Scientific Program

Developing Strategies for a Sustainable Career in Pathology

 

SATURDAY JUNE 10

0730-1830

Pathologists Assistants Program

0900-1230

Preconference Workshops W1011, W1012, W1013, W1014

1230-1400

Residents and Fellows Networking Lunch

1400-1730

Preconference Workshops W1021, W1022, W1023, W1024

1830-2030

Residents’ Symposium (followed by Residents’ Dinner)

1830-2030

Special Interest Group Meetings

 

 

SUNDAY JUNE 11

0800-0930

Opening Ceremony and Opening Keynote Speaker: Physician Health and Wellness: A Critical Component of a Sustainable Career

0930-1000

Refreshment Break

1000-1200

Concurrent Sessions: Symposia and Workshops

1330-1500

Concurrent Sessions: Symposia and Workshops

1500-1530

Refreshment Break

1530-1700

Concurrent Sessions: Symposia and Workshops

1700-1730

CAP-ACP Junior Scientist Award Lecture: The Intestinal Immune System in Obesity and Insulin Resistance

1730-1800

CAP-ACP William Boyd Award Lecture: Tribute to Guillermo Quinonez: Recipient of the 2017 CAP-ACP William Boyd Lectureship

 

 

MONDAY JUNE 12

0800-0930

Plenary Session: Debate: Wellness Around the Globe

“Given the increasing workloads in Pathology, be it resolved, non-Pathologists such as Pathologists’ Assistants and Technologists should report/sign out pathology cases”

0930-1000

Refreshment Break

1000-1200

Concurrent Sessions: Symposia and Workshops

1330-1500

Concurrent Sessions: Symposia and Workshops

1500-1530

Refreshment Break

1530-1700

Concurrent Sessions: Symposia and Workshops

1700-2000

Poster Presentations

 

 

TUESDAY JUNE 13

0800-0930

Cam Coady Seminar: Work-Life Integration in Pathology: Finding a Balance

0930-1000

Refreshment Break

1000-1200

Concurrent Sessions: Symposia, Oral Presentations, and Workshops

1330-1500

Concurrent Sessions: Symposia and Workshops

1500-1530

Refreshment Break

1530-1700

Concurrent Sessions: Symposia and Workshops

1700-1800

Closing Ceremony and Closing Keynote Speaker: Technology, Social Media and the 21st Century Pathologist: Waste of Time or Free Wellness Tool?

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Canadian Network of Uropathology SIG: A Case Based Interactive Approach to Challenging GU Diagnoses
Saturday June 10, 1830-2030

 

Michelle Downes, Sunnybrook Health Sciences Centre

Manal Gabril, London Health Sciences Centre

George M. Yousef, University of Toronto, St. Michael’s Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Identify new and emerging entities in GU pathology.
  • Differentiate between similar appearing tumours.
  • Integrate immunoprofile and morphology to arrive at a diagnosis.
  • Explain how a favoured diagnosis was reached.

This is an interactive, case based workshop led by two practicing GU pathologists. Cases covering a variety of GU pathologic entities will be reviewed and discussed over a 90 minute period. Each case will be presented and participants will vote on most likely diagnosis from a list of provided differential diagnoses. Following voting, the final diagnosis will be discussed with supportive evidence as to why this was the preferred diagnosis. The differential diagnoses will be discussed, highlighting relevant positive and negative findings. There will be the opportunity to interact and ask questions after each case and also at the end of the session.

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Opening Ceremony and Opening Keynote Speaker: Physician Health and Wellness: A Critical Component of a Sustainable Career
Sunday June 11, 0800-0930

 

Derek Puddester, University of Ottawa

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss the role of physician health and wellness in the context of CanMEDS competencies.
  • Summarize the evidence linking physician health and wellness to enhanced patient care and professional sustainability.
  • Identify at least three practical efforts to enhance their own sustainability.

This opening plenary will outline the current policy and scientific framework for physician health in Canada, and globally. Using ample references, cases, and resources, the plenary will help anchor the construct of physician health and wellness to the current efforts participants are making in their personal and professional lives. This session will be of value to all pathology residents and established practitioners, as well as those working collaboratively with them.

