Day 3 :
- Diagnostic Cytopathology | Cytopathology Case Reports | Cytopathology & Disease diagnosis | Clinical & Molecular Cytopathology | Fine Needle Aspiration Cytology | Exfoliative Cytopathology
Chair
Hamed Benghuzzi
University of Mississippi Medical Center, USA
Co-Chair
Israh Akhtar
University of Mississippi Medical Center, USA
Session Introduction
Laura Adhikari
Washington University School of Medicine, USA
Title: Evaluation of Non-Hodgkin Lymphoma by Fine Needle Aspiration – Overcoming the Barriers and Recognizing the Pitfalls
Time : 10:05-10:40
Biography:
Fine needle aspirates of enlarged lymph nodes are among the most commonly encountered specimens in cytopathology. They are common sites for evaluation of metastatic disease and lymphoma. Today there is still much debate over the clinical utility of fine needle aspiration for the work up in an abnormal lymphoproliferative process. A general understanding of lymphoma and reactive lymphoid processes are keys to understanding tissue limitations. In an age where molecular testing is more readily available, use of flow cytometry, fluorescence in situ hybridization (FISH), PCR and immunohistochemical stains can be helpful in the work-up for the initial presentation of a patient with lymphadenopathy.
Abstract:
Fine needle aspirates of enlarged lymph nodes are among the most commonly encountered specimens in cytopathology. They are common sites for evaluation of metastatic disease and lymphoma. Today there is still much debate over the clinical utility of fine needle aspiration for the work up in an abnormal lymphoproliferative process. A general understanding of lymphoma and reactive lymphoid processes are key to understanding tissue limitations. In an age where molecular testing is more readily available, use of flow cytometry, fluorescence in situ hybridization (FISH), PCR, and immunohistochemical stains can be helpful in the work-up for the initial presentation of a patient with lymphadenopathy.
Israh Akhtar
University of Mississippi Medical Center, USA
Title: Practical approach to effusion cytology
Time : 11:00-11:45
Biography:
Israh Akhtar has completed MBBS from University of Kashmir, India. She has completed her Anatomic and Clinical Pathology Residency at Nassau University Medical Center, NY, followed by one year of Cytopathology Fellowship at University of Mississippi Medical Center. She is currently an Associate Professor and Cytopathology Fellowship Program Director at University of Mississippi Medical Center, Jackson, MS. As an Academic Anatomic Pathologist, her interest includes gynecologic pathology, lung pathology and has a passion for cytopathology including gynecologic and non-gynecologic cytology. She is the author of numerous publications in reputed journals. She is a member of American Society of Cytopathology, College of American Pathologists and American Society of Clinical Pathology.
Abstract:
Serous cavity effusion can be benign or malignant and are always pathological. Cytologic diagnosis by examination of exfoliated cells in serous cavity effusions is one of the most challenging areas in the field of cytopathology. Benign effusions can be due to inflammatory or reactive conditions, in which case biochemical and microbiological investigations further substantiate in making the diagnoses along with clinical and imaging studies. Malignant effusions may be the initial presentation of an underlying malignancy. Cytologic study of effusion fluid is the simplest and most rapid method for obtaining a definitive diagnosis of malignant effusions. In my presentation I will be discussing diagnostically challenging cases with cytohistologic correlation and use of ancillary studies, which will try to eliminate gaps in practice. It will provide an organized educational experience for physicians seeking to acquire advancement in cytopathology, especially exfoliative cytology.
Ichiro Mori
International University of Health and Welfare Mita Hospital, Japan
Title: Digital pathology in diagnostic cytopathology
Time : 11:45-12:10
Biography:
Ichiro Mori has completed his PhD from Gunma University and Postdoctoral studies from Tokai University School of Medicine. He is a Professor of Pathology, Mita Hospital, International University of Health and Welfare. He has published more than 25 papers in reputed journals.
Abstract:
Aim: Together with recent advance of digital technology, digital pathology is getting popular. However, conservative pathologists believe the superiority of conventional microscope. This time, I’d like to show advantages of digital cytopathology assuming every glass slides are digitalized at the beginning. Material & Methods: We used toco (CLARO, Japan) as WSI scanner. Distance between 2 points is measured by iViewer (CLARO, Japan). Nuclear area and circumference is measured by eCyto (e-Path, Japan) to compare breast cancer specimen with different grade of nuclear atypia. RGB and gray scale value is decided by Photoshop Elements 13 (Adobe, USA) using oral squamous cell carcinoma specimens. Results: We could easily measure the distance on WSI to describe the invasion depth by micrometer. Breast cancer cells diagnosed grade 3 nuclear atypia showed nuclear area about 1000-3000 micro-square meters while grade 1 cells show 450-700. The orange cytoplasmic color of oral squamous cell carcinoma showed 190-220/R, 60-80/G and 20-50/B while non-neoplastic squamous cell showed 170-190/R, 120-180/G and 110-150/B. We also could describe nuclear chromatin density by gray scale rather than “increased nuclear chromatinâ€. Discussion: Digital images have apparent advantages in image database application where we can retrieve previous images directly from the database with no concern about color fading or slide label peeling off. Moreover, we could show the advantages of digital images by numerical conversion of morphologic features. Describing these so-called “atypical†features by numeric value we may increase the accuracy and the reproducibility of cytological diagnosis that conventional microscopy could not provide.
