SCIENTIFIC WORKSHOPS
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Saturday July 10 |
Sunday July 11 |
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W101: Surgical Pathology and Molecular Pathology Integration: A Case-based Approach
W102: Diagnostic Challenges in Cytology and Histology of Uterine Cervix
W103: The Role of Immunohistochemistry in Investigating Primary Unknown Malignancy And Work up of Medtastic Adenocarcinoma of Unknown Primary Origin
W104: Laboratory Practice Management Skills 101
W105: Benign Pediatric Hematopathology: Pitfalls and Pearls
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W301: Histopathologic Diagnosis of Pre-invasive Lesions of the Female Genital Tract
W302: Molecular Testing in Cancer: Current Application and Future Prospective
W304: Skin Pathology: Putting the Pieces Together
W305: Pathology of Diffuse Non-neoplastic Lung Disease
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W201: Practical Pathology of the Luminal Gastrointestinal Tract
W202: What's Wrong with FNA of the Thyroid?
W203: Controversies in the Diagnosis and Classification of Ovarian Tumours
W204: Hematopathology for the Surgical Pathologist
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W401: Forensic Pathology and Sudden Death - Looking Beyond the Standard Autopsy
W402: Practical Approach to Diagnostic Problems in Prostatic and Testicular Pathology
W403: Perinatal Pathology Made Easy: The Placental Findings Associated with Adverse Pregnancy Outcome
W404: Breast Pathology: New Entities and New Insights into Old Entities
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| SATURDAY JULY 10 MORNING WORKSHOPS |
| W101: Surgical Pathology and Molecular Pathology Integration: A Case-based Approach |
Alan Spatz, McGill University, Montreal, Quebec
Luc Oligny, CHU Sainte-Justine, Montréal, Québec |
The workshop will make use of 9 cases carefully chosen to reflect the need for morphological-molecular integration, and to cover the main tests currently used in Molecular Pathology. Each case will also contain information on the theoretical and technical principles inherent to the test. The cases will distribute as follows:
1 colorectal cancer- Adrian Gologan
1 breast cancer - Dragana Pilavdzic
1 neurodegenerative disease - Julia Keith
1 melanoma - Alan Spatz
1 genito-urinary tumour - Nathalie Stock
1 pediatric sarcoma - Luc Oligny
1 pediatric lymphoma - Raouf Fetni
1 familial cancer - TBA
1 adult lymphoma - TBA.
Objectives:
- To understand the principles of commonly used molecular pathology tests using a case-based approach;
- To identify the major indications for molecular pathology tests;
- To better understand the importance of phenotype-genotype correlations.
Format: Lecture
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| W102: Diagnostic Challenges in Cytology and Histology of Uterine Cervix |
Golnar Rasty, University Health Network, Toronto, Ontario
Marjan Rouzbahman, University Health Network, Toronto, Ontario |
This course is designed to provide updated pragmatic, problem-solving knowledge for residents, fellows, practicing surgical pathologists and cytopathologists who also wish to remain current with the changing trends in cytodiagnosis and gynecologic pathology. It addresses the resolution of diagnostic pitfalls relative to gynecologic cytopathology and histopathology. Selected cases will be presented as unknowns and discussed using an audience response system to facilitate audience participation.
Objectives:
- Know the key cytological and histological features of usual and complicated squamous and glandular lesions of cervix;
- Recognize recently described entities and understand their clinical significance;
- The participants will obtain an understanding of new standards, techniques, criteria and classifications in gynecologic pathology.
Format: Lecture
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| W103: The Role of Immunohistochemistry in Investigating Primary Unknown Malignancy And Work up of Medtastic Adenocarcinoma of Unknown Primary Origin |
Emina Torlakovic, University of Saskatchewan, Saskatoon, Saskatchewan
Malcolm Hayes, BC Cancer Agency, Vancouver, British Columbia
Mogens Vyberg, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark |
Objectives:
- Emphasize the role of immunohistochemistry (IHC) in pinpointing the primary origin of carcinoma;
- Emphasize that IHC results must be considered in the context of the clinical picture and the H&E morphology of the tumour;
- Illustrate immunoprofiles of the major different types of carcinoma and their subtypes;
- Illustrate immunopanels that assist in the differential diagnosis of different patterns of carcinoma;
- Illustrate immunopanels and algorithms that enable site of origin to be determined when dealing with carcinoma in different anatomical locations;
- Illustrate the use of non-specific antibodies for specific questions;
- Address the use of negative IHC results.
