Day 2 :
Keynote Forum
Kiyomi TANIYAMA
National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Japan
Keynote: Aberrant DNA methylation as a predictive marker for disease progression of LSIL in uterine cervix
Time : 09:15-09:45
Biography:
Taniyama completed his PhD in Pathology at the Hiroshima University School of Medicine in Japan in 1985, and he learnt molecular techniques and laser capture microdissection at the University of California, San Diego Cancer Center in 1998-99. He joined the National Hospital Organization (NHO), Kure Medical Center and Chugoku Cancer Center in 2002, and he became the president of this center in July 2014.
Abstract:
In the present study, 113 patients were classified into four groups according to their cervical cytology, HPV infection and follow up. Cytology samples were examined for aberrant DNA methylation (abMet) of DLX4 and SIM1 genes and their protein expressions. CaSki cells were treated with 5-Aza-2´-deoxycytidine (5-aza-dC). Of 113 samples, 40 in Group 1 were negative for intraepithelial lesion or malignancy. 21 low-grade squamous intraepithelial lesions (LSILs) in Group 2 showed a continuance of LSIL for longer than 365 days, and 12 LSILs in Group 3 showed an up-grading to high-grade (H) SIL+ within 365 days after the diagnosis of LSIL. 40 in Group 4 were squamous cell carcinoma. All but Group 1 were infected with high-risk HPV. Significant difference existed in frequency of abMet between groups 2 and 3 (p = 0.044), between groups 3 and 4 (p = 0.020) for DLX4, and between groups 1 and 3 (p = 0.0003), as well as between groups 2 and 3 (p = 0.005) for SIM1 gene. DLX4 protein expression was significantly reduced in the DLX4 abMet positive tissues, as compared to the negative tissues (p = 0.008), and 5-aza-dC treatment extracted DLX4 protein expression of CaSki cells in a dose-dependent manner (p < 0.005). The LSIL cases with abMet of SIM1 gene or both genes progressed faster to HSIL+ than others (p = 0.033 or p = 0.048). Therefore, AbMet of DLX4 and SIM1 genes should be a useful and novel progression marker of uterine cervical LSIL with HPV infection.
Keynote Forum
Guo-Min Deng
Key Laboratory of Antibody Technique of Ministry of Health, Nanjing Medical University China
Keynote: Pathogenesis and targeted treatment of skin injury in systemic lupus erythematosus
Time : 09:45-10:15
Biography:
Guo-Min Deng has obtained MD in China and PhD in Gothenburg University, Sweden in 2001. He worked as research fellow in NIH, USA during 2002-2006 and worked as instructor and assistant professor in Harvard University during 2006-2014. He is distinguished professor and the director of key Lab of antibody techniques of ministry of health in Nanjing Medical University. He has published more than 25 papers in reputed journals including Nature Medicine, Nature reviews Rheumatology and has been serving as an editorial board member of repute.
Abstract:
Skin is the second most common manifestation in patients with Systemic lupus erythematosus (SLE) yet the etiology and the mechanisms which are involved in the expression of injury remain unclear. We discuss the role of ultraviolet light (UV), immune cells, cytokines and the deposition of immunoglobulin in the development of inflammation and damage. UV represents the most typical environmental factor which triggers the expression of skin lesions in areas where immunoglobulin has been deposited and various components of the immune system have been amassed. Understanding of the interplay of environmental and immune factors has led to the identification of key molecules which can be targeted therapeutically. These include IgG/Fc receptor, tumor necrosis factor (TNF)/TNF receptor and interferon (IFN)/IFN receptor-initiated cell signaling. A number of intracellular kinases (spleen tyrosine and calcium/calmodulin 4) and transcription factors have also been demonstrated to be involved in the expression of skin lesions in lupus-prone mice. The possibility to apply small drugs locally with limited side-effects calls for further studies to eliminate the burden of skin inflammation in SLE patients.
- 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.
- 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.