Day 1 :
Keynote Forum
Shahla Masood
University of Florida College of Medicine – Jacksonville, USA
Keynote: The Expanded Role of Cytopathology in Breast Cancer Research and Management
Time : 10.00AM
Biography:
Shahla Masood is currently a Professor and Chair of the Department of Pathology at University of Florida College of Medicine, Jacksonville and Chief of Pathology and Laboratory Medicine at Shands Jacksonville. She is also the Director of the Pathology Residency Training Program, as well as Cytopathology and Breast Pathology Fellowship Training Program. In addition, she is the Medical Director of Shands Jacksonville Breast Health Center. An internationally recognized expert in breast cancer diagnosis and prognosis, she has fostered the concept of an integrated multidisciplinary approach in breast cancer care, research and education. She has recently been appointed to chair a committee of the National Accreditation Program for Breast Centers (NAPBC) with a new initiative to explore the possibility of expansion of this program to an international level.
Abstract:
During the last several years, the discipline of cytopathology has played a major role in responding to the changing trends in breast health care. Pathologists have been engaged not only in interpreting but also in performing minimally invasive procedures. These procedures have proved efficient in the diagnoses of benign and malignant breast disease and are reliable in providing prognostic/predictive information. Fine needle aspiration biopsy is a time challenged, convenient, cost effective and rapid procedure, which is designed to remove the anxiety of a patient with a benign breast disease. With the availability of the bedside interpretation, the diagnosis of malignancy can accelerate plans for an optimal therapy. Core needle biopsy is more time consuming, more invasive and more expensive. It also shares similar limitations with FNAB. Sampling errors associated with inherent heterogeneity of breast lesions are serious concerns. In CNB, the rate of discovering carcinoma in situ in the follow up surgical excision of a lesion previously diagnosed as atypical ductal hyperplasia is significant. In addition, it is not unusual to discover invasive lesions in lumpectomy or mastectomy specimens diagnosed as in situ lesions by CNB. Despite the credibility of breast FNAB and CNB, the choice of the procedure will ultimately depend on local practice considerations and the availability of an experienced pathologist interested in breast cytopathology. The National Cancer Institute guidelines recommending appropriate FNAB sampling technique, training requirements, uniform criteria for specimen adequacy and radiologic pathologic correlation may assist in further acceptance of FNAB as a preferred diagnostic procedure particularly in palpable breast lesions. Aside from FNAB, breast cytomorphology has become an integral part of practice of breast pathology. The use of imprint cytology for assessment of metastatic disease in sentinel lymph node biopsy is now a common practice. Lymphatic mapping with sentinel lymph node biopsy allows a detailed pathologic examination of the nodes most likely to contain metastatic tumor. Intraoperative detection of metastasis will lead to complete axillary lymph node detection in one surgical setting. Imprint cytology has shown superiority to frozen section and is the recommended procedure by the College of American Pathologists and the panelist of the “Philadelphia Consensus Meeting for Sentinel Node Biopsy.†Imprint cytology has also been effectively utilized for assessment of breast lumpectomy margins as a complement to frozen section. In addition, recent focus on early breast cancer detection and prevention has opened a new way to use minimally invasive procedures, such as FNAB, nipple fluid aspiration and ductal lavage for identification of high risk individuals. Chemopreventive studies have already confirmed the value of cytomorphology as a risk predictor. Recognition of cytomorphology of high risk proliferative breast disease and premalignant lesions is an intriguing concept to identify patients who may benefit from various risks reduction modalities. Coupled with molecular biologic testing and the new innovative imaging and surgical procedure such as ductoscopy, soon there will be an exciting opportunity for breast cytopathology to become an integral part of breast cancer research and preventions.
Keynote Forum
Hamed Benghuzzi
University of Mississippi Medical Center, USA
Keynote: The Effects of Sustained Delivery of Estrogen on the Structural and Functional Activity of Renal Pathology
Time : 10:30-11:00
Biography:
Ham Benghuzzi received his Master in Chemistry and PhD in biological Sciences with concentration in physiology from University of Dayton in Ohio. In 1993, he completed postdoctoral training in pathology department at the University of Michigan Medical center. Thereafter, he joined the university of Mississippi Medical Center and currently he is professor in the department of diagnostic and clinical health sciences. He is a fellow of the American Institute of Medical and Biological Engineering, as well as, International Fellow of the World Congress of Biomaterials Societies (Japanese, American, Asian, and European). He is a pioneer scientist in ceramic drug delivery systems. His area of research is the development and applications of novel ceramic drug delivery systems (over 26 years/over 300 publications and 600 abstracts at various meetings). He served and serving as a major advisor for over 35 PhD students as well as a mentor for students at various levels (High school, undergraduate, MS, residents and postdoctoral). He received Nemours awards and honors from very prestigious societies and organizations. He was invited as a keynote speaker at state, national and international levels. His recent research was the first, worldwide, to histopathologicaly identify the role of sustained delivery of reproductive hormones in the induction of azoospermia.
Abstract:
It was reported in numerous studies that estrogen replacement therapy in post-menopausal women may interfere with the functional capacity of the renal system. Strong scientific evidence about the level of alternation at the glomerular level has to be elucidated. Several experiments conducted in our laboratories hypothesized that sustained delivery of estrogen will alter the glomerular structure and function. The specific objective of this research was to evaluate the effect of physiological dose (10-20 pg./ml) of sustained delivery of estrogen on the glomerular histopathology using adult ovariectomized adult rats as a model. A total of 120 rats were divided into four equal groups and served as intact, control, sham (OVX), exposed to sustained delivery of E, respectively. At the end of 2, 4 and 8 weeks post treatment ten animals from each group were sacrificed and the kidney were removed, fixed and processed for histopathological evaluation following standard laboratory protocols. Blood samples were collected daily for eight weeks and subjected to differential hematology. The results of this study demonstrated that the wet weights of the kidneys collected from estrogen treated animals has shown a slight increase in weight compared to intact animals (p< 0.05). Histopathological evaluation revealed that the glomeruli appeared slightly larger in the E treated animals compared OVX, Sham and intact animals. Occasional tubular damage was observed at the end of 8 week phase in estrogen exposed animals. Major shift in essential biomarkers were noted upon sustained delivery of estrogen at the end of two weeks. Gonadotropins levels were suppressed in all estrogen treated animals compared to OVX group. This observation may contribute to a functional change in the filtration rate and has to be taken in consideration in the renal function assessment.
Keynote Forum
Sin Hang Lee
Milford Molecular Diagnostics, USA
Keynote: Workshop on Continued partnership between gynecologists and cytopathologists in the era of molecular medicine to prevent cervical, ovarian and breast cancers
Time : 11.20-12:00
Biography:
Sin Hang Lee, M.D. graduated from Wuhan Medical College in China. After a residency-fellowship at Cornell-New York Hospital and Memorial Hospital for Cancer, Dr. Lee was certified by the American Board of Pathology and obtained the F.R.C.P. (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. Dr. Lee is currently the director of Milford Molecular Diagnostics, Milford, Connecticut. In the past 10 years, Dr. Lee has developed Sanger sequencing-based testing methods for HPV, Neisseria gonorrhoeae, Chlamydia trachomatis, Lyme disease borreliae and Ebolavirus implementable in community hospitals.
