haematoxylin and eosin (H and E) staining and microscopic examination. An extensive immunohistochemical panel was performed and included markers necessary for the diagnosis (CD68, NSE, CD1a, CD4, CD21, CD23, cyclinD1, CD45, Ki67, vimentin, S100, and PanCK) and markers important to exclude other differentials.
Among 17 cases, LCH (8/17; 47%) was the most common subtype, and HS (7/17; 41.1%) was the second most common. One case each of FDCS (1/17;5.8%) and FRCT (1/17;5.8%). The mean age of the patients was 36.6 years with male to female ratio of 2.4:1. LCH was seen in head and neck region predominantly including occipital bone, scalp, subgaleal periosteum, external auditory canal, supraclavicular lymph node, and cervical spine. The site of HS varied from colon (2/7), lymph node (1/7), lower limb (2/7) and spine (2/7). FDCS was diagnosed in a lymph node and FRCT presented as an abdominal mass. For LCH, on morphology, grooved nuclei with longitudinal cleft in the Langerhans cells seen in a background eosinophilic infiltrate were the most striking morphologic feature (8/8; 100%). CD1a, S100 and CD68 co-positivity was seen in all 8 cases of LCH. Histiocytic sarcoma showed a consistent positivity for CD68 and CD4 in all the cases. FDCS showed characteristic histomorphologic features of tumor cells arranged in whorls, fascicles and storiform pattern with positivity of CD21 and CD23. The tumor cells in FRCT were arranged in a storiform pattern and showed positivity for vimentin and SMA.
HDCNs are a rare group of haematologic disorders that have variable clinical presentations, rare sites and different prognoses. A careful morphologic evaluation and an extensive immunohistochemical work up are mandatory for their diagnoses. As a future standpoint, more cases need to be pooled, studied and evaluated for genetic studies to attain optimal treatment protocols for this rare group of neoplasms.
Akbar Ali Thind
Thind Cosmetic Laser Centre, India
Title: Incidence of Opacities in Bacterial Corneal Ulcer Patients
Biography:
Akbar Ali Thind was born on 11-02-1966 in village Takhar Khurd. He is a Ph.D Research scholar. He run Thind Cosmetic Laser Centre, Malerkotla, Punjab India Since 1993. He is also the owner of Whole sale Medical Hall since 20th January 2011 under the name of "Areeb Thind Medical Hall"
He attended many Conferences Laser Training and workshops etc. He attend Laser Training Workshop of Lumenis (Gurgaon) for Lightsheer Diode Laser for Permanent Hair Reduction held at New Delhi on October, 2012. He attended Conference for Health Care in Singhania University Rajasthan in March, 2013. He attended Conference in Baba Farid Medical Univesity Faridkot (Punjab) in January, 2014
Abstract:
The aim and objective of the study to examine the incidence of opacities in bacterial corneal ulcer patients to isolate, identify and characterized pathogenic bacteria responsible for causing corneal ulcers. Antibiotic resistance/susceptibility of pathogenic bacteria was also investigated. Patients belonging to different age groups, sex and professions were examined for the presence of cornea ulcers in different seasons. After getting written consent of the patients a standardized performa was developed for recording history of the patients.
It was found that out of 110 patients, 72 patients were positive for corneal ulcer (65.45%), corneal opacity was observed in 16.66% cases of corneal ulcer. Further the study revealed 61.12% cases of trauma and 38.88 % cases of corneal injury. The study revealed 75% opacities which were unilateral and 25 % were bilateral. It has been observed the incidence of opacities increase with age. In general sufferers belonged to the lower economic strata. Further it was found most of the patients belonged to the rural areas.
The maximum corneal opacities were found in case of macular, opacities, central, peripheral opacities and half or more of cornea (16.66%). As results summarized, the minimum corneal opacities were found in case of nebular, leucomatious, adherent leucoma and anterior staphyloma. The etiological factors responsible for corneal ulcer are trauma, injury with any cases. In total 65.45% cases showed 61.12% corneal trauma. Trauma was more in region where agriculture work and industries were common. It was noticed that 60% people did not protect their eyes at the time of injury. It was found that superficial corneal trauma during agricultural work and industrial work often lead to progressing corneal ulceration and visual loss. Corneal trauma was the major cause of corneal ulcers. Among industrial workers corneal injury was mostly caused by iron particles, saw dust and paddy straw etc.