Format: Lecture
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| W104: Laboratory Practice Management Skills 101 |
Brian Cummings, Grand River Hospital, Kitchener-Waterloo, Ontario
Murray Treloar, Lakeridge Health Corporation, Oshawa, Ontario
Denis Macdonald, North York General Hospital, Toronto, Ontario |
The practice of Laboratory Medicine involves the application of more "Management Skills" than many other medical specialties as one is practicing in a high risk, intense and complex environment, which is essentially a factory type operation producing thousands of items of data daily which have a major impact on clinical practice. Management in the clinical laboratory is defined as the marshaling of human, scientific, technologic and data resources to optimize patient care. The clinical laboratory is also a highly regulated and medical legal environment where quality improvement plays a highly central and increasingly important role. One is also often called on to act as a Divisional or Departmental Director early in one's professional career with little or no additional training. Leading or managing a team of professionals, not all of whom are medically trained, can be a daunting task for the non-initiated and can induce additional stress over and above the level associated with clinical practice, where at least one has had the benefit of 5 or more years of intense training. This workshop will draw on the theoretical training and wide management experience of the co-directors in providing a basic platform in management theory and professional practice, including how to avoid finding yourself working in a "toxic" or uncomfortable professional work environment. In addition, basic financial skills such as the various models of remuneration important to the new as well as more experienced practitioner will be discussed.
Objectives:
- To provide an overview of current management theory as applied to the Clinical Laboratory with a review of national trends and an environmental scan;
- To briefly review different remuneration models for Pathologists, including self-employed contractor, employee, incorporated physician and membership in an alternative payment plan (APP), as well as different combinations of these arrangements;
- To overview the advantages and disadvantages of these respective models including business and income tax implications;
- To briefly elaborate on the status and potential benefits and pitfalls of incorporation for Pathologists in Canada today;
- To examine models of professional practice management in clinical (mostly anatomical pathology) practice including measuring and reviewing physician performance, quality management and conflict resolution;
- To provide both new and experienced practitioners insights on the modern workplace environment in anatomic and clinical pathology, including the responsibilities of the Laboratory Director.
Format: Lecture
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| W105: Benign Pediatric Hematopathology: Pitfalls and Pearls |
Louis Wadsworth, University of British Columbia, Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia
Jason Ford , University of British Columbia, Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia |
This workshop is a case-based exploration of interesting and important diagnostic considerations in pediatric laboratory hematology. Many Canadian centres do not have pediatric hematopathologists, and so rely on pathologists with more adult experience to diagnose pediatric cases. The goal of this workshop is to assist these pathologists (and pathologists in training) to develop a diagnostic approach to hematologic conditions which are more common in pediatrics. Recent molecular and other pathogenetic findings will also be reviewed.
Objectives:
- Be able to provide a diagnostic approach to paediatric patients with: severe anaemia (haemolytic and hemorrhagic) ; hemoglobinopathy and thalassemia ; coagulopathies; congenital and acquired cytopenias;
- Be able to describe how the workup of these conditions in children differs from adults;
- Be able to discuss recent advances in molecular diagnosis in pediatric hematopathology.
Format: Lecture
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| SATURDAY JULY 10 AFTERNOON WORKSHOPS |
| W201: Practical Pathology of the Luminal Gastrointestinal Tract |
Catherine Streutker, St. Michael's Hospital, Toronto, Ontario
David Grynspan, Health Sciences Centre, Winnipeg, Manitoba |
In this workshop, we will cover practical issues of gastrointestinal pathology from the esophagus to the anus. We will review the diagnosis of dysplasia and early carcinomas in various sites within the luminal GI tract and review new therapies such as endoscopic mucosal resection. Inflammatory lesions of children and adults will be reviewed, including eosinophilic esophagitis, celiac disease and autoimmune disorders of the mucosa. The wide variety of polyps of the stomach, small bowel and colon (including sessile serrated adenomas) will be reviewed and discussed.
