International Conference on Cytopathology September 01-02, 2015 Toronto, Canada

Biography:

Merce Jorda, M.D. is board certified in American Board of Pathology-Cytopathology. Has completed her fellowship from Jackson Memorial Hospital in Affiliation with the University Of Miami School Of Medicine. Prof. Jorda is the Medical Director, Clinical Laboratory Services -UMHC/SCCC and UM Hospital. Dr. Jorda’s research interests include molecular pathology of cancer and immunocytochemistry of tumors. She is interested in all markers, immunohistochemical and molecular, which may give the diagnostic, prognostic, predictive and treatment information. Dr. Jorda’s research interests have been basically at the level of anatomic pathology and cytopathology, specifically in the areas of breast and genitourinary tract malignancies as well as cytopathology.

Abstract:

Lung carcinoma sub-classification into small-cell and non-small-cell carcinomas has important implications for clinical management and prognosis of the disease. With the introduction of target therapy and its associated significant therapeutic implications for patients with advanced stage lung cancer, the subclassification of non-small cell carcinomas into adenocarcinomas and squamous cell carcinomas has also become an important task for practicing pathologists. Moreover in recent years, cytologic samples including fine needle aspiration, bronchoscopic brushings and washings, and bronchoalveolar lavages have been increasingly used to establish the diagnosis of lung cancer and subclassification of these tumors. Based on cytomorphology alone, distinction between nonkeratinizing squamous cell carcinomas and poorly differentiated adenocarcinomas can be difficult . Moreover, in some clinical settings the differential diagnosis may include primary versus metastatic carcinomas or adenocarcinoma vs. malignant mesothelioma. Cytologic features of these tumors can overlap, and a variety of factors can distort the cytomorphology of the tumor cells. In addition, the cytologic material may be limited in quantity and present only in direct smears or cytospin slides. Therefore, the availability of a reliable ancillary technique such as immunocytochemistry applicable to such cytologic preparations is desirable. Molecular techniques used as prognostic and predictor markers will be discussed with emphasis to their application in cytologic material. Following the session, participants will be able to 1- Formulate a differential diagnosis based on routinely prepared cytologic slides, based on clinical, imaging and cytologic findings; 2- Learn how to identify and mark diagnostic cells properly for further application of immunocytochemistry, select a limited panel of antibodies based on available clinical and cytomorphologic imformation and to interpret immunostain results, being aware of diagnostic pitfall; 3- To apply molecular testing in primary lung carcinomas using cytologic material; 4- differentiate lung primary carcinomas from those of metastatic origin, accurately diagnose small cell carcinomas of lung and sub-classify non-small cell carcinomas into those with squamous differentiation and distinguish between malignant mesothelioma and lung adenocarcinoma.

Biography:

Wilfrido Mojica MD is a Surgical Pathologist and Assistant Clinical Professor with the Department of Pathology at the University of Buffalo. He completed his MD degree from the St. Louis University School of Medicine and is trained and board certified in both Anatomic and Clinical Pathology. He is the Director of the Immunohistochemistry Laboratory within the Kaleida Health Laboratory. He has published over 25 peer reviewed manuscripts related to translational research and pathologic biospecimens.

Abstract:

An emerging problem pathologists are encountering is the receipt of vanishingly small core biopsy specimens and the increasing demands for molecular testing on them. Current tissue management requires traditional processing approaches to arrive at a point where a diagnosis can be made on morphologic grounds. However, even with judicious planning, examination of hematoxylin with eosin and immunohistochemically stained sections can lead to the depletion of these very small pieces of tissue, leaving nothing left over for molecular analysis. We have recently discovered that exfoliated cells can be recovered from core needle biopsies prior to their routine processing to create formalin fixed, paraffin embedded specimens. A wash step recovers cells which we believe are dislodged by the trauma associated with the mechanical procedure of performing this type of biopsy. Management of these cells using a microfluidic platform presents a novel paradigm capable of extending the diagnostic utility of the core needle biopsy, allowing for recovery of high molecular weight DNA, proteins and the possibility of other cellular constituents. Cytopathologic evaluation of these cells is integral to the success of this platform. A prototype working model is introduced with a discussion of the attributes this approach delivers relative to conventional pathologic specimen processing.