Abstract:
The cervical screening partnership between gynecologists and cytopathologists has lowered the number of cervical cancer deaths to about 4,000 per year, representing a 70% reduction in the United States. In comparison, 40,290 women and 14,180 women are still expected to die of breast cancer and ovarian cancer each year, respectively, due to a lack of effective cancer risk screening tools for the latter two malignancies. Since the carriers of the germline BRCA1 185delAG, BRCA1 5382insC and BRCA2 6174delT mutations are known to be at high risk of developing breast cancer and ovarian cancer, universal screening for these 3 mutations for all women at age 30 has been recommended if the cost for such screening can be markedly reduced and the quality of the tests can be assured [King MC, et al. JAMA 2014;312:1091-1092. ]. Presymptomatic salpingo-oophorectomy for these high-risk women after child-bearing ages can reduce breast cancers and ovarian cancers as well as overall mortality [ http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/Routine-Screening-for-Hereditary-Breast-and-Ovarian-Cancer-Recommended ]. The author will present a simplified technology to use liquid-based Pap smear cytology specimens (SurePath® or ThinPrep®) to detect single nucleotide deletions and insertions by Sanger sequencing for the detection of these BRCA mutations (see sample of a BRCA1 5382insC mutation with underlined “CCCC†instead of a normal “CCC†sequence). If these 3 BRCA mutations are tested in conjunction with Pap smear and HPV assays, the cost may be reduced to $200 per test since all the reagents are generic and inexpensive.
Keynote Forum
Qing Kay Li
The Johns Hopkins University School of Medicine, USA
Keynote: Current concept in the new WHO classification of lung cancers, and its impacts on the cytological differential diagnosis of lung cancers
Time : 12:00
Biography:
Dr. Li is an internationally recognized expert in the field of cytopathology and co-PI in Johns Hopkins Biomarker Discovery Center. She provides diagnostic surgical pathology service at Johns Hopkins Bayview Medical Center, and conducts research in the field of novel biomarkers in lung and prostate cancers. Her work 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 80 publications and book chapters. Dr. Li is also the co-editor of “Diagnostic Cytopathology Board Review and Self-Assessmentâ€.
Abstract:
The new WHO classification of lung cancers has been published recently. Several concepts and guidelines have been incorporated into this new edition based on molecular characterizations of lung tumors and targeted therapies. Many improvements have already been made in the past decade due to the discovery of EGFR mutation and the innovation of new diagnostic techniques. The new WHO classification has a critical impact on the cytological practice. The cytological specimens commonly used in clinical diagnosis include: sputum, bronchial brushing and washing, bronchoalveolar lavage, transbronchial fine needle aspiration (TBNA), endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA), and transthoracic CT- or ultrasound-guided fine needle aspiration. Familiarity with the new classification of lung cancers, cytomorphological features of respiratory specimens, and techniques of obtaining these samples are critical in order to make an accurate diagnosis. In addition, ancillary studies, including immunohistochemical studies and molecular tests, also play important roles in lung cancer classification. In this presentation, we will discuss the current concept of lung cancers, and the utility of ancillary tests, including immunohistochemistry and molecular test, in the classification of lung cancers.
Keynote Forum
Hamed Benghuzzi
University of Mississippi Medical Center, USA
Keynote: The Effects of Sustained Delivery of Estrogen on the Structural and Functional Activity of Renal Pathology
Time : 09.00AM
Biography:
Dr. Ham Benghuzzi received his Master in Chemistry and PhD in biological Sciences with concentration in physiology from University of Dayton in Ohio. In 1993, he completed postdoctoral training in pathology department at the University of Michigan Medical center. Thereafter, he joined the university of Mississippi Medical Center and currently he is professor in the department of diagnostic and clinical health sciences. He is a fellow of the American Institute of Medical and Biological Engineering, as well as, International Fellow of the World Congress of Biomaterials Societies (Japanese, American, Asian, and European). He is a pioneer scientist in ceramic drug delivery systems. His area of research is the development and applications of novel ceramic drug delivery systems (over 26 years/over 300 publications and 600 abstracts at various meetings). He served and serving as a major advisor for over 35 PhD students as well as a mentor for students at various levels (High school, undergraduate, MS, residents and postdoctoral). He received Nemours awards and honors from very prestigious societies and organizations. He was invited as a keynote speaker at state, national and international levels. His recent research was the first, worldwide, to histopathologicaly identify the role of sustained delivery of reproductive hormones in the induction of azoospermia.
Abstract:
It was reported in numerous studies that estrogen replacement therapy in post-menopausal women may interfere with the functional capacity of the renal system. Strong scientific evidence about the level of alternation at the glomerular level has to be elucidated. Several experiments conducted in our laboratories hypothesized that sustained delivery of estrogen will alter the glomerular structure and function. The specific objective of this research was to evaluate the effect of physiological dose (10-20 pg./ml) of sustained delivery of estrogen on the glomerular histopathology using adult ovariectomized adult rats as a model. A total of 120 rats were divided into four equal groups and served as intact, control, sham (OVX), exposed to sustained delivery of E, respectively. At the end of 2, 4 and 8 weeks post treatment ten animals from each group were sacrificed and the kidney were removed, fixed and processed for histopathological evaluation following standard laboratory protocols. Blood samples were collected daily for eight weeks and subjected to differential hematology. The results of this study demonstrated that the wet weights of the kidneys collected from estrogen treated animals has shown a slight increase in weight compared to intact animals (p< 0.05). Histopathological evaluation revealed that the glomeruli appeared slightly larger in the E treated animals compared OVX, Sham and intact animals. Occasional tubular damage was observed at the end of 8 week phase in estrogen exposed animals. Major shift in essential biomarkers were noted upon sustained delivery of estrogen at the end of two weeks. Gonadotropins levels were suppressed in all estrogen treated animals compared to OVX group. This observation may contribute to a functional change in the filtration rate and has to be taken in consideration in the renal function assessment.
- Workhop
Session Introduction
Sin Hang Lee
Milford Molecular Diagnostics, USA
Title: continued partnership between gynecologists and cytopathologists in the era of molecular medicine to prevent cervical, ovarian and breast cancers
Time : 11:20-12:00
Biography:
Sin Hang Lee, M.D. graduated from Wuhan Medical College in China. After a residency-fellowship at Cornell-New York Hospital and Memorial Hospital for Cancer, Dr. Lee was certified by the American Board of Pathology and obtained the F.R.C.P. (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. Dr. Lee is currently the director of Milford Molecular Diagnostics, Milford, Connecticut. In the past 10 years, Dr. Lee has developed Sanger sequencing-based testing methods for HPV, Neisseria gonorrhoeae, Chlamydia trachomatis, Lyme disease borreliae and Ebolavirus implementable in community hospitals.
Abstract:
The cervical screening partnership between gynecologists and cytopathologists has lowered the number of cervical cancer deaths to about 4,000 per year, representing a 70% reduction in the United States. In comparison, 40,290 women and 14,180 women are still expected to die of breast cancer and ovarian cancer each year, respectively, due to a lack of effective cancer risk screening tools for the latter two malignancies. Since the carriers of the germline BRCA1 185delAG, BRCA1 5382insC and BRCA2 6174delT mutations are known to be at high risk of developing breast cancer and ovarian cancer, universal screening for these 3 mutations for all women at age 30 has been recommended if the cost for such screening can be markedly reduced and the quality of the tests can be assured [King MC, et al. JAMA 2014;312:1091-1092. ]. Presymptomatic salpingo-oophorectomy for these high-risk women after child-bearing ages can reduce breast cancers and ovarian cancers as well as overall mortality [ http://www.acog.org/About-ACOG/News-Room/News-Releases/2009/Routine-Screening-for-Hereditary-Breast-and-Ovarian-Cancer-Recommended ]. The author will present a simplified technology to use liquid-based Pap smear cytology specimens (SurePath® or ThinPrep®) to detect single nucleotide deletions and insertions by Sanger sequencing for the detection of these BRCA mutations (see sample of a BRCA1 5382insC mutation with underlined “CCCC” instead of a normal “CCC” sequence). If these 3 BRCA mutations are tested in conjunction with Pap smear and HPV assays, the cost may be reduced to $200 per test since all the reagents are generic and inexpensive.