Objectives:
- Dysplasia of the luminal gastrointestinal tract: diagnosis and treatment options;
- Inflammatory lesions of the GI tract;
- Benign and malignant polyps of the GI tract.
Format: Lecture
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| W202: What's Wrong with FNA of the Thyroid? |
Scott Boerner, University Health Network, Toronto, Ontario |
Workshop participants will be faced with 13 case challenges that will serve as focal points in this comprehensive review of thyroid FNA. The workshop will address common problems and diagnostic errors that arise in FNA of the thyroid and illustrate both the cytologic and diagnostic features of a variety of common and not-so-common inflammatory and neoplastic thyroid masses. During this course, the new NCI endorsed terminology for thyroid FNA will be explored. A number of approaches to the diagnosis of thyroid cytology will be discussed including approaches to those troublesome follicular patterned lesions and Hürthle cell lesions. At the conclusion of the presentation, participants will be confronted with additional diagnostic challenges to assess their newly acquired knowledge.
Objectives:
- Review common diagnostic errors in FNA of thyroid lesions;
- Examine the cytologic and diagnostic features of inflammatory and neoplastic lesions of the thyroid;
- Develop an approach to those troublesome follicular patterned lesions and Hürthle cell (oncocytic) lesions;
- Acquire familiarity with the new NCI endorsed terminology for thyroid FNA.
Format: Lecture
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| W203: Controversies in the Diagnosis and Classification of Ovarian Tumours |
Patricia Shaw, University Health Network, Toronto, Ontario |
Recent advances in the understanding of the pathogenesis of epithelial ovarian cancer have led to newly proposed classifications of ovarian tumours, but also to controversy in the gynecological pathology community. In this workshop, cases from a collection of over 800 well-characterized ovarian cancers will be used to review and illustrate the pathogenesis, classification and diagnosis of ovarian tumours, aiming to clarify current ovarian tumour classification and grading for the practicing pathologist. The workshop will be interactive, using 12 precirculated cases as points of discussion. Topics to be included are:
- diagnosis and reporting of tumours of low malignant potential, including the significance of extra ovarian implants and lymph node involvement;
- the differential diagnosis of invasive and noninvasive implants;
- the relationship of borderline tumours to invasive carcinoma;
- pitfalls in the histotyping of the common types of ovarian carcinoma;
- newly proposed grading systems in ovarian carcinoma;
-hereditary ovarian cancer, and how to process and report prophylactic salpingo-oophorectomies;
-differentiating metastatic carcinomas to the ovary from tumours of ovarian origin;
-use of immunohistochemistry in the diagnosis of ovarian tumours.
Objectives:
- Understand the current concepts of ovarian tumour pathogenesis, classification and grading of epithelial ovarian tumours, and the relationship of borderline tumours to invasive carcinoma;
- Understand the two-tier and three-tier histologic grading systems;
- Know how to apply immunohistochemistry to the diagnosis and reporting of the pelvic mass.
Format: Lecture
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| W204: Hematopathology for the Surgical Pathologist |
Catherine Ross, Hamilton Health Sciences Centre, Hamilton, Ontario
Monalisa Sur, Hamilton Health Sciences Centre, Hamilton, Ontarion |
Twelve cases, which have significant potential to be missed or misdiagnosed, will be presented within the WHO classification. The emphasis will be on cases which may often be confused with non-hematopoietic neoplasms based on the morphology. In addition, cases in which the appearances and sometimes the ancillary studies can present confusion both in diagnosis and classification will be discussed. The utility of both immunohistochemistry and other studies (flow cytometry and molecular studies) as aids to diagnosis will be highlighted. Examples of newer entities within the WHO classificantion will be shown and discussed. The cases will have routine H&E stains and full immunohistochemical panel. Discussions on the differential diagnosis will be highlighted to demonstrate how to avoid diagnostic pitfalls.
Objectives:
- Have a heightened awareness about selected areas in hematopathology that are prone to diagnostic errors;
- Understand the importance of judicious use of ancillary techniques to avoid the pitfalls;
- Be aware of the current status of lymphoma classification and where the described entities fit in;
- Know when to consider HD neoplasms and variants in the differential diagnosis.