Salvatore Sciacchitano
University Nicholas of Cusa for Research Medical and Scientific, Italy
Title: Which is the best test-method to increase accuracy in thyroid nodules classified as indeterminate at FNA cytology? A comparative analysis of diagnostic performance, feasibility and cost of several different test-methods
Time : 12:10-12:40
Biography:
Salvatore Sciacchitano has completed his MD and his PhD in La Sapienza University of Rome and his Specialization in Endocrinology at Tor Vergata University of Rome. From 1994 to 1997 he was Fogarty Vising Fellow at the Diabetes Branch of the NIDDK/NIH in Bethesda, MD. He is professor in Endocrinology at the University La Sapienza or Rome and Chief of the Laboratory of Biomedical Research at the Niccolò Cusano University in Rome, Italy. He has published more than 38 papers in reputed journals and has been serving as an editorial board member of repute.
Abstract:
Since it is not possible to recognize malignancy at FNA cytology in thyroid indeterminate nodules, surgery is recommended for all of them, but cancer rate at the final histology is <30%. Many test-methods have been proposed for increasing the diagnostic accuracy in these lesions and new emerging molecular-based test-methods have been developed and commercialized. To allow a more cost-conscious clinical management of patients bearing such nodules, we compared technical features, feasibility, diagnostic performance and cost of the following test-methods: Galectin-3-ICC, FDG-PET/CT, GEC alone and GEC + BRAF, thyroid cancer mutation/fusion panel, alone and plus miRNA GEC, thyroid cancer mutation/fusion panel by NGS and TSHR mRNA blood assay. FDG-PET/CT was the best rule-out (sensitivity 95%) and TSH mRNA blood assay the best rule-in (specificity 96%) test-method, with some bias for the latter. Mutation/fusion panel by NGS showed the highest accuracy (92%) and diagnostic odds ratio (DOR=121). Mutation/fusion panel alone and plus miRNA GEC as well as TSHR mRNA blood assay showed very high DOR. Galectin-3-ICC approached the best performances both as a rule-out (sensitivity 83%) and rule-in (specificity 88%) test-method, with a good accuracy (87%) and DOR (38). Galectin-3-ICC is by far the cheapest one and it is the easiest one to be performed in different clinical settings. In conclusion, at this moment, the more accurate molecular-based test-methods are still very expensive and are restricted to few, highly specialized Centers. Galectin-3-ICC represents the most suitable screening test-method for indeterminate thyroid nodules and deserves a central place in the diagnostic algorithm of indeterminate thyroid lesions.
Cory Bernadt
Washington University, USA
Title: Fine Needle Aspiration Biopsy of HPV-Related Squamous Cell Carcinomas of the Oropharynx
Time : 12:40-13:05
Biography:
Cory Bernadt earned his MD and PhD from the University of Nebraska Medical Center. He completed a residency in anatomic pathology and a surgical pathology fellowship at the University of Iowa Hospitals and Clinics. He received his training in cytopathology from the University of Virginia. He is currently an assistant professor in the Department of Pathology and Immunology at Washington University in St. Louis School of Medicine.
Abstract:
Human papilloma virus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) is a unique form of carcinoma that is important to identify for prognosis and treatment. Patients with HPV-related oropharyngeal SCC have a much better prognosis and an enhanced response to radiation and chemotherapy compared to patients with conventional (HPV-negative) SCC of the head and neck. A significant proportion of patients with head and neck SCC present with neck masses as their first symptom. Fine-needle aspiration (FNA) of cervical lymph nodes is fast, easy to perform, minimally invasive, and accurate as a modality for the diagnosis of metastatic SCC. While morphologic features, particularly a non-keratinizing phenotype, strongly predict an association with HPV, ancillary studies are often used to confirm the diagnosis. A common and readily available modality is immunohistochemical staining for p16, an excellent surrogate marker for transcriptionally active, high-risk HPV. Even focal, strong and confluent p16 positive staining of FNA biopsy material correlates with high-risk HPV. Alternatively, high-risk HPV can be detected directly by RNA in-situ hybridization, and other molecular-based approaches, some of which are already routinely used in gynecologic cervical specimens. The objective of the presentation will be to discuss FNA of HPV-related oropharyngeal SCC, and to explore the different ancillary testing methods that are used to make the diagnosis.
Kafil Akhtar
Aligarh Muslim University, India
Title: Cytological study of radiation changes in cervical and vaginal smears in patients of carcinoma cervix
Time : 13:05-13:30
Biography:
Kafil Akhtar, Associate Professor in the department has completed his M.B.B.S, M.D in Pathology and D.M.R.T in Radiotherapy from Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. He has published more than 120 research papers in reputed journals and has written two books entitled Cytological study of Radiation Changes in Carcinoma Cervix and Principles of Transfusion Medicine. He is the Sub-Editor of Journal of Cytology and Histology and reviewer to more than 20 journals of repute. He has been Editors of Souvenirs of various Conferences and Joint Organizing Secretary of International Symposium on Women’s ((Breast & Gynae) Pathology.
Abstract:
Cancer cervix is a common malignancy among females in India and developing countries with an estimated approximately 90,000 new cases occuring every year in India. Cytology has been known to play a major role in evaluating patients after radiotherapy. This study was undertaken to study the radiation changes in cervical and vaginal smears in patients of carcinoma cervix after exposure to radiation therapy and to determine the significance of post radiation cytological changes in detecting recurrence of carcinoma and residual disease. Fifty histologically proven, previously untreated cases of carcinoma of the uterine cervix were taken up for this study. Cervical and vaginal smears were subjected to Papanicolaou staining before and after 8-12 weeks of completion of radiation therapy. The majority of cases were seen in the 5th and 6th decades of life, (90% cases). Nuclear enlargement was the most frequent change observed in 38 cases (95.0%), followed by vacuolization of the cytoplasm in 32 cases (80%), with fine, regular or large and voluminous vacuoles. Amphophilia and polychromasia of the cytoplasm was observed in 18 cases (45%). Multinucleation was also a prominent feature observed in 30 cases (75%). Histiocytic and neutrophilic infiltration of the smears was present in 23 cases (57%). Wrinkling of nuclei was observed in 17 cases (42.5%) and bizarre forms like tadpole and fibre like cells were noted in 15 cases (37.5%). Recurrence of squamous cell carcinoma was noted in 9 cases (22.5%), with presence of small dark tumor cells and large naked nuclei in the post-irradiated smears.