Biography:

Li is an internationally recognized expert in the field of cytopathology and co-PI in Johns Hopkins Biomarker Discovery Center. She provides diagnostic service at Johns Hopkins, and conducts research in the field of novel biomarkers in lung and prostate cancers. Her research has been presented at many national/international meetings. Dr. Li also serves as editorial board members for several journals, committee member of the American Society of Cytopathology, and study sections of government agents and private organizations. She has more than 70 publications and book chapters. Dr. Li is also the editor of “Diagnostic Cytopathology Board Review and Self-Assessment”.

Abstract:

Currently, the targeted therapy of cancers has changed the diagnostic and therapeutic paradigm of lung cancers from primarily morphological assessment of tumors to molecular analysis of genetic alterations in tumor cells. The molecular analysis requests certain quantity of tumor cells However, the cellularity of the conventional cell block (CB) preparation, particularly in TBNA specimens, is often low and inadequate for molecular study. We routinely apply a novel ‘blood clot’ technique (CB-BC) to improve the cellular yield in the CB preparation during TBNA procedures. By this technique, the cellular material within the aspirate needle is allowed to form a blood clot (CB-BC), and then, the cellular material is fixed in the formalin and processed in the histological laboratory. This technique enable us to improve the cellularity in the CB. We have compared this novel technique with conventional method (CB-NR) in the CB preparation. We have found that 84.6% of lung and 88.8% of lymph node samples have yielded sufficient material for diagnosis, immunohistochemistry studies and molecular analyses. In contrast, the conventional CB-NR method has yielded approximately 50% to 70% of the diagnostic rate. This novel technique improves the cellular yield, and provides material for molecular study without compromising the cytomorphological features of tumor cells.

Biography:

Ahmed El-Habashi has completed his MD, PhD at the age of 40 years from Cairo University and Tulane University in a channel system scholarship program. He got post-doctoral fellowship at Groningen University Hospital, The Netherlands at 1998. He is the past- director of pathology department, National Cancer Institute, Cairo University and now he is working in the capacity of Professor of Pathology. He got the International Board of Cytopathology from International Academy of Cytopathology at 2007. He is an international cytology speaker and he conducted many Cytopathology workshops in Egypt and Arab countries aiming to improve the cytology practice and profession. He has published more than 35 papers in reputed journals and has been serving as a reviewer for more than three reputed Journals.

Abstract:

Cytology is the diagnostic branch of medicine which, based on the microscopic cell examination, to recognise physiological conditions, and to diagnose benign, pre-malignant and malignant processes. It is easy, inexpensive, fast, reliable, and gives material for ancillary testing. Almost all surgeries for lung, pancreas, liver, thyroid, etc. are based on cytology diagnoses. Almost all biopsies of Cervix, bladder, etc. are done based on cytology diagnoses. However, cytology is different and difficult, due to potential subjectivity, heterogeneity and nonuniformity of material. Cytopathology studies diseases on the cellular level while in histopathology; cells are assessed in the spatial context. So cytology has different knowhow and diagnostic approach compared to histopathology. This presentation demonstrate diagnostic approach and general cytomorphology features (patterns, background, cell type, shape, cytoplasmic features,…..ect) in cytology material and potential diagnostic pitfalls and errors. High diagnostic accuracy and avoidance of cytologic pitfalls in cytopathology can be achieved by acquiring a detailed clinico-radiologic data, obtaining adequate specimens, having prior knowledge of the variety of diagnostic entities, strict application of established cytological criteria, and nothing can replace years of experience.