Format: Lecture
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| SUNDAY JULY 11 MORNING WORKSHOPS |
| W301: Histopathologic Diagnosis of Pre-invasive Lesions of the Female Genital Tract |
William Chapman, St. Joseph's Health Centre, Toronto, Ontario
Blaise Clarke, University Health Network, Toronto, Ontario |
This course will provide a case-based overview of pre-invasive neoplastic lesions of the female genital tract. It will focus primarily on cervix and endometrium, with lesser emphasis on vulva, fallopian tube and gestational trophoblastic disease. With vulva and cervical pathology, the spectrum of pre-invasive squamous and glandular lesions will be reviewed with particular reference to histopathologic criteria and to indications for biomarkers, which may be helpful in the interpretation of these lesions and in their differentiation from benign mimics. The endometrial component will cover classification systems for endometrial hyperplasia, histologic features useful in distinguishing the categories of hyperplasia and differentiation from both benign conditions and invasive malignancy. In addition, the role of immunohistochemistry as an adjunct tool will be reviewed. The endometrial component will also cover putative precursors to serous carcinoma. Recently there has been much literature on the fallopian tube as the site of origin of serous carcinomas involving the ovaries. This has led to some suggested changes in pathology practice when dealing with pelvic masses and adnexal specimens. New grossing protocols to improve assessment of the fimbriated end of the tube will be presented as well as the spectrum of changes seen and the use of immunohistochemistry in interpreting these lesions. There will also be a review of hydatidiform moles, complete and partial, as precursors to choriocarcinoma. This will include the diagnostic criteria and how they have evolved with earlier clinical intervention in addition to the role of adjuvant techniques in diagnosis.
Objectives:
- To improve the histopathologic diagnosis of pre-invasive lesions of the female genital tract through application of major criteria and recognition of differential diagnoses;
- To gain an appreciation of the diagnostic pitfalls in the interpretation of pre-invasive gynecologic conditions;
- To review the additional tools that may aid in the diagnosis of these early pre-invasive lesions.
Format: Lecture
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| W302: Molecular Testing in Cancer: Current Application and Future Prospective |
George M. Yousef, St. Michael's Hospital, Toronto, Ontario
Serge Jothy, St. Michael's Hospital, Toronto, Ontario |
This course is intended to provide an update regarding the rapidly evolving field of molecular testing in cancer. Advances in this field will have a major impact in diagnosis and management of cancer patients and, as well, will lead to moving into a new era of personalized medicine in cancer care. We will start with an overview of the basics of cancer genetics. We will then provide an overview of the spectrum of applications of molecular pathology cancer diagnosis and management. Specific examples of common neoplasms will be discussed. A quick overview of the principles of the most commonly used techniques will be also presented, with emphasis on PCR.. Using illustrative cases, we will discuss the role of molecular testing in colorectal cancer and its impact on patient management. The molecular events involved in colorectal cancer pathogenesis will be summarized. We will then introduce the concept of “personalized medicine” and discuss its great potential impact on cancer patient management. A short discussion will follow to highlight the potential role of miRNA in cancer diagnosis and management. This workshop will be of value to general and anatomical pathologists, pathology residents and fellows.
Objectives:
- Have an overview of the basics of cancer genetics, with emphasis on colon cancer pathogenesis;
- Understand the increasingly important role of molecular pathology in current practice and its impact on patient diagnosis, prognosis, and management, including targeted therapies;
- Understand the principles of the most commonly used techniques of molecular pathology, and be able to select the appropriate technique for the test to be performed;
- Be more familiar with the concept of “personalized medicine” in cancer and its potential impact on patient management;
- Have a brief overview of the emerging role of “microRNA” testing in cancer care.
Format: Lecture
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| W304: Skin Pathology: Putting the Pieces Together |
Danny Ghazarian, University Health Network, Toronto, Ontario
Ayman Al-Habeeb, University Health Network, Toronto, Ontario |
A wide range of common problematic skin lesions and cases will be covered, ranging from inflammatory dermatoses to melanocytic tumors to other commonly-encountered non-melanocytic tumors, such as adnexal tumors.