Biography:
Abstract:
Background: - Transfusion-transmissible viral infections, such as hepatitis C virus, hepatitis B virus, and human immunodeficiency virus, remain a major public health problem in developing countries. The prevalence of these viral infections among blood donors may reflect the burden of these diseases among populations. Therefore, the aim of this study was to assess the sero prevalence of transfusion-transmissible viral infections among blood donors. Methods: - A retrospective study was conducted using data obtained from registration books of blood donors from the Ethiopian North Gondar District Blood Bank from 2010 to 2012. Descriptive statistics, such as percentages, medians and interquartile ranges were computed. A binary logistic regression model was fitted to identify factors associated with each viral infection. The odds ratio with a 99% confidence interval was calculated. A p-value < 0.01 was considered statistically significant. Result: - A total of 6,471 blood donors were included in the study. Of these, 5,311 (82.1%) were male, and 382 (5.9%) were voluntary blood donors. Overall, 424 (6.55%) of the blood donors were sero-reactive for at least one transfusion-transmissible viral infection. Of all study participants, 233 (3.6%) were sero-reactive for HBV, 145 (2.24%) were sero-reactive for HIV, and 51 (0.8%) were sero-reactive for HCV. Four (0.062%) of the study's participants were co-infected: 3 (75%) with HBV-HCV and 1 (25%) with HIV-HBV-HCV. Being a farmer, unemployed or employed donor was significantly associated with transfusion-transmissible viral infections compared to being a student donor. Conclusion and Recommendations: -The prevalence of transfusion-transmissible viral infections is substantial and has increased overtime. Hence, it demands more vigilance in routine screening of donated blood prior to transfusion. Further community-based studies to identify societal risk factors are necessary.
Akanksha Gupta
Hartford Hospital, USA
Title: GATA3 expression in primary cutaneous mucinous carcinoma
Time : 15:05-15:30
Biography:
Akanksha Gupta has completed her MBBS, and currently is pursuing MD third year Pathology Resident at Hartford Hospital, CT, USA. She did a Pathology Residency in India and passed it with a Gold Medal and moved to US in 2013. While doing her second year Nephropathology fellowship in University of North Carolina at Chapel Hill, NC, USA, she has published five abstract/paper publications, 12 poster presentations, seven oral presentations and one online publication. She is very adept at oral presentations.
Abstract:
Introduction: Primary cutaneous mucinous carcinoma (PCMC) is a rare adnexal tumor of sweat gland origin with an indolent course. The primary challenge in diagnosis is distinguishing PCMC from metastatic mucinous breast carcinoma (MMBC)-an important distinction because of the poorer prognosis with metastatic disease, requiring aggressive management. GATA3 binding protein is a transcription factor known to be a sensitive marker for breast and urothelial carcinomas. Most primary and metastatic breast carcinomas express GATA3, making it useful in evaluating metastatic disease. GATA3 expression has also been demonstrated in various epithelial skin tumors but it has not been specifically studied in a cohort of PCMC.
Case Series: We evaluated the potential of GATA3 as a distinguishing marker between PCMC and MMBC by applying it in four consecutive cases of PCMC diagnosed at our institution. All patients were females, making mammary metastasis a relevant diagnostic consideration. All cases were CK7 (+)/CK20 (-), CDX2 (-) and expressed mammaglobin, ER and PR. Based on morphology and immunophenotype alone, the cases were practically indistinguishable from MMBC, except that they showed p63 (+) myoepithelial cells, suggestive of a primary cutaneous process. For each case, the diagnosis of PCMC was eventually made after possible extracutaneous primaries had been excluded by extensive systemic workup.
Result: All PCMC cases showed strong nuclear GATA3 expression.
Conclusion: GATA3 immunohistochemistry is not useful in contrasting PCMC from MMBC. In differentiating these histologic mimics, additional markers and thorough systemic workup are necessary to establish primary cutaneous derivation.