Marwa Moawia Awad
University of Khartoum, Sudan
Title: Prevalence of abnormal Pap smears in Sudan implications for screening
Time : 14:15-14:40
Biography:
Marwa Moawia Awad was graduated from University of Khartoum, Faculty of Medical Lab Sciences in 2010 and was awarded the University Prize for the Best Academic Performance over all the students. She has been certified as ASCPi/Gyn Cytotechnologist in 2013 and presently she is working as a Teaching Assistant at Nile College, Khartoum, Sudan at Histopathology and Cytology Department and as a Cytoscreener at Total Labcare Diagnostic Center.
Abstract:
Background: The Pap test is considered to be the most cost-effective cancer reduction program. Cervical cancer is a common health problem in Sudan and account for about 17% of all cancers in Sudanese women and is the second cause of death after breast cancer. Objective: To investigate the prevalence of abnormal Papanicolaou smear collected from cytology laboratory archive. These samples have been taken from the women who attended the gynecological clinics and on opportunistic screening base in Khartoum state. We also compared our data with other related studies from developing countries. Material & Methods: This descriptive study aimed to assess the cytological findings in cervical smears. Samples were collected from 1393 women. The smears were stained with conventional Papanicolaou stain and screened by senior cytologist and abnormal cases reviewed by consultant cytopathologist. Epithelial cell abnormalities included atypical squamous cells of undetermined significance (ASC US) and above. The 2001 Bethesda System was adopted to classify the epithelial abnormalities. Our results were compared to other similar studies from developing countries. Results: Out of the 1393 cases 17 (1.2%) were reported as unsatisfactory, 34 (3.1%) as epithelial cell abnormalities and 1333 (95.7%) of the Pap smear were found to be negative for intraepithelial lesion or malignancy (NILM). The epithelial cell abnormalities (N=34) included atypical squamous cell of undermined significance (ASC-US) in 44.2% of cases, L-SIL in 23.3%, H-SIL in 20.9%, atypical glandular cells in 2.3% and squamous cell carcinoma and adenocarcinoma in 4.6% of cases. Conclusion: In this study the prevalence of abnormal Pap smear was (3.1%). Pap smear in our study is relatively comparable to other countries.
Jai Kumar Chaurasia
Dr Lal PathLabs, India
Title: Histiocytic disorders: Cytological perspective
Time : 14:40-15:05
Biography:
Jai Kumar Chaurasia has completed his MD in Pathology from Jawaharlal Nehru Medical College, Aligarh Muslim University (AMU) in India in 2011 and has acquired experience in Pathology from the same institute for three years after completing MD. He is currently working with Dr Lal PathLabs as a Chief of Lab. He has many publications in journals of national and international repute such as Diagnostic Cytopathology (DC), British Medical Journal (BMJ), Journal of Cancer Research and Therapeutics (JCRT) and Indian Journal of Applied Research etc. He is also serving as Reviewer in journals like British Medical Journal and Annals of Medicine and Surgery. He is a Member of Oxford databases as Reviewer.
Abstract:
Histiocytic disorders encompasses a number of distinctive entities, arising from histiocytic proliferation ranging from benign, self-resolving lesions to malignant, life-threatening histiocyte rich leukemias and sarcomas. Histiocytes are derived from stem cell precursors in bone marrow from macrophages which later undergo differentiation in various organs to form histiocytes, which are part of the mononuclear phagocytic system. Cytology plays a pivotal role in diagnosing histiocytic disorders, leading to early diagnosis with implications regarding prognosis and treatment. Here, we discuss an interesting case of Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy with detailed discussion of differential diagnosis encompassing other histiocytic disorders such as Langerhans cell histiocytosis, hemophagocytic lymphohistiocytosis, xanthogranulomatous lymphohistiocytosis, reactive sinus histiocytosis and histiocyte rich lymphomas and tuberculosis. Rosai-Dorfman disease 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 histiocytic disorders. We here discuss an unusual case of Rosai-Dorfman disease in male patient who presented with diffuse abdominal pain and retroperitoneal lymphadenopathy and diagnosed on fine-needle aspiration cytology. This presentation emphasizes that histiocytic disorders should always be dealt with great care and FNAC can be used as a reliable tool to establish the diagnosis, avoiding unnecessary excisional biopsy, aggressive intervention and overtreatment.