Biography:

Sahar Samaha, M.D. is board certified in AP/CP and Cytopathology. Has completed her residency and 2 fellowships in surgical pathology and cytopathology at University of Kansas Medical Center. She is in practice for over 15 years. She got her medical degree from Ain Shams University, Cairo, Egypt. Before moving to the united states, she finished her residency and obtained her master’s degree in Ophthalmology. She is the director of Aloha lab at Miraca life sciences.

Abstract:

At Miraca Life Sciences, we receive anorectal pap smears and biopsies from a colorectal clinic dealing primarily with “high risk” populations, mainly HIV positive patients. Our large database includes anorectal pap smears for screening and follw up as well as biopsies collected from the keratinized, non-keratinized portions and transformation zone. Dacron fiber swabs and liquid-based sampling are used. Questions to be answered, What is the natural history of the anorectal dysplasia? What is the difference between the cervical and anorectal pap? Follow up and treatment, is it different from cervical dysplasia? Correlation between anal pap smears and biopsies? Should anal-rectal cytology be a standared of patient care in high risk population and female patients with genital HPV infection?

Biography:

Sin Hang Lee has graduated from Wuhan Medical College in China. After a Residency-Fellowship at Cornell-New York Hospital and Memorial Hospital for Cancer, he was certified by the American Board of Pathology and obtained the FRCP (C) degree by examination in 1966. He was on the Faculty of McGill University and Yale University from 1968-2004 while practicing hospital-based pathology. He is currently the Director of Milford Molecular Diagnostics, Milford, Connecticut. In the past 10 years, he has developed Sanger sequencing-based testing methods for HPV, Neisseria gonorrhoeae, Chlamydia trachomatis, Lyme disease borreliae and Ebola virus implementable in community hospitals.

Abstract:

Persistent infection by a high-risk human papillomavirus (HPV) is a necessary factor in the pathologic process which may lead to cervical cancer development. Absence of HPV in the cervico-vaginal cell suspension indicates no risk for cervical cancer and is invariably associated with a normal Pap smear. Since HPV infection precedes any morphologically recognizable “squamous intraepithelial lesions”, commercial HPV assays have been introduced to replace Pap smears as the more sensitive screening test for cancer prevention. However, triage of HPV-16/-18 positive patients to colposcopy without concomitant cytologic evaluation is known to cause excessive unnecessary cervical biopsies because the HPV genotyping may be inaccurate or the HPV infection is transient. On the other hand, some of the commercial test kits may not be sensitive enough for detecting HPV with low copy numbers such as in the small cancer cells with little cytoplasm. This workshop summarizes the author’s experience in developing and using nested PCR detection of HPV followed by Sanger sequencing for accurate genotyping to maximize the sensitivity and specificity of HPV assays and implementation of this technology in a small community hospital. Extended applications of this technology in molecular diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Lyme disease borreliae, Ebola virus and BRCA1 185delAG mutation have been successful. The overall aim of this workshop is to show how easy it is for cytopathology professionals to play a pivotal role in a DNA sequencing-based diagnostic laboratory to help improve patient care through molecular personalized medicine.

Biography:

Dr. Majumder has completed her PhD in 2009 from Human Genetics Unit of Indian Statistical Institute, Kolkata, India. Soon after she joined as a postdoctoral fellow in the Anatomy and Cell biology Department at the University of Western Ontario, Canada. She published 16 peer-reviewed publications and received several national and international awards as a graduate and postdoctoral fellow. Her expertise is in the field of cancer genetics and epidemiology, cancer stem cell biology and microRNA genetics.