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Symposium: Patient Safety and Quality Assurance
Sunday June 11, 1000-1200

 

Chair: Catherine Ross, McMaster University

 

Post Analytic Interpretation of Pathology Reports   Are We Making Ourselves Understood?

Gillian Bethune, Nova Scotia Health Authority

 

Objectives:

At the end of this session, participants will be able to:

  • Describe the post-analytic phase of the test cycle as it relates to surgical pathology.
  • Discuss the value and limitations of ‘customer satisfaction’ surveys.
  • Discuss some of the common issues raised by clinician stakeholders regarding pathology reports.

This part of the session will include an overview of the post-analytic quality phase of the test cycle, focusing on report quality, delivery, and interpretation. Results of ‘Customer Satisfaction Surveys’ of physician stakeholders, including family practitioners and specialist physicians in Nova Scotia will be presented. We will discuss the common problems and potential solutions for this important but often overlooked aspect of quality assurance and patient safety. The session will be of value to: general and anatomic pathologists, pathology residents.

 

Second Opinion in Pathology: Evidence For and Evidence Against

Nick Myles, Providence Health Care

 

Objectives:

At the end of this session, participants will be able to:

  • Distinguish between error and opinion; contrast accuracy and precision in pathology in respect to second review process.
  • Critically appraise and grade (Oxford system) core recent examples of published evidence in support and against second reviews in pathology.
  • Contrast second opinion which is actively sought and “reflex” second reviews (i.e. “node negative breast cancer etc).
  • Apply AGREE tool for critical appraisal of guidelines to determine the strength of the recommendations for second reviews in pathology.
  • Determine the efficient strategy to reduce diagnostic discrepancies resulted after second reviews in pathology.

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Workshop: Interpreting and Communication Findings in Medical Liver Biopsies: Pathologist as THE Clinician Behind the Microscope
Sunday June 11, 1000-1200

 

Oyedele Adeyi, University Health Network

Iram Siddiqui, Hospital For Sick Children

 

Objectives:

At the end of this session, participants will be able to:

  • Appreciate the importance of full understanding of clinical context as part of liver biopsy review.
  • Appreciate the short-comings of most published criteria for analyzing and inferencing liver biopsy findings in actual practice.
  • Integrate total biopsy, clinical, biochemical and other parameters into one final report that directly addresses specific clinical questions.

In our practice, we receive and review several liver biopsies for second opinion. While many of these are instigated by the pathologist, a significant number are also requested by the gastroenterologist/hepatologist who have been dissatisfied with the original diagnosis. Three related problems we have observed common to most cases are: pathologists interpreting microscopic features in isolation of clinical context; pathologist’s wrong application of published criteria in arriving at a diagnosis; and lack of a clear message in the final report that addressed the biopsy-initiating clinical questions. This workshop is therefore aimed at equipping pathologists to develop a process of medical liver biopsy review with the primary goal of using the biopsy to explain and shed light on the actual clinical condition, and clearly and unambiguously but appropriately writing an opinion that inform of “what next” in every case.

Most liver biopsies are performed with specific question(s) in mind, and the first responsibility is to address those questions. This workshop, among other things, will use real case examples to highlight how this can be done and will demonstrate the importance of thinking outside the box when using published “diagnostic criteria”. The participant will be taken through a process of disease identification from a pathogenetic and pathophysiologic focus towards identifying the actual clinical process in each case and ultimately defining the disease, before applying an appropriate grading, staging and other relevant criteria. Using specific examples that highlight each identified problem, this workshop will demonstrate a recommended approach to arriving at a context-appropriate conclusion and the importance of a clear and concise reporting system that addresses the clinical concerns and reduces incidence of clinician call-back.

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Symposium: Newborn Metabolic Screening
Sunday June 11, 1000-1200

 

Chair: Jefferson Terry, Children’s & Women’s Health Centre of British Columbia

 

Newborn Metabolic Screening

Jefferson Terry, Children’s & Women’s Health Centre of British Columbia

 

Objectives:

At the end of this session, participants will be able to:

  • Understand the assessment of metabolic disorders.
  • Describe an approach to newborn screening and metabolic autopsy.
  • Identify areas in perinatal autopsy where perinatal screening may diagnostically valuable.