Biography:
Dr ArunaKumari Prayaga has completed done her MD from Gujarat Cancer Institute, India. She is currently Professor and Head, Department of Pathology, Nizam’s Institute of Medical Sciences, Hyderabad. She has 25 years of experience in Cytology and is the President elect Indian Academy of Cytologists for the year 2017. She published nearly 100 papers and written chapters for books. She is on the editorial board of Acta Cytologica, Journal of Cytology and a reviewer for Cytopathology
Abstract:
Infections are a major public health concern and form a large proportion of hospital statistics. The spectrum of infections varies greatly based on geographic location and also the clinical material. A rapid diagnosis is important for timely interventions. Cytology is accepted as a rapid diagnostic modality. However, the literature on role of cytology in infections is limited to single entities and case series. Cytology can be used effectively in identification of infections namely bacterial, viral, fungal, parasitic. Species identification required support from microbiology. Tissue reaction can be a useful guide to carefully look for a pathogen and to assess the significance of the organism identified based on tissue reaction. Cultures may be difficult for fastidious organisms and in the absence of fresh tissues. Serologic results may not be reliable in immunocompromised patients. In addition to diagnosis, cytology sampling can be used for resampling for microbiologic studies when necessary. Morphology is the mainstay to identify the pathogen on cytology. However, it is important to differentiate the pathogens from artifacts and to identify atypical morphologic features. This necessitates that the cytologists are familiar with morphology. With increasing subspecialization there is a necessity for the cytologists to keep abreast with morphology. There is also a suggestion to develop infections as a subspeciality. Routine histochemical stains, immunochemistry, molecular techniques can be used on cytologic material. Coupled with morphology and ancillary techniques cytology can play a crucial role in the management of these critically ill patients.
Anita Bhandari
Chitwan Medical College, Nepal
Title: Evaluation of Coelomic Fluids and Its Clinical Correlation with Cytological Diagnosis
Biography:
Dr Anita Bhandari has completed her Master's degree (MD) in Pathology from College of Medical Sciences, Bharatpur , Chitwan, Nepal in November 2014 from Kathmandu University. She had been involved in the research in cytopathological analysis during her studies. Her studies are presently under revision in various journals and in the process of publication. She is presently working as Assistant Professor in Chitwan Medical College, Chitwan, Nepal under Tribhuvan University since December 2014
Abstract:
coelomic fluid aspiration is a simple technique to achieve a diagnosis which helps in narrowing the diagnostic dilemma faced by physicians. This was a prospective study conducted between January 2012 to May 2013, in the department of pathology, CMSTH, Bharatpur, Nepal. Out of 70 cases, 34 cases are of peritoneal fluid, 31 cases are of pleural fluid and five cases are of pericardial fluid. 59 cases diagnosed as chronic effusion (84.28%). Six cases are diagnosed as inflammatory effusion (8.57%) and five cases are of malignant effusion (7.14%). Out of 70 cases, 50% were turbid, 47% were clear and 2.9% were hemorrhagic. 52.9% of effusions were exudative and 47.1% of effusion were transudative. Mean glucose level of transudative effusion was 80.15±21.19mg/dl which was higher compared to exudative effusion. Mean protein levels in transudative effusion was 2.08±0.43gm/dl. The total leukocyte count ranged from 57 to 1,50,000 cells/mm3. The estimated mean±SD of all coelomic fluid cell count was 3151.5±17974.06 with average cell count in malignant, chronic and inflammatory effusion of 620cells/mm3, 520cells/mm3 and 31,141cells/mm3 respectively. The estimated mean ± SD of all transudative fluid total leukocyte count was 188.57±53.65 and of exudative fluid cell count was 5793.29±24576.28. Overall sensitivity of cytology was 60%, specificity 96.92% and accuracy 94.28%, while positive predictive value was 60% and negative predictive value was 96.92%. Hence, cytological study of the fluid is a complete diagnostic modality which aims at pointing out the etiology of effusion as well as, in certain cases, a means of prognostication of disease process.
- Veterinary Cytopathology | Clinical & Molecular Cytopathology | Gynecological and Breast Cytopathology | Cytopathology & Disease diagnosis
Chair
Qing Kay Li
The Johns Hopkins University School of Medicine, USA
Session Introduction
Qing Kay Li
The Johns Hopkins University School of Medicine, USA
Title: Current concept in the new WHO classification of lung cancers, and its impacts on the cytological differential diagnosis of lung cancers
Time : 10:00-10:25
Biography:
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.
Je-Chiuan Ye
Southern Taiwan University of Science and Technology, Taiwan
Title: Monoterpenes and sesquiterpenes develop potential anticancer activity in elderly lung cancer drug
Time : 10:25-10:50
Biography:
Je-Chiuan Ye has completed his PhD from Chung Shan Medical University. He has been engaged in academic research for many years. He has published in prestigious journals.
Abstract:
In this study, human lung cancer cells (A549) were used to elucidate the mechanism and death mode associated with monoterpenes and sesquiterpenes. We use a monoterpene and sesquiterpene in Human lung adenocarcinoma epithelial cell line A549 and it was assessed by MTT assay. Monoterpene and sesquiterpene can significantly reduce the proliferation of A549 cells in a dose-dependent fashion. By flow cytometric analysis, we analyzed that monoterpenes and sesquiterpenes treatment resulted apoptosis in A549 cancer cells. By Western blotting, we further explored the cell to study apoptosis. We examined the anti-proliferation effect of phytochemicals on human lung adenocarcinoma epithelial cell lines. Monoterpenes and sesquiterpenes can significantly reduce the proliferation of A549 cells in a dose-dependent fashion. We found that phytochemicals can suppress the growth of human lung adenocarcinoma epithelial cell lines (A549). This result suggests that monoterpenes and sesquiterpenes have anticancer activities against A549 cancer cells. Our finding suggests that monoterpenes and sesquiterpenes can be a good candidate of anti lung cancer drug and suggests that these are promising chemopreventive or chemotherapeutic agent.