- Cancer Cytopathology | Cervical Cytopathology | Histopathology | DNA Pap Cytology | Urine Cytology
Chair
Shahla Masood
University of Florida College of Medicine Jacksonville, USA
Co-Chair
Hamed Benghuzzi
University of Mississippi Medical Center, USA
Session Introduction
Keith J. Kaplan
Pathologist | CMO | Corista Publisher
Title: Update on Digital Pathology in Cytopathology
Time : 12:00-12:25
Biography:
Kaplan is a native of Chicago and a graduate of Michigan State University. He is a graduate of Northwestern University Feinberg School of Medicine and completed residency training in anatomic and clinical pathology at Walter Reed Army Medical Center, Washington, DC. Dr. Kaplan is board certified in anatomic and clinical pathology. His subspecialty interests include gastrointestinal and hepatic pathology, cytopathology and pathology informatics as well as research interests in gastrointestinal and hepatobiliary pathology, hyperspectral imaging, image analysis and the use of Web 2.0 tools in pathology. He has authored over 60 peer-reviewed scientific articles, book chapters, editorials and scientific abstracts and frequently lectures at both national and international meetings on topics related to pathology informatics. Dr. Kaplan currently serves as a member of the College of American Pathologists, American Society of Clinical Pathology and the American Society of Cytopathology as well as the American Pathology Foundation. He is also an executive board member of the American Pathology Foundation.
Abstract:
There is a growing body of literature referencing the uses of telecytopathology in clinical care. Telecytopathology (TCP) is the interpretation of cytopathology material at a distance using digital images. Although there is a long history of attempts at implementing TCP for broad clinical use, it still has limited, but important applications in patient care. While the technology has improved from low-grade video quality images to higher-grade static digital images and more recently, whole slide imaging with sub-micron resolution scanning capabilities, the nature of cytology material itself, both in terms of quantity and often quality of cells that can be imaged and viewed at a distance remains a challenge. Cytology material often is not as uniform as formalin-fixed paraffin embedded tissue in terms of thickness for focusing and cells with three-dimensionality may be spread across an entire slide compare with conventional histology processing. The use of multiple stains to detect subtle features, such as Papanicolaou and Romanowsky in tandem, may increase the number of slides to be viewed and limiting digital pathology techniques to perform assessments in a timely manner. While fine needle aspiration (FNA) is certainly not a new technique, recent developments in advanced imaging techniques, molecular testing and targeted therapies have coincided with a rapid increase in the number of FNA procedures being performed. Consequently, the demand for rapid on-site assessment has also increased, outstripping the capacity of available cytopathologists at many institutions. This session will address the value proposition and use cases for digital pathology in cytopathology.
Maoxin Wu
Stony Brook University Hospital, USA
Title: Ultrasound-guided Fine Needle Aspiration Cytology practice
Time : 12:25-12:50
Biography:
Maoxin Wu is a clinical full Professor of Pathology. She has completed her MD from Shanxi Medical University in China and subsequently earned PhD from University of Illinois in USA and passed all steps of examinations and trainings and certified to become a Medical Doctor in the United States. She is specialized in Pathologist with expertise in cytopathology and fine needle aspiration under ultrasound guidance. She has served as the Director of Cytopathology at two major academic medical centers (Mount Sinai Medical Center and Stony Brook University Hospital) in the United States for the past 10 years. She has published more than 60 papers and has been serving as Co-Editor and Reviewer of reputable scientific journals.
Abstract:
Introduction: Fine Needle Aspiration (FNA) cytology under ultrasound (US) guidance is a desirable diagnostic model, especially when the procedure is performed by a cytopathologist. The author will share her 8-year experiences as a board certified cytopathologist who also performs US-guided procedures in academic institutions in New York, USA. Aim: To provide guidance and road map for the audiences who are interested in building a US- guided FNA practice themselves. Materials & Methods: Various strategies for creating a US-FNA practice will be discussed. Representative case examples will be illustrated. Relevant published and unpublished data will be summarized for this presentation. Results: The results will be shown at the conference as published data, case examples, and recent data based on the new practice estabolished by the author at Stony Brook University Hospital. Conclusions: US-FNA cytology practice is a valuable medical practice that may provide not only accurate cytological diagnoses but also sufficient material for ancillary studies in majority of patients with superficially located masses including non-palpable ones. Such a one-stop-shop model practice should be applied, so that patients may receive maximum benefit with minimal or virtually no risk of complications.
Leena Elizabeth Joseph
University Hospitals South manchester NHS Foundation trust, United Kingdom
Title: Comparision of cytological preparations and optimisation of DNA retrieval from EBUS specimens
Time : 12:50-13:15
Biography:
Leena Elizabeth Joseph (MD Pathology: FRCPath) has been based in Manchester UK, for the last 18 years. Her specialist interests are in the fields of cardiothoracic, breast and Dermatopathology. She is the Clinical director Of Pathology at University hospitals South Manchester and this study was done in close collaboration with the Respiratory physicians at the UHSM Lung cancer centre and the Genomics laboratory in central Manchester.
Abstract:
In pharmocogenetic studies DNA extraction from fixed tissues is traditionally problematic as the DNA produced is highly fragmented and yields are often low. This can lead to a failure to obtain a result from some tumour samples thereby preventing the prescription of targeted therapies to some patients. The finding that Cytology samples can yield much larger amounts of good quality DNA is therefore of great potential benefit providing an improved resource of DNA for testing. There is also the potential that the greater quantities and higher quality DNA isolated fresh Cytology samples will be more suitable for broad based panel screens using NGS where DNA isolated from FFPE tissue is often inadequate. In our study we have analysed the DNA content in fresh samples and in FFPE samples.The success of sequencing and ability to detect mutations were comparable for both fresh and fixed cells although there was a suggestion that success rates and mutation detection may be better for the fresh cells. However, the sample size is very small and the significance of the data would need to be tested on a larger sample.
Sahar Samaha
Miraca Life Science, USA
Title: Correlation of p16 expression and the clinicopathologic presentation of Anal Squamous Cell Carcinoma
Time : 14:00-14:25
Biography:
Sahar Samaha, M.D. is board certifi ed in AP/CP and Cytopathology. She 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 fi nished her residency and obtained her master’s degree in Ophthalmology. She is the director of Aloha lab at Miraca life sciences.