Abstract:

MicroRNAs (miRs) are small regulatory molecules emerging as potential biomarkers in cancer. Previously, it was shown that COX-2 expression promotes breast cancer progression via multiple mechanisms including induction of stem-like cells (SLC), owing to activation of the prostaglandin E2 receptor EP4 (PTGER4). COX-2 over-expression also up-regulated microRNA-526b (miR-526b), in association with aggressive phenotype. We tested functional roles of miR-526b in breast cancer and the mechanistic role of EP4 signaling in miR-526b up-regulation were examined. A positive correlation was noted between miR-526b and COX-2 mRNA expression in breast cancer cell lines. Stable over-expression of miR-526b in poorly metastatic MCF7 and SKBR3 cell lines resulted in increased cellular migration, invasion, EMT phenotype and enhanced tumorsphere formation in vitro and lung colony formation in vivo in immunodeficient mice. Conversely, knockdown of miR-526b in aggressive MCF7-COX-2 and SKBR3-COX-2 cells reduced oncogenic functions and reversed the EMT phenotype, in vitro. Furthermore, it was determined that miR-526b expression is dependent on EP4 receptor activity and downstream PI3K/AKT and cyclic AMP (cAMP) signaling pathways. Additionally inhibition of COX-2, EP4, PI3K/PKA in COX-2 overexpressing cells down-regulated miR-526b and its functions in vitro. Finally, miR-526b expression was significantly higher in breast cancer tissues and associated with reduced patient survival. This study presents novel findings that miRNA 526b is a COX-2 up-regulated, oncogenic miRNA promoting stem-like cells, the expression of which follows EP4 receptor-mediated signaling. miR526b expression correlates with breast cancer patient survival and is a promising biomarker for monitoring and personalizing breast cancer therapy.

Biography:

Dr Gayane Badalian-Very (MD, PhD) is a leading physician of the world and a Top Doctor. Dr. Badalian-Very has obtained her Medical degree from Semmelweis University and attended Harvard Medical School for a fellowship. During her fellowship training Dr. Badalian-Very and her collaborators at Dana Farber Cancer Institute and Harvard Medical School had a breakthrough when they demonstrated that Langerhans cell histiocytosis -an orphan childhood disease which had an unknown etiology for the past two centuries since the disease was defined by Langerhans- is a neoplasia. Currently the primary research focuses of Dr. Badalian-Very are secondary hepatic tumors, where lack of effective treatment gets manifested in 6-12 months of overall survival of affected individuals. Dr. Badalian-Very is a prominent speaker in international meetings and conferences and she serves as board member in several scientific societies. Dr. Badalian-Very has received several awards and recognitions from International societies such as Histiocytosis Association, Leading Physician of the World, National Association of Distinguished Professionals, Executive of the Year and Who’s Who in America. Gaia Medical Diagnostics and Intervention (GMDI) was Founded by Dr. Badalian-Very where she serves as Chief Executive Officer. GMDI focuses on personalized medicine and companion diagnostics to promote the medicine of future.

Abstract:

Personalized medicine attempts to identify tailored treatment based on the susceptibility profile of each individual. Although this approach has generated much excitement, few personalized-medicine therapies have achieved high levels of clinical adoption. To personalized medicine, one needs robust diagnostics and a clear understanding of disease pathomechanism. We have observed four main obstacles to the advancement of personalized medicine: scientific challenges (a poor understanding of molecular mechanisms or a lack of molecular markers associated with some diseases, for instance), economic challenges (poorly aligned incentives and high cost of new medications), lack of outcome based data (a comprehensive study of cost effectiveness/health benefit of personalized medicine) and operational issues. Although economic challenges remain, the scientific shortcomings and operational issues now seem to be the biggest hurdle. Diagnostics/companion diagnostics is the key to personalized medicine, yet it is hard to identify which tests truly save costs and select effective responders. On the other hand experimental testing leads to fears that although individual tests may not be very expensive, the overall eventual costs could be unjustifiably high. A third concern is the difficulty of enforcing standard protocols to ensure that physicians follow through with appropriate patient care based on test results. Fourth, test information could be misused—particularly in the early stages of investigation and development—which could harm patients and payers. Finally, there is no longitudinal accounting, which would enable payers to capture long-term cost savings from near-term testing. Even if operational issues get resolved within a particular stakeholder group, overcoming the scientific burden and correcting the incentive structure and modifying the relationships between stakeholders could be more complex.