Nazan Eras
University of Mersin, Turkey
Title: Investigation for Polymorphisms of Caspase 3 and Caspase 9 Gene and Enzyme Levels in Leukemia Patients
Time : 10:50-11:15
Biography:
Nazan Eras, M.D., Ph.D. Eras was born in Malatya in 1970. She graduated from Dicle University, School of Medicine, Diyarbakır, in 1995. Nazan Eras; after graduate from Dicle University Faculty of Medicine, she worked as a general practitioner. She completed her MSc in 2006 and PhD in 2012 at Mersin University Faculty of Medicine, Department of Molecular Biology and Genetics. She has published more than 39 papers and announcement in journals and has been serving as peer reviewer in journals. Nazan Eras still continues to work as Medical Doctor at Ministry of Health Turkey. Her research interests include clinical cancer genetics, human molecular genetics and oxidative stress.
Abstract:
For understanding of leukemia and treated with early diagnosis, it should be investigated moleculer changes that occur during the development of leukemia. Apoptosis is central to the development and homeostasis of the hematopoietic system. Previous studies have reported that leukemia cells invariably have abnormalities in one or more apoptotic pathways. The current study investigated the relationship between polymorphisms of caspase 3 G>T rs4647601 and caspase 9 A>G rs4645978 and leukemia. Besides that we aimed to determine caspase 3 and caspase 9 enzyme levels possible effects on the risk of developing leukemia. The case group consisted of 100 patients (mean age:56±03) who had been newly diagnosed with leukemia at the Department of Hematology, Mersin University Faculty of Medicine, Turkey. The control group comprised of 100 healthy properly age and sex matched individuals (mean age:54±15) with a no history of leukemia. The genotypes detected by using Real-Time PCR. We measured enzyme levels of caspase 3 and 9 in serum which obtained from blood samples. No significant association was observed between caspase 3 G>T rs4647601 and caspase 9 A>G rs4645978 polymorphisms and leukemia. We found that median levels of caspase 3 and 9 were higher in leukemias than in normal blood cells (P <0.001). This is the first study reporting the detailed distribution of alleles and genotypes of caspase 3 and caspase 9 in leukemia patients in Turkish population. Taken together, we conclude that caspase 3 and caspase 9 levels may useful for the early diagnosis of leukemia.
Noeme Sousa Rocha
Sao Paulo State University. Brazil
Title: Fine Needle Aspiration: Osteomyelitis and Osteossarcoma in dogs
Time : 12:00-12:25
Biography:
Noeme Sousa Rocha is graduated in Veterinary Medicine from the State University of Maranhão (1989), Masters in Pathology from the Sao Paulo State University (1994) and PhD in Pathology from the Sao Paulo State University (1998). It is currently - Journal of Animal Science Faculty, Veterinary Medicine and Agronomy (Uruguaiana) and associate professor of Sao Paulo State University. Has experience in the area of veterinary medicine, with emphasis on Animal Pathology Anatomy, acting on the following topics: veterinary, cytopathology, pathology, cancer and istopathology. Associate member of the International Academy of Pathology.
Abstract:
Osteosarcoma (OSA) is a primary malign, non-hematopoietic osteogenic tumor with an increased incidence of cases in the last years, which is probably related both with patients’ longevity and with the advent of technics that allow more accurate diagnosis. OSA appears spontaneously in the appendicular bone with significant impact both in dogs and in children, being this biological similarity that has made dogs a clinical model for the study of OSA in humans. Unfortunately, the lesion is aggressive and has high metastasis rates regardless of species, affecting, among other organs, the lungs. The survival prognosis is bad in patients with pulmonary metastasis or unresponsive to chemotherapy, making it highly lethal. Traditionally, the therapy consists in amputation, followed by chemotherapy. For humans, chemotherapy, based on a previous histological diagnosis including the degree of aggressiveness, exhibits better survival due to metastasis reduction; however, the conduct is not much explored in Brazil. Osteomyelitis is an inflammation of the bone, bone marrow, endosteum, periosteum and vascular channels, and can be associated with bacterial, fungal and viral diseases. According to the medical condition evolution, osteomyelitis can be classified as chronic or acute, the last being less frequently diagnosed. Chronic osteomyelitis can result from inadequate treatment of acute bone inflammation, which indicates the importance of rapid and accurate diagnosis to better therapeutic conduct of the osteomyelitis being treated. In this study it was verified, by light microscopy, the morphological expression of parameters used for cytological OSA and osteomyelitis diagnosis of 20 different pure and mixed breed dogs, followed by analyzing both possible malignancy criteria. The goal of this project is to demonstrate that the fine-needle aspiration technique is able to carry out efficiently the diagnosis of osteomyelitis as well as canine osteosarcoma.
Noeme S Rocha
Sao Paulo State University. Brazil
Title: Cytopathological staging of transmissible venereal tumour
Time : 11:35-12:00
Biography:
Noeme Sousa Rocha is graduated in Veterinary Medicine from the State University of Maranhão (1989), Masters in Pathology from the Sao Paulo State University (1994) and PhD in Pathology from the Sao Paulo State University (1998). It is currently - Journal of Animal Science Faculty, Veterinary Medicine and Agronomy (Uruguaiana) and associate professor of Sao Paulo State University. Has experience in the area of veterinary medicine, with emphasis on Animal Pathology Anatomy, acting on the following topics: veterinary, cytopathology, pathology, cancer and istopathology. Associate member of the International Academy of Pathology.