Abstract:
BACKGROUND : Many studies have shown a strong association between human papilloma virus (HPV) and anal squamous cell carcinoma (ASCC). Recent studies have also shown that HPV- related squamous cell carcinoma typically show abnormal overexpression of p16(INK4a), which is detected by immunohistochemical (IHC) staining. In this study we will compare the clinicopathological features of p16 positive (p16+)and p16 negative (p16-) ASCC. DESIGN : Th e Miraca Life Sciences Data Warehouse was searched for cases with the diagnosis of ASCC on anal biopsies diagnosed between 1/1/2009 and 6/1/2011. Th e fi rst 50 consecutive cases were included in this study. Original H&E stained slides were retrieved. Th e slides were reviewed by 3 pathologists and a representative block was selected for p16 immunohistochemical analysis. Pertinent clinical and pathologic details were gathered. RESULTS : We get 43 (86%) p16 positive ASCC patients, 11 male and 32 female with mean age at presentation 63.6 of the 43 p16 positive ASCC, 23 (53.5%) were poorly diff erentiated including the basaloid pattern and 20 (46.5%) were moderately diff erentiated. p16 negative ASCC patients were 7 (14%), 3 male and 4 female with mean age at presentation 74.8. All 7 (100%) p16 negative ASCC were moderately diff erentiated. CONCLUSION : p16 + ASCC represented the majority of ASSC (86%). Th is group of patients had a female predominance and a wide range for age of presentation (47-84, mean=63.6). Patients with p16 (-) ASCC represent only 14% of cases. Th ey presented at older age (54-91, mean =74.8) and showed almost equal gender distribution. Interestingly, poorly diff erentiated ASCC was only seen in p16 + ASCC and represented 53.5% of this group.
Laurentia Nodit
University of Tennessee, USA
Title: Rapid on-site evaluation (ROSE) in a busy cytopathology practice
Time : 14:25-14:50
Biography:
Laurentia Nodit is a board-certified Anatomical and Clinical Pathologist and board-certified Cytopathologist. She currently serves as an Associate Professor and Cytopathology Residency Rotation Director at the University of Tennessee in Knoxville. She was graduated from University of Medicine, Romania and followed up with Pathology Residency and Specialty Fellowships in Cytopathology and Gastrointestinal Pathology at University of Pittsburgh and University of Alabama at Birmingham, USA. She has more than 30 publications in reputed journals in areas of pancreatic cytopathology and surgical pathology.
Abstract:
Current cytopathology practice requires teamwork to assure adequate tissue sampling and specimen triage for proper diagnosis and patient management. With the advent of molecular studies required for appropriate treatment, there is a greater pressure to obtain more diagnostic information from less tissue. Immediate feedback regarding the need for additional passes and a preliminary on-site diagnosis assures tissue submission for ancillary studies with the main goal of avoiding repeat procedures, fewer patient complications and significant overall cost savings. Although adequacy criteria are available for some tissue samples, for other cytology samples the adequacy criteria, the sequence for tissue retrieval and workflow are not well defined. 6 months review performed in our cytopathology practice showed significant pitfalls in different areas including test ordering, clinical history and nature of the lesion, as well as specimen preparation, microscopic interpretation and communication which influenced the intraoperative decision making. Practical process improvements will be demonstrated in cases of lymphoma work-up, pulmonary cytopathology and CT-guided biopsies of other organs.
Kuan Chou Chen
Shuang Ho Hospital, Taipei Medical University, Taiwan
Title: De novo large cell neuroendocrine carcinoma (LCNEC) of the prostate
Time : 14:50-15:15
Biography:
Kuan Chou Chen has completed his MD degree at the age of 25 years from School of Medicine, Taipei Medical University and PhD studies from Graduate Institute of Clinical Medicine, Taipei Medical University. He is the professor and director of Department of Urology, School of Medicine, College of Medicine, Taipei Medical University and Department of Urology, Shuang Ho Hospital, Taipei Medical University. He has published more than 40 papers in SCI journals and has been serving as a reviewer of several scientific journals.
Abstract:
Large cell neuroendocrine carcinoma (LCNEC) of the prostate is extremely rare. Previously reported cases in the literature were almost exclusively developed in men receiving androgen deprivation therapy (ADT) for prostate adenocarcinoma. We herein present a case of de novo LCNEC: A 66-year-old man was incidentally diagnosed as LCNEC after he underwent transurethral resection of prostate. The pathologic examination of the surgical specimen revealed large cell neuroendocrine carcinoma of the prostate (LCNEC), involving more than 90% of prostate tissue. Microscopically, it showed solid sheets, trabeculae and smaller nests of tumor cells with high nuclear cytoplasmic ratio, eosinophilic cytoplasm and brisk mitotic activity. Large areas of tumor necrosis are noted. Conventional acinar adenocarcinoma of prostate was not found. Immunohistochemical (IHC) stains showed diffusely positive for pan-cytokeratin, and synaptophysin [Figure 1C and 1D]. It was focally positive for Ki-67, chromogranin, p53, and c-Myc, TTF-1 [Figure 2]. Stains for CK7, CK20, AR, PSA, P504S, p63, GATA-3, vimentin, and CD45 were negative. A computed tomography scan (CT scan) of the abdomen and pelvis revealed an irregular soft mass measuring about 12 cm in diameter with pelvic wall invasion. On the basis of above finding, initial TNM stage is pT4N1M1. Therefore, the patient was treated with 6 cycles of cisplatin and etoposide in the following 6 months, which achieved a partial remission. He gave up the chance to eradicate the residual mass. Three months later, the tumor progressed rapidly. In conclusion, LCNEC is a rare prostate cancer. Our experience shows that chemotherapy with etoposide and cisplatin is effective to achieve a significant remission. However, LCNEC is highly malignant in nature, post-chemotherapy surgery for the residual mass should be considered.
Hung-Tu Huang
Kaohsiung Medical University, Taiwan
Title: Inflammation enhances exocytotic release of secretory granules in serous cells of the trachea in specific pathogen free rats
Time : 15:15-15:40
Biography:
Hung-Tu Huang has completed his PhD from Kaohsiung Medical University and Postdoctoral study in the University of California San Francisco Cardiovascular Research Institute. He has been a professor and chairman in Department of Biological Sciences, National Sun Yat-Sen University. Currently, he is a Professor of Anatomy, School of Medicine in Kaohsiung Medical University. He has ublished more than 50 papers in reputed journals and served as Reviewer of several journals.
Abstract:
The epithelium of the trachea of specific pathogen free rats is characterized by the presence of numerous serous cells with secretory granules containing calcitonin gene related peptide, instead of goblet cells with mucin granules. Few studies investigate the secretory activity of serous cells. The present study investigated whether a high dose of histamine administered intravenously, an important mediator of mast cells in pathogenesis of asthma, could increase serous cell secretion that was associated with tracheal mucosal inflammation and edema formation and whether pretreatment with mepyramine, a H1 receptor inhibitor, could inhibit serous cell secretion. Transmission and scanning electron microscopy showed that histamine application resulted in an increase in the number of actively secreting serous cells as evidenced by exocytotic figures and plasma membrane invaginations. Mepyramine, but not atropine, significantly inhibited the histamine induced acute inflammation and serous cell degranulation. The present study concluded that histamine induced plasma leakage, mucosal edema and serous cell exocytosis mediated through H1 receptors in the trachea of specific pathogen free rats.
Sangjeong Ahn
Pusan National University Hospital, South Korea
Title: Can we use alternative tumor size criteria in T3 sub-classification of pancreas head cancer?
Time : 15:40-16:05
Biography:
Sangjeong Ahn has completed his MD, Resident training from Korean University Medical Center and Fellow training from Samsung Medical Center. She is the Assistant Professor of Pusan National University Hospital.