Biography:

Jacinto was 23 years old when he completed his degree. He has an MSc in biophysics, a specialist in cytopathology at the Federal University of Pernambuco and a PhD from the University of São Paulo-USP. Currently: visiting professor at McGill University, Department of Oncology - Faculty of Medicine - Division of Cancer Epidemiology. Activities Federal University of Pernambuco-UFPE/Brazil: professor, coordinator of the cytopathology sector, coordinator of postgraduate cytopathology, professor/Supervisor of the Postgraduate Program in Pathology-POSPAT/UFPE, and professor/Supervisor of the Postgraduate Program in MorphoTechnology/UFPE. Lines of research: cancer (biomarkers and carcinogenesis), and Human Papillomavirus (HPV).

Abstract:

Cervical cancer is the third most common type of cancer among women worldwide. The infection and persistence of human papillomavirus (HPV) is the essential condition for this type of disease. However, only HPV infection is not enough for cervical pathogenesis are necessary cofactors and activation of intracellular and extracellular mechanisms to start and continue the process of progression of cervical lesions, such as the action of matrix metalloproteinase (MMP), one family endopeptidases capable of digesting the extracellular matrix components, basement membrane and induce tumor growth factors, leading to invasion and metastasis. Although much studied little is known about the specific mechanisms of MMPs in cervical lesions and its association with high-risk HPV oncoproteins. MMPs are important both for their role in carcinogenesis, as it constitutes potential markers for detection and analysis of prognostic and predictive of cervical lesions. This is because the initial intraepithelial lesions overexpressing certain MMPs tend to progress to invasion. Obtaining material for analysis of MMPs can be made by cytological brushed at the time of collection of the Pap smear or colposcopy as well as biopsies. Further study of the incidence of the polymorphisms of the MMP genes is also an additional form of predictive analysis in patients with cervical intraepithelial lesions.

Biography:

Gramatik Svetlana she completed his Phd at the age of 33 years from Grigoriev Institute from the National Academy of Sciences of Ukraine. She has a master\'s degree in infectious diseases. She is the assistant director of Grigoriev Institute for Medical Radiology Hospital, Kharkov, Ukraine. Is the Head Department of Laboratory Diagnostic and Heads of research Projects summary. She has published more than 30 papers in reputed journals and serving as an editorial board member of repute. She has published more than 10 training manuals for students and bachelors.

Abstract:

Despite advances in clinical therapy, metastasis is still the leading cause of death in breast cancer patients. Tumor cells also generate high levels of reduced forms of NAD+, NADH, and NADPH as important cofactors and redox components. Aim our present study the markers of potentially common to all breast cancer types metabolism as an essential driver of tumor growth and metastasis. Materials and Methods. 210 patients breast cancer patients we examined. Among them 147 patients were with metastatic breast cancer (MBC), 63 patients were with non-metastatic breast cancer (NMBC). Serum proteins phosphorescence and the oxidation protein modification were studied by the intensity of serum phosphorescence in 159 patients with breast cancer. Diagnosis was confirmed by clinical and histo-morphological methods. Native fluorescence emission of tissue tryptophan (340 nm), collagen (380 nm), NAD+/NADH (460 nm) and flavins (525 nm). Results and Discussion. Thus, total protein was increased in 14.8% and 9.3%, in patients NMBC and MBC. Research has found disorders of protein and fat metabolism in patients with breast cancer at which it should be considered that catabolic processes predominate over anabolic. Serum phosphorescence intensity in patients at activation with monochromatic light of 290 nm wavelength raised up by 1.2 and 1.93 times accordingly in NMBC and metastatic breast cancer in comparison with a group of conditionally healthy people. At activation with wavelength of 400 nm serum phosphorescence in patients increased by 3.5 times, at 380 nm by 3.1 times in comparison with a group of conditionally healthy people.