Abstract:
Transmissible venereal tumor (TVT) is a neoplasm of round cell plasmocitoide and linfocitoide aspect. The tumor present several particularities, for example, in the recent years has been evidenced a progressive increase of tumor with high percentages of aggressiveness and different response to chemotherapy, including resistance. In order to obtain better information for cytological staging and therapeutic approaches to treatment of patients with this tumour, eighteen dogs with cytological diagnosis of TVT were studied. For each tumour, the smears were analysed qualitatively and quantitatively for the presentation of nuclear malignancy criteria as evidenced by moulding, denuded, nuclear inclusions, evident nucleoli, halo around the nucleolus, slit and binucleation, and cytoplasmatic characteristics such as tadpole, signet ring, projections and cannibalism. Those stained by the Giemsa method were used for cytoplasmatic and nuclear classification; the Shorr method was used to determine specific nuclear malignancy criteria. Ten fields from each slide were analyzed to give average values for each characteristic. Chi-square test was used for data analysis. Fiftteen of the 18 dogs were mixed breed, with one French Poodle, one Teckel and other Bull Terrier. Dog ages ranged from 5 to 10 years. Eighty percent were males. The tumour was most commonly found in the external genitalia (15 cases) and the other three tumours on skin and gum. The plasmocytoid type morphology was found on all cases. In general the nuclear and cytoplasmic malignancy criteria observed in different TVTs analyzed, did not differ from the literature, and clinical relationship was seen between staging and cytopathological findings suggesting that put provide greater certainty about the degree of aggressiveness, progression and prognosis in the patients with TVT. Use of cytopathological staging in this tumour can serve as a criterion to suggest the possible evolution and thus type of therapy.
Ali Aliabadi
Islamic Azad University, Iran
Title: Transmission electron microscopy of the retina following Thyroidectomy in rabbit
Time : 12:25-12:50
Biography:
Ali Aliabadi has completed his doctorate on veterinary surgery at the age of 25 years from Shiraz University. He has completed his clinical fellow studies on orthopedic surgery in Munich Ludwig Maximillian University. He is an assistant professor of veterinary surgery. His researches had focused on animal model in surgical pathology. He has published more than 14 papers in reputed journals.
Abstract:
Thyroid hormones play a crucial role in the neuroretinal maturation of the eye and central nervous system development. An experiment was conducted to survey the effects of thyroidectomy on rabbit retina. In this study, 10 male rabbits of New Zealand strips were divided into two groups of five animals each (control group and thyroidectomy group). Before surgery, the rabbits were maintained in 12-h light and 12-h dark. The animals were anesthetized with intra peritoneal injection of 10 mg/kg xylazine and 6 mg/kg ketamine, and bilateral thyroidectomy was performed. One and 2 weeks after surgery, the rabbits were sacrificed by humane methods. Then, retinas of the killed rabbits were isolated in the laboratory and examined by electron microscopy for evaluating cells and changes in inner segment, outer segment, outer limiting membrane, and outer nuclear layer. The result of this experiment showed vacuolization in inner section and endoplasmic reticulum of rabbit retina in group two. It was also observed that mitochondria of the inner segment of retina were larger and more circular than mitochondrial in control group; moreover, most of them had lost their crystal. The core in the control group was normal and had round to oval shape and distributed chromatin, but in thyroidectomy group, the mode of the nucleus was small and dark (pyknosis) and some nucleus had been destroyed. In our study, we focus on electron microscopic changes of retina following thyroidectomy that reflects us a new concept of cellular changes. In conclusion, this study showed that thyroidectomy affected retinal compounds such as in outer segment, inner segment, and outer nuclear layer, and ultimately leads to vision problems.
Maral mokhtari
Shiraz university of Medical Sciences, Iran
Title: Hepatocellular Carcinoma: Cytological Findings
Time : 12:50-13:15
Biography:
Maral Mokhtari has completed pathology specialty in Shiraz university of Medical Sciences. She is lab director of Shahid Faghihi Hospital. She has published more than 25 papers in reputed journals.
Abstract:
The occurrence of hepatocellular carcinoma is rising especially in areas with high incidence of viral hepatitis. Fine needle aspiration is a safe, cost effective and accurate method for diagnosis of liver space occupying lesions. In this study we report our experience in cytology of HCC. 58 patients (20 female and 38 male), histologically documented cases of hepatocellular carcinoma were studied, retrospectively. 25 patients were cirrhotic. The frequency of viral hepatitis was 40% (30% HBV and 10% HCV). The smears were hyper-cellular, consisting of two and three-dimensional clusters of round cells with centrally located nuclei in 58, 100% of cases. Atypical bare nuclei were frequently noted (49, 84% patients). Prominent nucleoli (25, 43% patients), endothelial cell rapping clusters of hepatocytes (40, 68% cases), transgressing vessels (38, 65% patients) intra-cytoplasmic bile (42,72% patients), intra-nuclear pseudo inclusions (22, 37% patients), and hepatitic rosettes enclosing extracellular bile plugs (20, 34% cases) were observed.Tumor giant cells (31, 53% cases), tad pole-like cells (5,8% cases) and Reed-Stenberg-like cells (1, 1.7% patient) were also seen.Some smears showed clusters of hepatocytes with clear cytoplasm and some of them showed micro-vesicular fatty change in 12, 20% patients. In conclusion, using different cytologic criteria, hepatocellular may reliably be differentiated from its mimickers. Besides other previously defined cytological features, Reed-Stenberg-like cells can be seen in hepatocellular carcinoma.
- Young Researchers Forum
Session Introduction
Snehal Sonawane
University of Illinois at Chicago, USA
Title: Acquired cystic disease of kidney associated renal cell carcinoma mimicking adult polycystic disease of kidney
Time : 15:05-15:25
Biography:
Snehal Shankar Sonawane has completed her Medical School at Government Medical College Miraj and has done Diplomate of National Board in Pathology from RCSM Government Medical College Kolhapur. She is presently working as Pathology Resident Physician at University of Illinois at Chicago. Her research work is in area of ‘Dry Eye Disease’ and is published in reputed journals.