Abstract:
Background: Pathologic tumor staging is the most powerful predictor. However tumor staging of pancreatic cancer has been known to be less predictive because most surgically resected pancreatic cancer corresponds to T3. We hypothesized current T3 included wide range of cases and suspected tumor size can be useful parameter to induce alternative pathologic T3 sub-staging system. Method: We reviewed surgically resected 151 pancreatic head cancer cases during 2006~2009. The receiver operating characteristic curve was used to verity that tumor size is a superior predictor of survival to pT stage. Further a recursive partitioning technique with the log-rank test was used to identify a significant cutoff value for the sub-staging of tumor size of pancreas head cancer using. Result: Among total 151 cases, 2 cases were staged as T2 (1.3%), 148 cases as T3 (96.1%) and 4 cases as T4 (2.6%), respectively. The mean size of tumor was 3.0 cm, ranging 1.4~6.0 cm. ROC curve analysis revealed that tumor size reflects patients survival better than current pT stage of AJCC 7th edition (AUC=0.707, P=0.001; AUC=0.530, P=0.626). The cutoff value of tumor size was 2.4 cm and 3.6 cm, which segregated patients into 3 groups: Each group with statistically significant decreasing length of median survival (P<0.001). Conclusion: We found tumor size cutoff value 2.4 cm and 3.6 cm could be an alternative size criteria in sub-classification of pathologic T3 pancreatic head carcinoma. Here we propose an alternative size criterion in T sub-classification of pancreas head cancer.
Laurentia Nodit
University of Tennessee, USA
Title: Challenges in fine needle aspiration of pancreatic cystic lesions
Time : 16:15-16:40
Biography:
Laurentia Nodit is a board-certified Anatomical and Clinical Pathologist and board-certified ytopathologist. She currently serves as an Associate Professor and Cytopathology Residency Rotation Director at the University of Tennessee in Knoxville. She was graduated from University of Medicine, Romania and followed up with Pathology Residency and Specialty Fellowships in Cytopathology and Gastrointestinal Pathology at University of Pittsburgh and University of Alabama at Birmingham, USA. She has more than 30 publications in reputed journals in areas of pancreatic cytopathology and surgical pathology.
Abstract:
During the last two decades, endoscopic ultrasound fine needle aspiration (EUS-FNA) has revolutionized the diagnosis and treatment of pancreatic lesions. Cystic lesions of the pancreas are incidentally recognized with increasing frequency due to widespread use of advanced imaging modalities. Their characterization is challenging on FNA cytology, mainly due to sparse cellularity. The presentation provides an overview of the main cytologic findings in common and rare entities, as well as biochemical and emerging molecular markers in cyst fluid analysis which complement the cytologic examination. Integration of Bethesda guidelines for evaluation of these samples, correlation with the WHO classification of pancreatic tumors and future promising advances in diagnostic techniques will be discussed.
Mahboob Hasan
Aligarh Muslim University, India
Title: Spectrum of Granulomatous Lesions with Emphasis to Tuberculosis- A Cytopathological Perspective
Time : 16:40-17:05
Biography:
Mahboob Hasan has completed his M.B.B.S and M.D in Pathology from Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. He is presently working as a Professor in the department for 05 years. He has published more than 30 research papers in reputed journals and has been the Organizing Secretary of International Symposium on Women’s ((Breast & Gynae) Pathology. He has been involved in WHO funded project "Development of an atlas of cancer in India" under the aegis of National Cancer Programme and supervised and co-supervised more than 10 M.D.
Abstract:
A wide range of infectious and noninfectious causes are known to produce granulomas. The aim of this study is to analyze the spectrum of cytological presentation of dermal granulomatous diseases and their clinic-histopathological correlation. Twenty-five infectious and non-infectious lesions were studied on the basis of their clinical presentation, cytological impression and correlated with the histopathological findings along with special stains. Out of the 25 granulomatous lesions studied, 15 cases (60.0%) were bacterial, 2 cases (8.0%) each of fungal and associated with malignancy and 6 cases (24.0%) due to non-infectious etiology like granuloma annulare and foreign body associated were recorded. Amongst the bacterial granulomatous lesions, predominance of Mycobacterium tuberculosis was seen, 09 cases (36.0%). 4 cases (16.0%) of cutaneous tuberculosis caused by Mycobacterium tuberculosis was seen in our study and were typified as lupus vulgaris, 3 cases (12.0%), 2 cases (8.0%) each of tuberculosis lip and tongue and a single case (4.0%) each of conjunctival tuberculosis and tuberculosa verrucosa cutis. The varied presentation of Hansen’s disease in our study included 4 cases (16.0%) of tuberculoid leprosy and 2 cases (8.0%) each of lepromatous leprosy and borderline tuberculoid leprosy. Single case (4.0%) of Klebsiella rhinoscleromatis was also seen. Granulomatous lesions have varied modes of presentation. A classical clinical picture may not always be present, posing a diagnostic challenge. Cyto-histopathological studies help in arriving at a conclusive diagnosis, if aided by a proper clinical history and examination and assisted by special stains, culture of organisms, PCR and immunoflourescence.
Reena Tomar
Maulana Azad Medical College, India
Title: Comparison between modified ultrafast Papanicolaou stain (MUFP), rapid economic acetic acid Papanicolaou (REAP) and Papanicolaou stain (PAP) in routine cytology
Time : 17:05-17:30
Biography:
Reena Tomar has completed her MD in Pathology from Government Medical College, India in 2010. She is currently an Assistant Professor at Department of Pathology at Maulana Azad Medical College (MAMC), India. She has great interest in cytohistopathology and has published many articles in national and international journals.
Abstract:
Objectives: The objective of this study is to compare three stains MUFP (Modified Ultrafast Papanicolaou), REAP (Rapid Economic Acetic acid Papanicolaou) and PAP (Papanicolaou) on routine cytopathology, to assess its utility depending on nuclear characteristics, cytoplasmic details, air drying artefacts, cell morphology and background and to calculate the quality index. Methods: 100 patients attending fine needle aspiration (FNA) clinic of tertiary hospital of India were selected. Various sites including breast, thyroid, lymph nodes, salivary glands and Gynecological smears were included. Three smears per organ were made and stained with MUFP, PAP and REAP respectively. Results: Air dried fixed and MUFP stained smears showed clean background. MUFP stained smears showed crisp nuclear characteristics. REAP stained smears were similar and economical to PAP stained smears but nuclear morphology was not very clear. Conclusions: MUFP is a very good alternative to PAP stain in benign as well as malignant lesions. REAP stain is a good economical alternative in benign lesions.
Leyla Bahar
Mersin University, Turkey
Title: Investigation of Relationship Between -1195 A>G Polymorphism of COX-2 Gene and mRNA Levels of COX-2 Gene in Peripheral Blood Monocyte in Colorectal Cancer Patients
Time : 17:30-17:55
Biography:
Leyla Bahar; after graduate from Çukurova University Faculty of Medicine, she worked as a doctor in Mersin until 2002. In Department of Histology-Embryology she completed her PhD in Mersin University Faculty of Medicin in 2008. She has published more than 20 papers and announcement in journals and has been serving as an editor and editorial board member of repute. Leyla Bahar still continues to work as scientist and lecturer at Mersin University who is working on many issues and as peer-review in journals.
Abstract:
Colorectal cancer (CRC) arises from the colorectal epithelium as a result of the accumulation of genetic alterations in defined oncogenes and tumour suppressor genes. The molecular changes occurring during the development of the tumor must be investigated in order to understand the carcinogenesis. The cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, catalyze the formation of prostaglandins, thromboxane, and levuloglandins. COX-2 is induced by inflammatory and mitogenic stimulants and prevails on tumor carcinogenesis by increasing the prostaglandin synthesis in inflammatory and neoplastic tissues. The aim of this study was to investigate the association the COX-2 gene -1195 A>G polymorphism and CRC risk. We also investigated the relationship between the COX-2 gene mRNA levels in peripheral blood monocytes and -1195 A>G polymorphism in CRC. Ninety individuals with CRC and 106 healthy individuals are included in our study. The genotypes are determined by using PCR-RFLP. RNA of individuals withs CRC is isolated and RT-PCR is applied. Genotype distribution and allelic frequencies for -1195 A>G polymorphism of COX-2 gene weren’t significantly different between patients and controls. COX-2 gene mRNA levels and genotype distributions of this polymorphism no difference between CRC patients and controls. While one of the other factors of developing CRC; the advanced age and male gender increases the risk of developing CRC, BMI, smoking and alcohol intake have no affect on risk of developing CRC. Our study is the first study to investigate the relation between -1195 A>G polymorphism and mRNA levels of COX-2 gene in CRC in Turkish population.