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Biography:
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Abstract:
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- Microbial Pathology | Breast Pathology | Dermatopathology | Veterinary pathology | Digital Pathology | | Plant pathology | Immunopathology | Histopathology | Speech & language pathology | Experimental Pathology
Session Introduction
Gireesha Rawal
Safdarjung Hospital, India
Title: Immunohistochemical surrogate for molecular subtype of breast carcinoma and its correlation with Cyclin D1 expression: An Indian scenario
Biography:
Gireesha Rawal has completed her Bachelor of Medicine and Bachelor of Surgery (MBBS) degree at the age of 23 years from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, and is currently persuing postgraduation in Pathology from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Her areas of interest include breast pathology, immunopathology and female genital tract pathology. She has published many case reports and papers in reputed journals.
Abstract:
Various prognostic parameters have been described and validated for breast cancer, but the search for newer prognostic factors continues since existing parameters don't provide sufficient information for accurate risk assessment and tailor-made treatment planning. Thus, in the St. Gallen International Expert Consensus on Primary Therapy of Early Breast Cancer, 2011, breast carcinoma was classified on molecular basis. Further this correlated well with immunohistochemical expression of the tumours and was called surrogate molecular classification.
Studies on Cyclin D1 have shown inconsistent and conflicting results with regards to its role in prognosis.
This study was aimed at classifying breast carcinoma using surrogate molecular classification into immunophenotypes, studying the immunohistochemical expression of Cyclin D1, and correlating Cyclin D1 as well as immunophenotypes with various parameters.
Fifty cases of breast carcinoma were studied and their pTNM staging and Bloom Richardson (BR) grading done. Immunohistochemistry for Cyclin D1, ER, PR, Her2neu and Ki67 was performed, and they were classified into immunophenotypes.
Majority of the cases (40%) were Luminal A subtype, and least (16%) were Triple negative. Cyclin D1 positivity was seen in 54% cases. Cyclin D1 showed statistically significant decreasing positivity with increasing grade as well as with increasing stage. On correlating immunophenotype with Cyclin D1, 75% Luminal A, 75% Luminal B, 20% Her2neu enriched, and 12.5% triple negative cases were positive for Cyclin D1. This decreasing trend was statistically significant.
This is one of the initial studies from India analyzing immunophenotypes and correlating them with Cyclin D1 expression, in addition to other parameters. The significant association of Cyclin D1 with low stage, low grade and Luminal immunophenotypes may indicate that Cyclin D1 is a good predictive and prognostic factor that closely interacts with hormone signaling pathway. This may aid in investigating the response and clinical outcomes of treatment targeting Cyclin D1.
Mark Podberezin
University of Saskatchewan, Canada
Title: Malignant Mesothelioma and Differential Diagnosis with Reactive Mesothelial Proliferation.
Biography:
Mark Podberezin has completed his Postdoctoral Research Fellowship during the year of 2001 from Children Hospital Los Angeles and University of Southern California and Residency in Anatomic and Clinical Pathology at University of Illinois at Chicago. He has done the Fellowship in Hematopathology during the year 2013 from Texas Methodist Hospital. He is the Clinical Assistant Professor at University of Saskatchewan, Canada. He has published more than 12 papers in reputed journals.
Abstract:
Malignant mesothelioma (MM) is one of most lethal forms of cancer, causing about 3000 deaths per year in USA and 5000-in Europe. Asbestos exposure is one of most important causative factor, and latency period after exposure can be as long as 40 years. Being tumor of serosal membranes, it most commonly involves pleura, with minority of cases manifesting as peritoneal mesothelioma. Despite recent advances in multimodality treatment, prognosis of MM patients is dismal, and average survival is less than a year after diagnosis. Most common clinical presentation is unilateral recurring pleural hemorrhagic effusion. However, depending on histologic variant, some patients do not have pleural effusion and present with shortness of breath and increased pleural thickness. The latter is particularly true in sarcomatoid and desmoplastic variants of MM. Definitive diagnosis of MM can be done on pleural biopsy based on combination of assessment of both morphologic and immunohistochemical findings, with the recent inclusion of molecular cytogenetic findings in the diagnostic armamentarium. Most crucial and difficult task is to separate malignant process from its benign mimics. And, despite all recent advances in the diagnosis of MM, differential diagnosis between MM and reactive mesothelial proliferation remains major challenge. Importance of careful and thorough morphologic evaluation of growth pattern cannot be overestimated. Presence of invasion is unequivocal criterion of malignancy while absence of definitive invasion seen on the biopsy still cannot completely rule out MM. Therefore, other features, such as cellularity with cell distribution and growth pattern, necrosis, and cytologic atypia have to be evaluated. Recent addition of BAP-1 immunostaining, as well as molecular studies, have proven to be very helpful in differential diagnosis between MM and reactive mesothelial proliferation. Discussion of the above diagnostic aspects is main focus of current presentation.