Abstract:
Clinical History: A 59 -year-old male with history of chronic hypertension, end stage renal disease, dialysis presented to UI health for bilateral cadaveric kidney transplant. Hemorrhagic nodule from enlarged cystic kidney is identified. Diagnosis: Acquired cystic disease associated renal cell carcinoma Differential Diagnosis: • Adult (AD) polycystic kidney disease • Acquired Cystic disease of Kidney • Acquired Cystic disease of Kidney associated renal cell carcinoma Key Microscopic Features: • Acinar, tubular, multicystic, papillary and solid pattern in various combinations • Presence of inter or intracytoplasmic lumina imparting sieve like appearance • Large tumor cells with eosinophilic cytoplasm and prominent nucleoli • Calcium oxalate crystals in stroma and lumina Immunohistochemical stains: • AE1/AE3, CD10, AMACR positive • CK7: Negative Discussion: • Acquired Cystic Kidney Disease (ACKD) can morphologically mimic autosomal dominant polycystic kidney disease • Acquired cystic disease associated RCC is uniquely associated with ACKD recognized as a distinct clinical entity in WHO-2016 • Pancreatic cysts and possibly liver cysts can be seen in patients on hemodialysis.
Murad Ahmad
Aligarh Muslim University, India
Title: Spectrum of different lesion’s in pleural effusion on cytopathology
Time : 15:25-15:45
Biography:
Murad Ahmed has completed his MD (Pathology) from Jawaharlal Nehru Medical College, Aligarh Muslim University, India. He is presently working as Senior Resident in the Department of Pathology. He has published 10 papers in reputed journals. He 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 also attended more than 20 conferences/CME and has presented oral & poster presentation in 13 conferences.
Abstract:
Introduction: 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. Aim: 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; AMU, Aligarh from January 2012 to November 2015. Methods & Materials: This cross sectional study on 150 pleural tap specimens was stained by the Papanicolaou and Hematoxylin and eosin stains. Lesions were categorized into non neoplastic which included tuberculosis, non specific infections and reactive mesothelial hyperplasia. Neoplastic lesions which are 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 is accessory investigative tools in few atypical cases.
Sayda Omer Mohammed Ali Ebnaof
Khartoum University, Sudan
Title: Oral Epithelial Atypical Changes in Apparently Healthy Oral Mucosa Exposed to Smoking, Alcohol, Peppers and Hot Meals, Using the AgNOR and Papanicolaou Staining Techniques
Time : 15:45-16:05
Biography:
Sayda has completed her Msc in Molecular Medicine from Institute of Endemic Diseases- University of Khartoum in 2012. She has started her PhD in molecular biology program at University of Ferrara, Italy and she is going to defense her degree in February, 2016. She is a lecturer of Histopathology and Cytology at university of Khartoum. She has published three papers in reputed journals.
Abstract:
To evaluate cytological atypical changes in apparently healthy oral mucosa exposed to smoking, alcohol, hot meals, and peppers using the AgNOR and Papanicolaou methods. A total of 180 individuals were evaluated, of which 60 were smokers, 34 were alcohol users, 52 were habitual peppers and hot meal (exposed) consumers, 24 were non-exposed, and 10 were patients with Oral Squamous Cell Carcinoma, as an internal control. Cytological materials were obtained by brushing of buccal mucosa, on the border of the tongue and on the floor of the mouth, and participants underwent the Papanicolaou test for cytological changes and AgNOR staining for evaluation of the mean number of AgNOR dots per nucleus. SPSS program was used to perform the Pearson chi-square test. The 95% confidence level and Odds Ratio were used. The features of cytological atypia were verified among 10 individuals, including 5 smokers, 2 alcohol users, 2 hot meals and peppers consumers, and one non-exposed. For atypia among tobacco smokers, the adjusted Odds Ratio, and the 95% CI were found to be 2 (0.246–16.24). Increased keratinization was detected among 27 (45%) of the smokers (P < 0.0001), 17 (32.7%) of the pepper and hot meals consumers (P < 0.005), 4 (11.8%) of the alcohol consumers, and among 2 (3.7%) of the non-exposed group. Statistical analyses revealed a greater mean number of AgNORs per nucleus in smokers (3.68) followed by (2.82) alcohol consumers, compared to the habitual peppers and hot meal consumers (2.28) and the non-exposed group (2.00). What’s more, 80% of the smears with cytological atypia were identified with 6 6 2 AgNOR mean count. The increase of the variables suggests that the evaluation of epithelial atypical changes in individuals exposed to smoking and alcohol carcinogens may be a useful screening tool. While hot meals and peppers didnot seem to be a risk for oral mucosal proliferation, they increased the potency of keratinization and infection.
- Poster Session
Session Introduction
Xianghua Huang
The Second Hospital of Hebei Medical University, China
Title: Clinical validation of high risk HPV DNA testing versus cytology for predicting cervical cancer
Biography:
Dr. Huang has completed her M.D. at the age of 21 years and PhD at the age of 39 years from Hebei Medical University. She is the director of department of Obstetrics and Gynecology, chairman of Ob/Gyn branch association of Hebei medical association. She has published more than 30 papers in reputed journals.