The value of newborn screening in detecting metabolic abnormalities is well known but the application of newborn metabolic screening in perinatal and infant death is perhaps less well appreciated. Presently there are a number of metabolic abnormalities that may present as perinatal or infant death, and as metabolic diseases become better characterized and the technologies for detecting these abnormalities improve, newborn metabolic studies will become an increasingly important. Moreover, in an era of decreasing interest in pursuing anatomical autopsies, a metabolic autopsy may offer families and their caregivers a non-invasive approach to discover clinically significant abnormalities. This session is designed to provide an overview of metabolic disorders and potential applications in pediatric and perinatal pathology practice with a focus on perinatal autopsy.

 

Newborn Screening and Metabolic Autopsy

Zaiping Liu, IWK Health Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Provide an overview newborn screening: metabolic disorders.
  • Understand key points of a metabolic autopsy.
  • Appreciate the limitations on a metabolic screening test using a NBS method.
  • Discuss the interpretation challenges due to a lack of references & guidelines.

This talk will provide a overview of newborn screening program, recommended screening panel, specifically on screening for Inborn errors metabolism. In addition, key points of metabolic autopsy will be covered as well. By the end of the talk, the participant will understand the limitations on metabolic screening test using a NBS method and the interpretation difficulties due to a lack of references and standardized guidelines.

 

Horses, Zebras and Unicorns: Assessing Metabolic Disorders

Lori Beach, IWK Health Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Summarize the special considerations of laboratory involvement in metabolic disorders.
  • Compare the technologies involved and consider the complexity of interpretation of results.
  • Appraise cases that highlight the importance of teamwork from collection to bench to physician.

In this section, three unique cases will be described that practically exemplify the technology and interpretive rigour inherent to a biochemical genetics laboratory for assessment of metabolic disorders. This session will be of value to: pathologists with an interest in laboratory medicine and metabolic disorders.

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Symposium: Anatomical Pathology: Gynecologic Pathology
Sunday June 11, 1330-1700

 

Chair: Nadia Ismiil, Sunnybrook Health Sciences Centre

 

Uterine Smooth Muscle Tumors, What You Want to Know

Anais Malpica, The University of Texas MD Anderson Cancer Center

 

Objectives:

At the end of this session, participants will be able to:

  • List the histological features of problematic uterine leiomyoma variants.
  • Apply diagnostic criteria to distinguish leiomyomas from leiomyosarcomas.
  • Utilize the term “smooth muscle tumor of uncertain malignant potential” effectively.
  • Identify the clinicopathologic features of mullerian smooth muscle tumors occurring at extrauterine sites.

In this session, we will present a practical review on uterine smooth muscle tumors encompassing leiomyoma variants that can represent a diagnostic challenge, the diagnostic criteria for the different types of leiomyosarcoma (i.e., spindle cell, epithelioid, and myxoid), the use of the term “STUMP” and its clinical significance, and the clinicopathologic features of mullerian smooth muscle tumors occurring at extrauterine sites.

This session will be of value to pathology trainees, PAs, and pathologists.

 

Vulvar lesions: More Than Just Itchy Skin: Benign, Inflammatory and Pre-malignant Vulvar Dermatoses

Mary Kinloch, Saskatoon Health Region

 

Objectives:

At the end of this session, participants will be able to:

  • Appraise skin biopsies for common vulvar inflammatory conditions.
  • Review the morphologic spectrum of differentiated Vulvar Intraepithelial Neoplasia (dVIN).
  • Examine difficult clinicopathologic scenarios for diagnosing usual type Vulvar Intraepithelial Neoplasia (uVIN).
  • Identify some uncommon vulvar lesions that shouldn’t be missed.

This session will walk through the common and uncommon pathologic specimens of vulvar biopsies seen in a gynecologic pathology practice. Topics to be covered will include morphologic review, correlation with clinical findings, important sign-out points and ancillary test interpretation, for benign, inflammatory and pre-malignant vulvar conditions. This session will be of value to pathology residents, general and anatomic pathologists.