Biography:

Abstract:

Breast carcinomas in a dog is a malignant disease relatively frequent in bitches of 10 years old displays important morbidity and evolve to death. The cell block for the diagnosis of injury in women is the method of choice in the investigation, because it provides subsidies to provide for response to therapy. However, for the dog is unknown the application of this technique, therefore, this study aimed to correlate the morphological patterns of canine mammary tumors between cell block technique and surgical specimen and compare the immunohistochemical marking of ER, PR and CK5 between the two methods in 23 animals. After the diagnosis of breast carcinoma made by cytological exam the animal was submitted to mastectomy, FNA for cell block was made in the surgical specimen. The cell block and surgical specimens were submitted to histological processing, preparation of slides for HE and subsequent immunohistochemistry (IQ) for estrogen receptor α (ER) and cytokeratin 5 (CK5). Were considered positive for ER and CK5 the cases where there was marking on more than 10% of neoplastic cells. The level of agreement between the cell block and the surgical specimen was 86.9% for CK5 and 82.6% for the RE. Finally, the procedure that has been established for the woman when applied in dog kept the same benefits, such as affordable method, time and limited financial resources, sensitivity and specificity expressive. Therefore it validates the technique for the diagnosis of breast cancer in dogs.

Biography:

Dr. Giorgadze, Associate Professor of Pathology, received her MD and PhD degrees from Tbilisi State Medical University (Georgia). She completed her Anatomic and Clinical Pathology residency at East Tennessee State University, subsequently followed by Surgical Pathology and Cytopathology fellowships at the University of Pennsylvania. Dr. Giorgadze practices Surgical Pathology and Cytopathology and is an expert in Head and Neck Pathology. She has published more than 50 peer-reviewed papers in the major pathology journals. She is an editorial board member of Cytojournal and the journal of Applied Immunohistochemistry and Molecular Morphology, and is a committee member of Papanicolaou Society of Cytopathology.

Abstract:

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Fine needle aspiration (FNA) remains the cost-effective first line diagnostic modality in the evaluation of thyroid lesions. This practical presentation will focus on FNA cytomorphological of PTC variants, with the emphasis on its aggressive subtypes. The subtle cytomorphological differences between the common and aggressive variants of PTC seen in the conventional and liquid-based preparations (LBP) will be analyzed. A case-based approach will be used to discuss the pre-operative diagnosis of more aggressive PTC variants (tall cell, columnar cell, diffuse sclerosing, clear cell, and hobnail). Corresponding ultrasound images, gross and microscopic characteristics of follow-up surgical pathology specimens will be reviewed and correlated. The utility of ancillary studies (immunostains and molecular markers) which facilitate the diagnosis and help to differentiate variants of PTC from other primary thyroid tumors or metastatic malignancies will be addressed. Importance of recognition of aggressive variants of PTC in FNA specimens for the completeness of preoperative planning (total thyroidectomy, possible cervical lymph node dissection, and search for distance metastases) will be demonstrated. By the end of this presentation the participants will be able to recognize the differential cytomorphological criteria of PTC and its variants in the conventional and LBP preparations and effectively integrate clinical data, sonographic features and ancillary tests in the preoperative workup of these lesions.

Biography:

Grace C. H. Yang, MD is Clinical Professor of Pathology and Laboratory Medicine at Weill Medical College of Cornell University. She has published more than 100 papers in reputed journals and serving as an editorial board member of Acta Cytologica and Journal of American Society of Cytopatholgy, and was editorial board member of Cancer Cytopathology until 2013. She published “Thyroid Fine Needle Aspiration” in 2013.