Rezaei M.S
Shahid Beheshti University of Medical Science,Iran
Title: Necrotizing Sarcoid Granulomatosis :case report
Biography:
Mitrasadat Rezaei worked as Assistant professor of pathology at Flowcytometry department, High Institute for research and education in blood transfusion medicine, Tehran, Islamic Republic of Iran from 2011-2014. Currently she is working as Assistant professor of pathology at pathology department, National Research Institute of Tuberculosis and lung disease, Shahid Beheshti University of Medical Science,Tehran,Iran, from 2014 and she is the Director of Molecular pathology Laboratory , Masih Daneshvari Hospital from 2014 and she is the Head of cental lab in school of medicine, Shahid beheshti University of Medical Science, Tehran, Iran from 2016.
Abstract:
Necrotizing SarcoidGranulomatosis(NSG) is a rare granulomatous pneumonitis which is composed of background of sarcoidosis-like granulomas with granulomatous vasculitis and variable amount of necrosis .We reported a case of 38-year-old non-smoking woman presented by left-sided chest pain and dyspnea for three days.Chest CT scan exhibitedcollapse consolidation of left lower lobe with presence of two septated small sized cystic lesions within collapsed segment.Video-Assisted Thoracic surgery (VATS) was performed and histologicalexamination confirmed the diagnosis by excluding other causes of granulomatousdisease.The prognosis of NSG is favorable and medical treatment is usually not necessary,as well as our case.
NSG is a rare disease with nonspecific symptoms and good prognosis which frequently confused with Wegener’s granulomatosis,sarcoidosis and churgstrauss.this entity should also be considered as differential diagnosis of necrotizing granulomatous diseases.
Keywords: Necrotizing SarcoidGranulomatosis, Granuloma,Necrosis.recognition.
Nuri Emrah Goret
Canakkale State Hospital, Canakkale, Turkey
Title: Histopathological Evaluation of 103 patients with rectal carcinoma
Biography:
Nuri Emrah Goret was born in Turkey in the year 1981. He graduated from medical school in 2006 and completed his residency training in general surgery in 2016. He is currently working at Canakkale State Hospital as a staff surgeon since 2016.
Abstract:
Objective: Colorectal carcinomas are the third most common carcinomas in men and the second most common carcinomas in women worldwide. Pathological examination of rectum specimens requires special attention for correctly evaluating many prognostically important factors. In this study, we aimed to present pathological results of 103 lower anterior resection (LAR) and abdominoperineal resection (APR) specimens that we retrospectively evaluated over a 6-year period.
Patients-Method: One hundred three LAR and APR specimens were included in this study. Patients were evaluated in the Istanbul Ekin Private Pathology Laboratory between January 2010 and January 2016.
Results: Of the 103 specimens, 14 (13.5%) were APR and 89 (86.5%) were LAR specimens. Fifty-six patients (54.4%) were males and 47 patients (45.6%) were females. The mean age of the patients was 61.1 years. Twenty-three patients (22.3%) had undergone neoadjuvant therapy. All surgical margins were negative in 100 specimens (97.1%), whereas a tumor was present in the distal surgical margins in 3 specimens (2.9%). There was no lymph node metastasis in 59 patients (57.3%), whereas there was lymph node metastasis in 44 patients (42.7%). Four (3.9%), 25(24.3%), 58 (56.3%), 12 (11.6%) patients had stage T1, T2, T3, and T4 tumors, respectively, whereas 4 (3.9%) who had undergone neoadjuvant therapy had stage yT0 tumors. Eighty-six (83.6%), 7(6.8%), 4(3.9%), 1 (0.9%), 1 (0.9%), and 4 (3.9%) patients had adenocarcinoma, mucinous adenocarcinoma, intramucosal adenocarcinoma in the setting of a high-grade tubulovillous adenoma, synchronous colon/prostate adenocarcinoma, malignant melanoma, and adenocarcinoma diagnosed by the examination of colonoscopic biopsy specimens that showed complete regression with neoadjuvant therapy, respectively.