 

1500-1530 Refreshment Break

 

Gestational Trophoblastic Neoplasia (GTN)

Matthew Cesari, Sunnybrook Health Sciences Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Describe key concepts in placentation.
  • Relate these concepts to the classification of non-molar gestational trophoblastic disease.
  • Develop an approach to the diagnosis of non-molar gestational trophoblastic disease.

Gestational trophoblastic disease can cause cognitive and emotional distress to the pathologist. By focusing on the normal development of the placenta, this session hopes to highlight a logical approach to the diagnosis of non-molar gestational trophoblastic disease. Case studies will be used to illustrate disease prototypes and fundamental clinical concepts of this subset of gestational trophoblastic disease.

 

Click here to review the advance material

 

Interpretation and Reporting of Benign Endometrial Pathology: Simple Approach and Updated Consensus Terminology

Carlos Parra-Herran, Sunnybrook Health Sciences Centre, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • List the most relevant benign diagnoses encountered in endometrial biopsy and their current proposed terminology.
  • Recognize the strengths and limitations of pathologic assessment of benign physiologic and non-physiologic endometrial changes in biopsy material.
  • Appraise the factors influencing specimen adequacy in endometrial samples and the implications of adequacy in patient care.
  • Identify diagnostic instances in endometrial biopsy that require urgent communication and reporting.
  • Discuss the importance of consistent, unified diagnoses in benign endometrial pathology for clinical, quality assurance and educational purposes.

Uniform and consistent reporting of endometrial pathology is important for patient care and quality assurance. Reporting of benign pathology diagnoses in biopsy material currently lacks the level of standardization achieved in cancer assessment. In addition, some of the diagnostic terminology has not kept pace with clinical practice, especially in the area of infertility management. Therefore, the development of consensus standard terminology for endometrial biopsy diagnosis is needed. The Gynecologic Pathology Interest Group (GPIG) of the Canadian Association of Pathologists – Association Canadienne des Pathologistes (CAP-ACP) embarked in the elaboration of national guidelines for benign endometrial biopsy reporting, which will serve to practicing pathologists and other health care professionals in the analysis and reporting of benign endometrial samples for clinical, quality assurance and educational purposes. The session will cover the most relevant diagnostic entities in benign endometrial pathology, introducing the consensus terminology included in the guideline and highlighting its clinical relevance. The session will be interactive and promote critical analysis of each presented case / pathology by the audience. This session is primarily aimed to pathologists in training (residents, fellows), general pathologists who encounter endometrial samples in their practices, and gynecologic pathologists.

 

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Workshop: Between the Hope and the Hype: Molecular Pathology in the Age of Precision Medicine
Sunday June 11, 1330-1700

 

Harriet Feilotter, Queen’s University

George M. Yousef, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Understand the evolving central role of the pathologist in patient management in the upcoming age of precision medicine.
  • Have a grasp of the basics of next generation sequencing, and its clinical applications and limitations.
  • Understand the basic principles of new evolving technologies/approaches in molecular pathology and their advantages and limitations.
  • Appreciate the phases of implementation and challenges that face molecular pathology in the age of precision medicine.

The promise of precision medicine (PM) has been upon us for years. PM aims to eliminate the “one-size fits all” model of medicine, which has mainly centered on reaction to a disease (treating the symptoms) based on average responses to care, by shifting the emphasis to prevention and early intervention for high-risk individuals. Stepping into a new era of genomic medicine, pathologists need to be familiar with and understand the concept of precision medicine. Also, the role of the pathologist is gradually evolving. The pathologist is no longer a “diagnostic specialist” but an active participant in patient management. New technologies are fast evolving and are approaching the clinic. There is an urgent need for pathologists to understand the basic principles and limitations of these technologies. Next generation sequencing is a reality in the clinic.

Pathologists need to know how to interpret the results of NGS and understand its applicability and limitations in the clinical lab. There is also an urgent need for pathologists to participate in decisions to approve new testing modalities based on cost/effectiveness in patient management. Pathologists should be prepared to address the phases of implementation and the new challenges that face our transition into the era of PM, including how to deal with ethical and QC issues etc. Finally, there is also a need for training of pathologists and residents on molecular pathology and the basic concepts of molecular profiling approaches that represent the revolution of PM.