Biography:
Dr. Rao is a professor of pathology and epidemiology, the chief of Cytopathology, the director of international telepathology, and the medical director of cytotechnology school at UCLA. He has been invited to be a speaker for over 100 meetings and occasions locally, nationally and received continuous funding from NIH or other agencies n the last 25 years, with over 150 peer-reviewed research publications and served as an editor for many scientific journals. His notable research accomplishments include established the international Telepathology program for patient second opinion consultation, investigated cytoskeletal actin remodeling in cancer development and progression, and studied cellular nano-mechanical profiling as a biomarker for cancer.
Abstract:
The hallmark of cancer is the invasive and metastatic nature of the disease. Cancer cell invasion and metastasis are driven by the altered cytoskeletal infrastructures that result from the complex interplay of activation/inactivation of multiple signaling pathways regulating these cellular events, which can occur at either the genetic or epigenetic level. Thus, attempts to accurately assess these physiologically relevant mechanical properties of cancer cells using single, or even multiple marker profiles at the DNA, RNA, or protein level, have largely been unsuccessful. Recently we showed that cancer cell mechanical properties, or mechanotypic biomarkers, including cell elasticity and deformability can be directly and accurately measured by state of the art label-free technologies at the single cell level. These mechanical properties of cells can be a marker for cancer cell behavior including invasion, metastasis, and drug response. Our multi-disciplinary team of investigators developed an approach that combines morphology, molecular, and mechanotypic profiling for cancer cell analysis, a process called “Nanocytologyâ€. The technologies we have developed and utilized include Atomic Force Microscopy (AFM), Deformability Cytometry (DC), and Parallel Microfiltration (PMF), which collectively enable robust and high throughput measurements and can potentially be implemented either in clinical setting (for detecting cancer cells) or for drug screen. The nanocytology approach has potential to bring cancer diagnosis and management to a new level to overcome some of the limitations of current morphological and molecular based analysis.
Philip Davies
European Cervical Cancer Association, Belgium
Title: Moving Forward with the Implementation of Cytology-Based Cervical Cancer Screening Programs in Eastern Europe and Central Asia
Biography:
Completed medical studies in Canada in 1988, PhD at the Institute for Cancer Research in London in 1992 and post-doctoral training at the Pasteur Institute in Paris in 1994. Established the European Cervical Cancer Association in 2002 to advance public health strategies to reduce the incidence of cervical cancer in Europe. The ECCA currently has 120 institutional members (charitable, non-profit or governmental organizations) in 34 countries across Europe. Since 2008, the ECCA has focused on health system strengthening for the implementation of cancer prevention programs in Eastern Europe, the Caucasus and Central Asia.
Abstract:
Cervical cancer is one of the most common cancers among women in low and middle income countries, although the vast majority of cases could be prevented by well organized, population-based cervical screening programs. At this time, the current trend in developed countries is to move from cytology (the Pap test) to the use of HPV testing for cervical screening. However, the use of HPV testing in many low and middle income countries is problematic because of the high prevalence of HPV infection combined with suboptimal adherence to, or the complete absence of, clinical guidelines for the triage and follow-up of HPV-positive women and the incentives to conduct these follow-up and treatment procedures that are created by formal or informal payment to doctors. Therefore, cytology-based cervical screening with a lower sensitivity but high specificity than HPV testing is likely to be a more cost-effective and safer option for many low and middle income countries, but particularly for Eastern European and Central Asian countries where cytology and cytopathology were highly developed during Soviet times. In recognition of these issues, this presentation will discuss: 1) the status of cytology and cytopathology in Eastern Europe and Central Asia during Soviet times; 2) the current status of cervical screening in this region; 3) the potential problems with using HPV testing in this region including HPV prevalence rates and the issues pertaining to clinical guidelines for the follow-up and treatment of screen-positive women; 3) the process that is required to implement cytology-based cervical screening programs in this region, and 4) the progress that has been achieved with the implementation of a cytology-based cervical screening program in the Republic of Moldova.
Renata Setti
AC Camargo Cancer Center, Brazil
Title: Liquid based cytology, a propose of a new diagnosis method for canine lymphoma
Biography:
Renata Setti is a Veterinary physician graduated in 2004 from FMU in Brazil. All her career has been in veterinary hospital positions. She has been specializing in small animal oncology since 2012 and is now a Master's degree candidate in cytology at AC Camargo Cancer Center - Brazil's leading human oncology research center.
Abstract:
Canine lymphoma is the most common hematopoetic tumor in dogs. Its diagnosis can be achieved through fine needle aspiration (FNA) and lymph node biopsy. In a biopsy it is possible to define the phenotype, on the other hand there is the need to anesthesia for this procedure. At the time of diagnosis, dogs are usually in too frail a state for an invasive procedure, hence a non-invasive test will be useful by avoiding patient exposition to risk procedures. Until now, the biopsy and conventional smears (CS) are the methods available to perform lymphoma diagnosis. The method of liquid-based cytology (LBC) is available in human medicine about two decades ago but it hasn’t yet become a clinical routine in veterinary medicine. Using FNA in large lymph-nodes, the liquid-based cytology method keeps the cells better preserved, including its cytomorphological features. The aim of this study is to compare the renowned CS method with the liquid based cytology one. Dogs suspected of being afflicted by lymphoma have been diagnosed using lymph nodes aspirates and afterwards these aspirates samples have been analyzed using both previously described methods (FNA and LBC). Our results with the samples in LBC (Thinprep® stained H&E) and the samples in CS (stained diff quick) show the LBC leads to a clean and uncontaminated sample making it possible to better analyze results and suggesting future molecular technics, immunocytochestry in LBC using anti-CD3 and CD20 are under analyses by our groups. The LBC method is an option for diagnosis canine lymphoma.
Grazyna A. Stanczuk
University of Edinburgh, United Kingdom
Title: Clinical performance of HPV16/18 genotyping, reflex cytology and CINtec plus immunocytochemistry to triage of hrHPV+ women: Pilot nested in the Scottish PAVDAG study
Biography:
Grazyna completed Medical School in Gdansk, Poland in 1989. She became the member of RCOG in 1997. During her work for Medical School, University of Zimbabwe she defended her PhD in Karolinska Institute, Stockholm, Sweden in 2004. In 2014 and 2015 she was a main investigator of a large (5000 participants) population-base study in Dumfries and Galloway, which clinically validated self-sampling for HPV detection in primary cervical screening. Grazyna speaks on the topic of HPV oncogenesis and detection as well as cervical. She is a keen reader of evolution, immunology and virology.