Objectives:
- Histopathological criteria and clues will be discussed and woven together to reach a diagnosis;
- Differential diagnoses will be addressed, with common diagnostic pitfalls highlighted and their prevention stressed;
- To inform and expose the practicing pathologist to the subtleties in skin pathology.
Format: Lecture
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| W305: Pathology of Diffuse Non-neoplastic Lung Disease |
John English , Vancouver Coastal Health, Vancouver, British Columbia |
Diffuse non-neoplastic pulmonary disease often poses diagnostic dilemmas for beginner and experienced pathologists alike. This is due, in part, to the fact that these conditions are not common, or at least are not commonly biopsied, and thus it is difficult to acquire a comfortable understanding of the relevant issues. In addition, the entire population of diffuse lung diseases has inadvertently acquired a complex nomenclature with overlapping descriptive terminologies and etiological classifications. This workshop is directed at practicing Anatomical and General Pathologists as well as residents in pathology. The central focus of this course will be on the idiopathic interstitial pneumonias with discussion of other conditions that routinely enter the differential diagnosis, including hypersensitivity pneumonitis, collagen vascular-related lung disease, smoking-related interstitial lung disease and lung manifestations of drug toxicity. Acute lung injury will also be addressed in this context, as will the relevant pulmonary eosinophilic disorders. Throughout the discussion, relevant radiological and clinical correlation will be related to pathological manifestations, underscoring the utility of the "team" approach to the diagnosis of diffuse pulmonary disease.
Objectives:
- Understand the importance of appropriate specimen handling in the context of diffuse lung disease;
- Be able to develop an overall approach to determining the salient injury/repair patterns that form the basis of a confident diagnosis or differential diagnosis in diffuse pulmonary disease with special reference to the idiopathic interstitial pneumonias ("the IP's") and secondary forms of interstitial lung disease;
- Understand how patterns of pulmonary inflammation and fibrosis are common to many idiopathic and secondary causes of diffuse lung disease and how these patterns pose difficult diagnostic challenges to the pathologist;
- Understand how knowledge of clinical features and radiological disease patterns can assist the pathologist in making a diagnosis or an appropriate differential diagnosis in a difficult case of diffuse lung disease.
Format: Lecture
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| SUNDAY JULY 11 AFTERNOON WORKSHOPS |
| W401: Forensic Pathology and Sudden Death - Looking Beyond the Standard Autopsy |
Christopher Milroy, The Ottawa Hospital, Ottawa, Ontario
Jacqueline Parai, The Ottawa Hospital, Ottawa, Ontario
Kris Cunningham, The Ottawa Hospital, Ottawa, Ontario |
This case-based workshop will present an approach to investigating sudden death. The workshop will concentrate on 3 main areas:
1. Sudden death in patients with underlying diseases.
2. Use of histology in criminally suspicious deaths.
3. Non-atherosclerotic cardiovascular pathology in sudden death.
The workshop is designed for both forensic pathologists as well as hospital pathologists whose practice includes autopsies. Using cases, the audience will be shown how specialized dissections, histology and ancillary testing can be used to assist the pathologist in working up a case and ultimately in establishing a cause of death.
Objectives:
- Develop an overall practical approach for investigating sudden death;
- Understand how specialized dissection, histology and ancillary testing can be used to assist the pathologist in establishing a cause of death;
- Develop a diagnostic approach to non-atherosclerotic cardiovascular diseases seen in sudden death.
Format: Lecture
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| W402: Practical Approach to Diagnostic Problems in Prostatic and Testicular Pathology |
Kiril Trpkov, Calgary Laboratory Services, Calgary, Alberta
Asli Yilmaz, Calgary Laboratory Services, Calgary, Alberta |
This case-based workshop will focus on common and diagnostically challenging problems in prostatic and testicular pathology. Selected topics will cover specific and practical diagnostic issues. The goal of the workshop is to help pathologists and pathologists-in-training to develop a practical diagnostic approach in dealing with common and diagnostically challenging problems in prostatic and testicular pathology.