The workshop is designed as a series of 4 lectures designed to teach the novice pathologist the basics of emerging molecular technologies, including next generation sequencing. The application of these technologies to the area known as molecular pathology is leading the way to precision medicine, a term that will be discussed and explained. Particular attention will be paid to some of the limitations and challenges that are posed by the use of molecular biomarkers in molecular pathology.

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CAP-ACP Junior Scientist Award Lecture: The Intestinal Immune System in Obesity and Insulin Resistance
Sunday June 11, 1700-1730

 

Daniel Winer, University Health Network

 

Objectives:

At the end of this session, participants will be able to:

  • Review basic fundamental principles of intestinal immunology.
  • Discuss how obesity changes the makeup of the intestinal immune system, including its phenotype in morphological sections.
  • Explain how the changes to the gut immune system control whole body glucose homeostasis.

Obesity and its associated metabolic abnormalities, including insulin resistance (IR) and type 2 diabetes (T2D), represent a major global cause of morbidity and mortality. IR precedes T2D and is a key driving factor in its development. Multiple factors contribute to insulin sensitivity but chronic inflammation of metabolic tissues, including visceral adipose tissue and liver is a major contributor. More recently, growing evidence implicates the gut immune system as a new player in metabolic disease. Diet induced obesity alters the intestinal immune system at levels of innate and adaptive immunity. These alterations impact the gut microbiota, intestinal barrier, gut hormone release, and oral tolerance, with downstream implications to metabolic homeostasis. Accordingly, the gut immune system may represent a novel therapeutic target for IR. This talk will outline emerging concepts in the field of intestinal immunity in IR and discuss its potential as a new therapeutic approach to metabolic disease. This session will be of value to residents, PAs, general and anatomic pathologists who wish to understand more fundamental immunology and how it shapes physiological processes in the body.

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CAP-ACP William Boyd Award Lecture: Tribute to Guillermo Quinonez: Recipient of the 2017 CAP-ACP William Boyd Lectureship
Sunday June 11, 1730-1800

 

At the end of the presentation the participants will have an appreciation of Dr. Guillermo Quinonez’s significant contribution to the CAP-ACP, the Department of Pathology at the University of Manitoba, the Royal College of Physicians and Surgeons of Canada, and the fields of the History of Medicine, and Electron Microscopy.

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Plenary Session: Debate: Wellness Around the Globe
Monday June 12, 0800-0930

 

A debate with international pathology leaders: “Given the increasing workloads in Pathology, be it resolved, non-Pathologists such as Pathologists’ Assistants and Technologists should report/sign out pathology cases”

 

CHAIR

AFFIRMATIVE TEAM

OPPOSING TEAM

Victor Tron
Victor Tron

Bruce Latham
Bruce Latham

Michael Harrison
Michael Harrison

Annie Cheung
Annie Nga-Yin Cheung

Suzy Lishman
Suzy Lishman

Victor Tron, President, Canadian Association of Pathologists (CAP-ACP)

Bruce Latham, Vice President, Royal College of Pathologists of Australasia (RCPA)

Michael Harrison, President, Royal College of Pathologists of Australasia (RCPA)

Annie Nga-Yin Cheung, President, Hong Kong College of Pathologists

Suzy Lishman, President, Royal College of Pathologists (RCPath)

 

Objectives:

At the end of this session, participants will be able to:

  • Identify the skills required to report surgical pathology cases.
  • Summarize the pros and cons of allowing non-pathologists perform traditional pathologist activities.
  • Appraise the debate format as a means of teaching.

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Workshop: Time Management: Global Strategy
Monday June 12, 1000-1200

 

Marcio Gomes, University of Ottawa, The Ottawa Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Describe the important elements for a time management global strategy.
  • Classify daily activities according to degrees of urgency and importance.
  • Identify meaningful individual professional goals at long, medium and short terms.
  • Align goals and activities in order to better allocate priorities and time usage.