Abstract:

Ultrasound-guided fine needle aspiration (US-FNA) has become a first diagnostic modality and a gold standard for evaluation of thyroid nodules and thyroid has become the most popular site for FNA. Recently, cytopathologists started to show interest in performing US-FNA themselves. In addition to special training in performing FNA under the US-guidance, familiarity with US features of various thyroid lesions is essential. In addition, up to 15% of thyroid FNAs were reported indeterminate. One way to reduce the "indeterminate" rate is to use team approach and to gain the knowledge of thyroid ultrasound by correlating ultrasound with the final cytologic findings with follow-up surgical pathology, including gross pathology and histologic findings of aspirated lesion. Knowing the gross and histopathologic basis of thyroid ultrasound will be tremendously helpful in cytologic interpretation and in minimizing the indeterminate and non-diagnostic rates in thyroid cytology. The presenter has been doing on-site assessment of >100,000 US-FNA of thyroid, and would like to share her collection of ultrasound, Doppler, FNA cytology, gross image of resected tumors, and histology ranging from scanning to high magnifications. Cases selected for this presentation are adenomatoid nodule, follicular adenoma, follicular adenoma with cystic degeneration, angioinvasive follicular carcinoma, follicular variant of papillary carcinoma, encapsulated follicular variant of papillary carcinoma, HÈ•rthle cell adenoma with post-FNA infarction, HÈ•rthle cell carcinoma, classic papillary carcinoma with psammoma bodies, cystic papillary carcinoma, hobnail variant of papillary carcinoma, tall cell variant of papillary carcinoma, and poorly differentiated thyroid carcinoma.

Biography:

MA El-Barrawy post doctoral fellow of M.D. Anderson Cancer & Tumor Institute, Texas University (Houston, USA): October 1988-April 1989 and currently teaching and supervising postgraduate Physicians, Pharmacists, Chemists, and Veterinarians enrolled at HIPH, Alex. University, to get their postgraduate degree. Having experience in various investigations of: Microbiology (Bacteriology, Virology and Mycology), Immunology, Clinical Pathology, Histocompatibility, and field surveys .

Abstract:

Ameloblastoma is the most frequently encountered neoplasm arising from the odontogenic epithelium. Beclin 1 protein plays a critical role in autophagy as a tumor suppressor gene. Whereas, the Murine Double Minute 2 (MDM 2) is a cellular proto-oncogene capable, if amplified, of causing tumor-genesis. The expression & prognostic significance of both genes are largely unexplored, yet, in this neoplasia. Therefore, the present investigation aimed to assess their possible biological role in ameloblastomas. Methods: This study was done among 35 studied cases: 29 cases of benign ameloblastomas, and 6 cases of ameloblastic carcinomas. Labeled Streptavidin Biotin (LSAB + Dako) immunohistochemical method, utilizing monoclonal antibodies for Beclin 1 & MDM 2 genes, was used. Results: Most of the benign ameloblastomas showed intense total cell positivity for the Beclin 1, while, the ameloblastic carcinomas revealed mild to negative expression. Inversely, the MDM 2 oncoprotein demonstrated intense brown total cell reactivity in amelobastic carcinoma & loss of the reaction to mild brown stain in benign ameloblastoma. Conclusion: Based from these findings, one could conclude that, MDM 2 could be a specific marker to identify the proliferative activity, tumor aggressiveness & directly proportional with the degree of malignancy. In contrast, the high Beclin 1 expression could be a good indicator of prognosis in ameloblastomas. Hence, an overall comparison, both studied genes may be very promising molecular prognostic biomarkers.

Biography:

Prof. DR. Ahmed El-Habashi has completed his MD, PhD at the age of 40 years from Cairo University and Tulane University in a channel system scholarship program. He got post-doctoral fellowship at Groningen University Hospital, The Netherlands at 1998. He is the past- director of pathology department, National Cancer Institute, Cairo University and now he is working in the capacity of Professor of Pathology. He got the International Board of Cytopathology from International Academy of Cytopathology at 2007. He is an international cytology speaker and he conducted many Cytopathology workshops in Egypt and Arab countries aiming to improve the cytology practice and profession. He has published more than 35 papers in reputed journals and has been serving as a reviewer for more than three reputed Journals.