Abstract:
Objective: Cervical cancer and its precancerous lesions are caused by persistent high risk human papilloma virus (HPV) infection. Some studies suggest that HPV test is safe, effective and sensitive than cytology. Considering the previously published literature draw that conclusion only based on taking CIN2/3 and above as the endpoint rather than that cervical carcinoma itself, this study was conducted to compare the validity of the high risk HPV test to Thinprep cytologic test for predicting cervical cancer. Design: Retrospective study Setting: Department of Obstetrics and Gynecology, The second hospital of Hebei Medical University, Shijiazhuang, China. Methods: Two hundred and forty-seven cases of histologically confirmed cervical cancer were collected from January 2004 to September 2015. Among them, ThinPrep cytological results and cobas hr-HPV DNA testing results were observed in 164 patients 1 year ago. Results: Cytological results was negative in 17.4% of 132 cases one years before the histological diagnosis. The negative rate of squamous cell carcinoma and adenocarcinoma were 15.5% and 21.1% respectively. HPV was negative in 13.3% of 120 cases. The HPV negative rate of adenocarcinoma was higher than that of squamous cell carcinoma (47.1% vs 6.1%). In 88 patients had both HPV test and cytology results, 14 (15.9%) cases were HPV negative, but only 4 (4.5%) cases were negative. Conclusion: HPV screening for identifying cervical cancer has a relatively higher negative rate than cytology test. Cytology and HPV test combination is better than HPV test alone for cervical cancer prevention and primary screening.
Kuan-Chou Chen
Taipei Medical University Shuang Ho Hospital, Taiwan
Title: Histopathological and morphometric evaluation of sciatic nerve with the change of pain sensation in diabetic neuropathy rat receiving exercise therapy and metformin
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:
Diabetic peripheral neuropathy increases the risk of inflammation and degeneration of peripheral nerve fibers. Aerobic walking exercise increases the blood glucose stabilization and might improve inflammation. The aim of the study was to evaluate the histopathological changes on small nerve fiber in skin paws and sciatic nerve due to chronic hyperglycemia. Spraw-Dawley (SD) rat weighing 150-200 g divided into normal and DM groups, which induced by low doses of streptozotocin (45 mg/kg BW) i.p combining with high fat diet (60% calories from fat). After induction, all rats were further divided into control with exercise (CEX), DM, DM exercise and DM exercise combined with metformin by oral gavage for 8 weeks observation. Pain response was measured by heat pad analysis. Pathological evaluation of skin paws by HE and immunofluorescence staining for PGP 9.5, TNF-ï¡ and IL-6 antibody. Morphometry of sciatic nerve was stained by toluidine blue and observed by 400x magnification of light microscope. It was found the reduction of epidermal thickness accompanied by the damage of stratum corneum and flattening of basal lamina layer in skin paw within DM group (p<0.05). Morphometric measurement showed the smallest axon diameter in DM group (p=0.03). The PGP 9.5 and TNF-ï¡ were also significantly overexpression in DM group compared with the control group. The significant increase of IL-6 in DM and CEX could be correlated with the change of pain sensation in small nerve fiber. Both of attenuation of thickness in skin paws and flattening of basal lamina could be correlated with the reduction of axon diameter in sciatic nerve fiber in DM group. Improvement of inflammatory markers in DM exercise group may also correlates with the alleviation of pain sensation. Conclusively, decrease of mean time thermal latency for pain response and epidermal thickness in DM group might be correlated with the decrease of print length and stance phase time. Walking aerobic exercise has an effect to increase epidermal thickness compared with DM metformin group.
Snehal Shankar Sonawane
University of Illinois at Chicago, USA
Title: Emphysematous pyelonephritis: A pathologist’s perspective
Biography:
Snehal Shankar Sonawane has completed her Medical School at Government Medical College Miraj and has obtained Diplomate of National Board in Pathology from RCSM Government Medical College Kolhapur. She is presently working as Pathology Resident Physician at University of Illinois at Chicago. Her research work is in area of ‘Dry Eye Disease’ and is published in reputed journals.
Abstract:
Emphysematous pyelonephritis (EPN) is a rare, special form of pyonephritis with radiologic significance affecting female diabetes, characterized by severe, necrotizing, infection of the renal parenchyma, collecting ducts and perinephric tissues by gas forming microorganisms (e.g., Escherichia coli and Klebsiella). Diverse pathologic features in EPN can cause diagnostic dilemma for pathologist. We report a case of 75 year diabetic, hypertensive male with history of lacunar infarcts and benign prostatic hyperplasia presented with generalized weakness. Laboratory examination revealed neutrophilic leukocytosis, hyperglycemia with Escherichia coli in urine and blood culture. Patient received culture directed antibiotics. Despite subsequent surveillance blood cultures were negative; his clinical condition deteriorated. CT scan of the abdomen showed air in the collecting system of the left kidney with no discrete abscess, consistent with EPN. Patient failed to improve and underwent radical nephrectomy. Macroscopic examination of the kidney showed patchy areas of soft, tan/red areas of discoloration (0.7-2.6 cm) with partial loss of corticomedullary junction and no obvious mass lesions. Histology showed neutrophilic abscesses, necrosis of renal parenchyma and emphysematous cystic spaces with no definite lining. Thrombosis, focal glomerulosclerosis and acute tubular necrosis was noted in adjacent kidney parenchyma. The differential consideration's mainly included analgesic nephropathy complicated by bacterial infection, xanthogranulomatous pyonephritis, neutrophilic infiltrate associated with myeloma cast nephropathy, acute lobar nephronia, developmental hypoplasia (Ask-Upmark kidney) and ischemia/infarction. The diagnosis of EPN was rendered considering the radiological and histopathological findings. EPN is a rare, potentially life threatening condition. Clinical information in correlation with imaging and pathologic findings is crucial to clinch the diagnosis.
- 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.