Abstract:
Background: The objective of this study is to examine clinical performance of HPV 16/18 genotyping, reflex liquid-based cytology (LBC) and CINtec plus immunocytochemistry for triage of high-risk HPV positive (hrHPV+) women for detection of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in a Scottish population. Methods: LBC samples of 536 hrHPV+ women identified in the papillomavirus Dumfries and Galloway (PAVDAG) study were processed for CINtec plus immunocytochemistry. All women with positive CINtec plus tests were invited to colposcopy if they had not been otherwise investigated through the PAVDAG protocol. Results: Triage of hrHPV+ women with CINtec plus was more sensitive for CIN2+ than LBC. However, the sensitivity of CINtec plus for CIN2+ was relatively low (84.2%) in HPV16/18+ women. One in three (32%) women with CIN2+, who tested LBC negative were also CINtec plus negative. Relative sensitivity and specificity of LBC vs. CINtec plus in cervical and vaginal hrHPV+ women with other than HPV16/18 types (hrHPV other+) was 0.95 (0.73-1.23), 1.12 (1.09-1.12) and 1.00 (0.78-1.28), 1.07 (0.95-1.20) respectively. Conclusions: CINtec plus has better sensitivity for CIN2+ in non type-specific hrHPV+ women compared to LBC. However this difference is much smaller when HPV16/18+ women are referred for colposcopy directly and only hrHPV other+ women are triaged. These results are similar irrespective of the sampling method used (clinician-collected cervical or self-collected vaginal samples) for hrHPV detection. The optimal hrHPV based cervical screening should include HPV16/18 typing to allow direct referral to colposcopy for all HPV16/18+ women. Further triage of other than HPV16/18 hrHPV+ women should include LBC follow-by CINtec plus testing of LBC- women.
Gayane Badalian-Very
Gaia Medical Diagnostics and Intervention (GMDI), Hungary
Title: Companion diagnostics in personalized medicine
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 (PM) is an evolving field of medicine in which treatments are tailored to the individual patient. Targeted therapies used in PM have narrow range of efficacy and consequently only a specific group of patients benefit from each inhibitor. Determining the susceptible group is of outmost important both from clinical and economic (payers) perspectives. To learn which patients would benefit from a particular drug therapy or, conversely, which patients should not receive the medication, the Food and Drug Administration works with drug and device manufacturers that are developing certain tests called companion diagnostics (CDx). These refer to a particular clinical diagnostic test that is under evaluation and is specifically linked to a known drug therapy. The CDx is used to identify who would benefit from the treatment and sometimes to determine if there are patients who not only would not benefit, but could be harmed by use of a certain drug for treatment of their disease. The companion diagnostic is essential to the safe and effective use of the drug. They go together. The molecular diagnostics field plays a vital part in PM / CDx and has greatly expanded over the past twenty years; expanding by more than 20% annually compared to most other laboratory procedures. Companion diagnostics is one of the fastest growing segments in the in vitro diagnostic (IVD) market. And while the concept of a drug-diagnostic combination is not new, it has only recently started to generate interest with the move of healthcare towards pharmacogenomics. Because the companion diagnostic test is designed to be paired with a specific drug, the development of both products requires close collaboration between experts in both regulatory device center, which evaluates the test to determine whether it may be cleared or approved, and regulatory drug center, which evaluates the drug to determine whether it may be approved. Many payers are eager to support CDx tests that enable clear decision making with proven clinical utility. However, unlike medical devices and drugs, there is no clear or standardized method of preparing evidence of clinical utility, establishing coverage, or setting a reimbursement rate for a CDx test. Instead, coverage and reimbursement is set on a case-by-case basis whereby payers determine what is best for their beneficiaries in terms of improving their quality of life and treatment outcomes with opportunities to reduce medical costs. In the face of rapidly evolving technology and absence of a clear road map for decision making, there is a payer dilemma: how to quickly evaluate, cover, and pay adequately for CDx tests that provide a clear benefit to patients and the insurer, while ruling out those tests that are of no benefit.
Geetika Goyal
St. Stephens Hospital, India
Title: To study the colonoscopic and histopathological features in Inflammatory Bowel Disease and other forms of Colitis
Biography:
Dr.Geetika has completed her Diplomate of National Board, [D.N.B] in Pathology from St.Stephens hospital, Delhi India. She worked as senior resident in Pathology Department, at a multispeciality hospital in Delhi; presently working as Consultant Pathologist. She has strong inclination towards academic research and has been presenting her cases and research through posters on national and international level. Joining as observer in Gastro-Intestinal Pathology Department, JohnsHopkins University, Maryland, USA in July 2016. Research interest: GI Pathology and Molecular Pathology.
Abstract:
Objectives: To study the colonoscopic and histopathological features in Inflammatory Bowel Disease (IBD) and other forms of colitis. To grade the colonoscopic and histopathological appearances in Ulcerative Colitis, UC and compare the severity of colitis. Methodology: An institutionally approved study done in 2006 to 2008 includes 151 cases with both colonoscopy and biopsy done by gastroenterologist in OPD.Upon histopathological examination,the biopsies were categorized on the basis of “Guidelines for the initial biopsy diagnosis of suspected Chronic Inflammatory Bowel Disease†published by British Society of Gastroenterology.A definite protocol for grading colonoscopic appearances and the histopathological features in UC is followed and comparison of severity of UC is done. Results: Out of 151, 105 were Non-IBD [Normal 3, Infective type 36, Infection Unclassified 33,Tubercular colitis 14, Solitary Rectal Ulcer Syndrome 6, Pseudomembranous colitis 5, Amoebic colitis 2, Melanosis coli 2 and 1 each of Diversion colitis and Stercoral ulcer] and 46 were Chronic Inflammatory Bowel Disease (IBD)[UC 37,Crohns Disease(CD) 6 and IBD indeterminate 3]. Left sided colitis (39.13%) and Pancolitis (30.43%) were more common in IBD (21.7%) than in Non-IBD(19.8%). Right sidedcolitis was higher in Non-IBD (24.5%) than IBD (8.69%). On colonoscopy, loss of vascular pattern, friability, granularity were more commonly seen in UC (p value < 0.001) whereas erosions in Infective colitis (pvalue=0.002).Histopathological features differentiating IBD from Non-IBD were irregular mucosal surface (pvalue< 0.001), reduced crypt profile, crypt distortion (p value <0.001),Grade2Cryptitis(>10Neutrophils,NP/crypt)(pvalue=0.02), Crypt abscess grade2(>10NP/crypt lumen)(pvalue< 0.05), marked and transmucosal inflammation (p value < 0.001), epithelial ulceration(pvalue= 0.02) and mucin depletion (p value < 0.001). No significant difference was observed in the severity of UC upon endoscopy and histopathology.(pvalue=0.05).The agreement between the colonoscopic and histopathological diagnosis was found in 23/37 cases of UC, 1/6 cases of CD, 26/ 36 cases of infective colitis,5/6 cases of Pseudomembranous colitis and 7/8 cases of SRUS. Conclusions: Colonoscopy can diagnose the cases as IBD but definitive diagnosis of UC or CD is made upon biopsy. Infective colitis are diagnosed upon endoscopy but a few cases present with similar endoscopic features of IBD, so biopsy is important to rule out IBD. Endoscopic biopsies are the gold standard for the diagnosis of IBD and to distinguish the various forms of colitis from IBD. Further evidence is needed to study the agreement between endoscopy and histology in IBD and colitis.