Abstract:

Background: Fine-needle aspiration cytology (FNAC) has proven to be valuable tool in the primary diagnosis and management triage of patients with breast lesions. Objectives: This study aimed at evaluation of diagnostic utility of FNAC in breast lesions with an emphasis on potential cytological pitfalls that might lead to erroneous diagnoses. Methods: The study was carried out on 640 patients presented to breast clinic complaining of breast lumps. FNAC was performed after physical and radiological evaluation. The FNAC results were correlated with the available subsequent histological diagnoses and follow-up as a gold standard. The accuracy was calculated. The author discussed the cytologic pitfalls that may lead to “erroneous” false positive or false negative diagnoses. Results: The cytological diagnoses included unsatisfactory in 45 cases (7%), benign in 495 (78%), suspicious in 40 cases (6%) and malignant in 60 cases (9%). The potential causes of false positive diagnoses were fibroadenoma, Swiss cheese disease, lactating adenoma, Lactational mastitis, pregnancy changes, sclerosing adenosis, fat necrosis, ductectasia and others. The potential causes of false positive diagnoses were lobular carcinoma, mucinous carcinoma, adenoid cystic carcinoma, tubular carcinoma and proliferative changes with carcinoma transformation. The FNAC has achieved 94%, 100%, 100%, 98%, sensitivity, specificity, positive predictive value and negative predictive value, respectively, with an accuracy of 99%. Conclusions: This study confirmed the valuable diagnostic role of FNAC in management triage of patients with breast lumps. The diagnostic accuracy of this procedure can be significantly improved by acquiring a detailed clinico-radiologic data, obtaining an adequate specimen, having prior knowledge of the variety of diagnostic entities and strict application of established cytological criteria.

Biography:

Abstract:

Introduction Younger women generally do not consider themselves to be at risk for breast cancer, and in fact, just under 7% of all breast cancer cases occur in women under 40 years old. The incidence is strongly associated with the apprearence of the prognostic factors. Juvenile breast cancer seems to be more aggressive in comparison with other age-related breast cancer types. We present a case of a 23 year old female patient with appearance of multifocal breast cancer successfully diagnosed and treated. Case A 23 year old female patient was admitted to our Department complaining of pain and presence of a palpable mass located at her right breast. The physical examination confirmed this atypical appearance. The breast ultrasound and mammography revealed the presence of multifocality (hypodencic lesions at 10th , 11th hour and near the nipple). Due to the multifocality of the lesion a FNA of these areas was performed. The FNA examination confirmed the malignancy of the lesion. The preoperative staging of the lesion( bone scanning , CT thorax and abdominal CT) did not reveal any signs of metastatic infiltration. The patient underwent total right mastectomy. The sentinel node biopsy was positive for malignancy. After carrying out the mastectomy , a total axillary dissection was followed. (9/45 lymph nodes were infiltrated) The patient was discharged from the hospital in a good clinical condition on the 5pod. Depending on the multidisciplinary decision, the patient is undergoing cycles of chemotherapy, hormonal therapy(ER+ PR+ receptors) and radiotherapy. Discussion Breast cancer is very rare in adolescents and very young women. Invasive breast cancer occurring in women before the age of 35 years has a more aggressive biological behaviour and is associated with a worse prognosis than in older premenopausal women. Breast cancers in these young women are more frequently poorly differentiated, oestrogen-receptor (ER)-negative, have lymphovascular invasion and high proliferating fractions. Breast conserving methods are accompanied with high reccurence rate and should be offered adjuvant therapy. Conclusion Juvenile breast cancer represents a rare entity in comparison with all other age-related types. It is characterized by the aggressive infiltration and the high recurrence rate. Multidisciplinary approach is mandatory in order to establish the ultimate confrontation.