Objectives:
- Illustrate and understand common diagnostic problems in prostatic and testicular pathology;
- Sharpen the expertise and the diagnostic work-up in resolving common diagnostic problems in prostatic and testicular pathology;
- Develop a practical step-wise approach in solving common diagnostic problems in prostatic and testicular pathology.
Format: Lecture
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| W403: Perinatal Pathology Made Easy: The Placental Findings Associated with Adverse Pregnancy Outcome |
Sarah Keating, Mount Sinai Hospital, Toronto, Ontario
Patrick Shannon, Mount Sinai Hospital, Toronto, Ontario |
The workshop will focus on commonly encountered problems in perinatal pathology. It will be designed for pathology residents and pathologists practicing in community hospitals or tertiary hospitals that do not have specialized fetal/perinatal expertise. The workshop will be presented in lecture format but questions and interaction will be encouraged throughout the presentation. In order to best utilize the available time, the emphasis will be on learning an approach to fetal and placental specimens, rather than on trying to show examples of multiple unusual entities. The three main topics covered will be:
1. The approach to pregnancy losses in the 1st and 2nd trimester: What can we learn from the macerated fetus and its placenta? What can we learn from curettage specimens?
2. The approach to the unexplained third trimester stillbirth: what are common findings in the placenta and the fetus?
3. The approach to intrauterine growth restriction; the optimum placental examination and commonest pathologic findings in the placenta.
Objectives:
- The learner will be given an approach to pregnancy losses from the first and second trimester. Following the workshop the learner will know when to perform a complete dissection of a surgical fetus, what can be learned from the placental tissue and when special studies are indicated;
- The learner will become familiar with the common placental abnormalities found in third trimester stillbirth and intrauterine growth restriction (IUGR). Furthermore, following the workshop the learner will recognize what placental abnormalities are likely to recur in subsequent pregnancies;
- The learner will acquire an approach to congenital anomalies, both common and rare, which are associated with pregnancy loss. Following the workshop, the learner will appreciate the important differences between an adult and a perinatal autopsy and how to preserve anatomic structures during dissection so that the full extent of anomalies can be appreciated and appropriately documented.
Format: Lecture
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| W404: Breast Pathology: New Entities and New Insights into Old Entities |
Anna Marie Mulligan, St. Michael's Hospital, Toronto, Ontario
Anita Bane, Hamilton Health Sciences Centre, Hamilton, Ontario |
This course will review a number of recently described entities as well as older entities on which we are beginning to gain more insight. Where applicable, immunohistochemical and/or molecular methods used in diagnosis and reporting will be discussed. Among the topics for discussion are the spectrum of columnar cell lesions including flat epithelial atypia, lobular neoplasia and its differentiation from other intraductal proliferations and apocrine lesions, ranging from benign proliferations to invasive apocrine carcinoma with discussion of its molecular aspects. Encapsulated papillary carcinoma, the recently proposed term for an old lesion will be discussed including its differential diagnosis and its clinical significance. An overview will be given on a new approach to breast cancer classification, which includes luminal, HER2 and basal phenotypes. While originally based on molecular profiling, emphasis will be placed on classification according to immunohistochemical profile. Recent evidence suggests that tumour morphology and immunophenotype can predict for an underlying BRCA germline mutation. The role of the pathologist in recognizing potential carriers and the clinical significance of this will be presented. The growing appreciation of the need for using standardized testing methods for ER, PR and HER2 will be the subject of the final session. Emphasis will be placed on diagnosis and differential diagnosis as well as on the clinical significance and management implications for the patient. A case-orientated approach will form the basis for each topic. A syllabus will be distributed following the course. The presentations will be aimed at a level appropriate for general surgical pathologists and will provide the participants with the opportunity to address specific questions following each presentation.
Objectives:
- To recognize recently described entities and understand their clinical significance;
- To address new issues as they apply to well-known lesions;
- To review the application of immunohistochemistry and molecular methods used in diagnosis and as prognostic/predictive markers.
Format: Lecture
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CAP Conference Secretariat
Email: cap@eventsmgt.com
Tel: 613.531.9210
Fax: 613.531.0626
4 Cataraqui Street, Suite 310
Kingston, ON K7K 1Z7
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