Biography:
Zehra Safi Oz graduated from Hacettepe University, Faculty of Science, Department of Biology in 1995. She completed her MSc in 1998 and PhD in 2004 at Hacettepe University, Department of General Biology. She is the director of Bulent Ecevit University, Faculty of Medicine, Department of Medical Biology. She has published more than 25 papers in reputed journals and one chapter “The Interaction between Human papillomavirus proteins and cytoskeletal ilaments†in Human Papillomavirus and Related Diseases - From Bench to Bedside - Research aspects, 2012. Her work has been presented at many national/international meetings. She still continues to work as scientist and lecturer at Bulent Ecevit University who is working on many issues and as peer-review in journals. Her research interests include cellular biology, exfoliative cytology (gynecologic and buccal cytology), cell skeletal filaments, cytomorphometry, infectious agent such as Human papillomavirus, Trichomonas vaginalis and Candida.
Abstract:
Human papillomavirus virus (HPV) is the main causal factor of cervical carcinoma. The oncogenic human papillomavirus (HPV) types are the most significant risk factors in its aetiology. HPV 16 is one of the important oncogenic types. Micronuclei (MN), cytoplasmic fragments of DNA, have been reported as a marker for high cancer risk as it arises in response to carcinogens. MN scoring can be used in various clinical settings such as disease biomonitoring, genotoxicity, screening of cancer, and diseases related to genetic causes. The aim of this study was to evaluate the nucleus/cytoplasm ratio and micronucleus frequency of HPV type 16 positive exfoliated epithelial cells prepared via Liquid based cytology. In the present study, 30 HPV-16 infected patients’ cervical smears and 30 control smears’ with no infection agent prepared via liquid based system were evaluated for MN frequency and also cellular and nuclear size. Micronucleated cells were counted in each smears. Also nuclear and cellular areas were evaluated using image analysis software at a magnification of ×400. The frequency of micronucleated epithelial cells was higher in the HPV-16 infected group compared with the control group (p<0.05) The mean nucleus/cytoplasm ratio in HPV 16 patients was higher than the value in the control group, but the difference between the groups was not statistically significant. HPV type 16 affects the frequency of micronucleated cells and nucleus/cytoplasm ratio. Light microscopic analysis of MN in cervical smears increases the sensitivity and specificity of cytology in the evaluation of micronuclear pictures due to HPV type 16.
Jai Kumar Chaurasia
Head and Chief of Lab at Dr. Lalpathlabs, India
Title: Rosai–Dorfman Disease: Unusual Presentation and Diagnosis by Fine-Needle Aspiration Cytology
Biography:
Dr. Jai Kumar Chaurasia has completed his M.D. in Pathology from Jawaharlal Nehru Medica College, Aligarh Muslim University (AMU), Aligarh in 2011 and acquired experience in pathology at the same institute for 3 years after M.D. He is now working with Dr.lalpath Labs as Chief of Lab. He has published more than 14 publications in journals of national and international repute like Diagnostic Cytopathology (DC), British Medical Journal (BMJ), Journal of cancer Research & Therapeutics(JCRT), Indian Journal of Applied Research..etc He is also serving as reviewer in journals of repute, particularly British Medical Journal and is also member of Oxford databases as reviewer.
Abstract:
Rosai–Dorfman disease (RDD) or sinus histiocytosis with massive lymphadenopathy is a rare non-neoplastic, self-limiting histiocytic proliferative disorder of unknown etiology that usually presents with painless bilateral cervical lymphadenopathy and show distinct cytological features. Retroperitoneal lymph node enlargement due to Rosai–Dorfman disease is unusual and is rarely reported in literature. It is a difficult diagnosis due to disease’s non-specific clinical, hematological, and radiological findings, often overlapping with other diseases. We report an unusual case of Rosai–Dorfman disease in a male patient who presented with diffuse abdominal pain and retroperitoneal lymphadenopathy and diagnosed on fine-needle aspiration cytology (FNAC). This case emphasizes that Rosai–Dorfman disease should always be considered in cases presenting with retroperitoneal lymphadenopathy and FNAC can be used as a reliable tool to establish the diagnosis, avoiding unnecessary excisional biopsy, aggressive intervention, and overtreatment.
Murad Ahmad
Aligarh Muslim University, India
Title: Spectrum of Different Lesion’s in Pleural Effusion on Cytopathology
Biography:
Dr. Murad Ahmed has completed his MD(Pathology) from Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. He is presently working as Senior Resident in the Department of Pathology. He has published 10 papers in reputed journals. He performed his MD (Pathology) thesis on the topic of “Histopathology Typing of Breast Duct Carcinoma and ER and EGFR2 Immuno-Expressionâ€. Has published a book entitled “ER, PR And EGFR2 Status In The Variants Of Female Breast Duct Carcinoma†published by Lap Lambert Academic Publication, Germany 2013. He has attended more than 20 Conferences/CME and has presented oral & poster presentation in 13 conferences
Abstract:
Cytological evaluation of pleural effusion is used routinely in the diagnosis, prognosis and management of inflammatory, benign and malignant lesions. In developing nations like India, pleural effusion cytopathology can aid in the discrimination of reactive, benign and malignant lesions. The main aim of the present study was evaluate the spectrum of lesions presenting as pleural effusion and to discuss the cytomorphological features on cytospin smears in the department of Pathology, Jawaharlal Nehru Medical college, A.M.U, Aligarh from January 2012 to November 2015. Methods and materials: This cross-sectional study on 150 pleural tap specimens were stained by the Papanicolaou and Hematoxylin and eosin stains. Lesions were categorized into :a) Non neoplastic which included Tuberculosis, Non-specific infections and reactive mesothelial hyperplasia b) Neoplastic lesions which is further divided primary, secondary, suspicious for malignancy and malignant cells of unknown primary . Conclusions: Cytopathology is a useful and reliable tool in discrimination between malignant and benign pleural effusions. However use of pertinent clinical history, cell block analysis with histopathology and immunohistochemical studies are accessory investigative tools in few atypical cases
Sandeep Singh
Shitla sahai Institute of Medical Science, India
Title: Exploring the possibility of cervical cancer screening in resource-poor settings Via Tele-cytology approach: A proposed hypothesis
Biography:
Dr Sandeep Singh has completed his MBBS from Gajra Raja Medical College, Gwalior affiliated to Jiwaji University, Gwalior, India from 2007-2013. He is presently associated with, Shitla sahai institute of medical science Gwalior, India. He has published 16 National and International research articles in various reputed journals and delivered paper presentations at various platforms. His core area of interest includes cervical cancer screening, generation of new screening tools and policy framing. He is actively associated with NGOs to provide health care to the underserved communities.
Abstract:
Carcinoma cervix remains the fourth most common cancer among women worldwide and leading cause of cancer mortality among women in countries lacking any screening program. Polarization of conventional cytology mainly in tertiary care center makes it totally unaffordable to Indian women, especially in the remote areas. Failure of this measure in decreasing the toll of disease suggests the need of a real time modality with door to door screening capability. For any screening modality to be effective it should be adequately sensitive, specific, reproducible, cheap, simple, affordable, and the most important is should be real time to ensure wide coverage and curtail loss to follow-up. Use of Telecytology approach for screening cervical cancer could overcome several hindrances faced by conventional cytology. Telecytology is the interpretation of cytology material at a distance using digital images. A mobile van housed with automated image capturing system and satellite equipment for transferring the data is the central theme behind this idea. Imaging of the cervical smear prepared at the screening site will be carried out and those images will be sent to the central cytopathology laboratories situated at the tertiary care center. This approach will nullify the need of trained cytopathologists in rural areas to carry out the screening process and would increase the feasibility of women to get screened in remote areas. There is possibility that the designed approach may not detect the entire women positive for the disease but if the desired objective is to diagnose patients maximally in resource poor setting, then this process offers an added advantage over no screening at all.