Conclusion: When evaluating specimens from patients with colorectal carcinoma, pathological evaluation, which is one of the most fundamental pillars, must be performed carefully and meticulously. Each pathological parameter should be evaluated carefully, and clinicians and pathologists should evaluate these cases together.
Tahseen M. M. Al Omoush
Mùtah University, Jordan
Title: Melanocytic Hyperplasia in the Epidermis Overlying Trichoblastomas in 100 Randomly Selected Cases
Biography:
Tahseen M. M. Al Omoush has completed his Fellowship in Dermatopathology and soft tissue pathology from Charles University, Czech and Pathology Residency Program from Institute of pathology, University hospital of Udine, Italy. He is the Assistant Professor, Faculty of medicine, Department of Pathology of Mu’tah University, Al Karak-Jordan. He worked as Specialist histopathologist at University Hospital “Santa Maria Della Misericordia”, Udine, Italy from 1st Sep 2015 to 4st Sep 2016.
Abstract:
Abstract: One hundred cases of trichoblastomas (large nodular, small nodular, cribriform, lymphadenoma, and columnar) were randomly selected and studied for the presence of melanocytic
hyperplasia in the epidermis overlying the tumors, which was defined as foci of increased melanocytes in the basal layer of the epidermis (more than 1 per 4 basal keratinocytes). Focal melanocytic hyperplasia was detected in a total of 22 cases of trichoblastoma
(22%), and this phenomenon was most frequently seen in columnar trichoblastoma (7 cases), followed by large nodular trichoblastoma (5 cases). The mechanism of epidermal melanocytic
hyperplasia overlying trichoblastoma is unclear. Ultraviolet may be a contributing factor, as focal melanocytic hyperplasia was also detected in one-third of cases in the epidermis overlying uninvolved skin, usually associated with solar elastosis. This is further corroborated by the occurrence of the lesions predominantly on the face. Melanocytic hyperplasia overlying trichoblastoma appears to have no impact on the clinical appearance of the lesion and is recognized only microscopically. In an adequate biopsy specimen containing at least part of trichoblastoma, it should not cause any diagnostic problems.
Key Words: melanocytic hyperplasia, trichoblastoma, adnexal tumors, collision, trichoepithelioma
Biography:
Abstract:
Background:Bladder cancer is the second most frequent malignancy of the urinary tract after prostate cancer.The involvement of lipids in carcinogenesis has been reported in some malignancies. The recently recognized lysophosphatidylcholineacyltransferase 1 (LPCAT1); the most important enzyme in membrane biogenesis, has been currently implicated in carcinogenesis. The role of LPCAT1in bladder cancer development and progression and its impact on patients’ outcome has not been previously investigated.
Methods:In this study, we evaluated the immunohistochemical expression of LPCAT1 in 60 cases of bladder urothelial carcinoma in relation to other clinicopathological features of the tumor as well as patients' prognosis.
Results:LPCAT1was expressed in all studied cases of urothelial carcinomas with two distinct patterns of staining, a strong nuclear expression pattern significantly detected in low grade tumors and a weak cytoplasmic staining with nuclear membrane accentuation significantly seen in high grade tumors. Furthermore, nuclear staining pattern correlated significantly with tumor recurrence, progression and patient's survival. Although tumor stage, vascular invasion, angiogenesis, percent of necrosis and mitotic count in the studied cases were significantly related to tumor recurrence and progression, no significant correlation was detected between any of those variables and LPCAT1 expression. In Multivariate cox regression model including significant variables, LPCAT1 nuclear expression emerged as independent predictor of early tumor recurrence.
Conclusions:We concluded that LPCAT1 protein is likely involved in bladder tumor carcinogenesis, recurrence and progression, and it provides a new perspective for targeted therapy.
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