This session will help attendants to take ownership of their time and plan for the next phase in their careers. Through reflection and interactive exercises, attendants will be able to align their goals, activities, values and strengths in order to better allocate priorities and time usage. The session will be of value to any trainee or Lab Medicine professional.

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Workshop: Cytopathology of the Pancreas and Biliary Tract
Monday June 12, 1000-1200

 

Yonca Kanber, McGill University

 

Objectives:

At the end of this session, participants will be able to:

  • Diagnose commonly encountered lesions of the pancreatobiliary tract.
  • Differentiate neoplasms of the pancreatobiliary tract of using cytologic features and ancillary tests.
  • Categorize these lesions using the Papanicolaou Society of Cytopathology System for Reporting Pancreatobiliary cytology.

This workshop will discuss the cytologic features and differential diagnosis of commonly encountered as well as challenging lesions of of the pancreatobiliary tract. It will cover the Papanicolaou Society of Cytopathology System for Reporting Pancreatobiliary cytology and how to categorize diagnoses using this system.

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Gynecological Pathology SIG
Monday June 12, 1000-1200

 

Chair: Carlos Parra-Herran, Sunnybrook Health Sciences Centre, University of Toronto

 

1000-1015

Introduction and Update on Endometrial Biopsy Reporting

Carlos Parra-Herran, Sunnybrook Health Sciences Centre, University of Toronto

 

1015-1050

BRCA Testing in Ovarian Cancer – the Role of Pathology

Bojana Djordjevic, Sunnybrook Health Sciences Centre, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Describe the clinical relevance of identifying patients with BRCA mutations.
  • Assess the pathological phenotype of BRCA mutation associated high grade serous carcinoma.
  • Compare germline and somatic BRCA mutation testing in terms of their respective advantages and disadvantages.
  • Discuss the logistical challenges and approaches to population.

Up to 20% of high grade serous carcinomas have a mutation in BRCA 1 or BRCA 2 genes. Recent studies have shown that such tumors are also associated with a particular pathological phenotype. To date, the referral rates of patients with high grade serous carcinoma to genetic counseling have been low and associated with long turnaround times. The widespread adoption of next generation sequencing technology is creating an emerging opportunity for pathology laboratories to play a role in BRCA gene mutation testing of on formalin fixed and paraffin embedded tissue. Utilization of somatic mutation testing, both as a triage tool for germline mutation testing and for identifying patients who would benefit from PARP inhibitor therapy, will be outlined. Logistical challenges and approaches to population-based BRCA testing will be discussed. The session will be of value to pathology residents and general and anatomic pathologists.

 

1050-1125

Pathology of the Female Peritoneum, A Practical Review

Anais Malpica, The University of Texas MD Anderson Cancer Center

 

Objectives:

At the end of this session, participants will be able to:

  • Interpret benign entities occurring in the female peritoneum that can potentially represent a diagnostic challenge.
  • List the clinicopathologic features of well differentiated papillary mesothelioma.
  • Describe the clinicopathologic features of peritoneal inclusion cysts.
  • Summarize the morphologic features and ancillary tests required for the diagnosis of malignant mesothelioma.

In this session, we will cover a wide range of lesions detected in the female peritoneum from non-mesothelial, benign lesions that can represent a diagnostic challenge (i.e., endometriosis , keratin granulomas, histiocytic aggregates, etc.) to malignant mesothelioma and entities to be considered in its differential diagnosis. The review includes a discussion of the clinicopathologic features and ancillary studies to ensure the proper diagnosis of each entity.

 

1125-1200

Uterine Mesenchymal Tumors: Changes, Controversies, and Common Ground

Bradley Quade, Harvard Medical School, Brigham and Women’s Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Recognize mesenchymal tumors newly or recently described in the uterus.
  • Summarize the strategies that facilitate their distinction from well-recognized morphologically similar tumors.
  • Define genotype-phenotype relationships associated with various female reproductive tract mesenchymal tumors.
  • Discuss how knowledge gaps in our understanding of smooth muscle tumor biology impact the approach to pathological diagnosis.

The collection of recognized mesenchymal tumors found in the uterus and the approach to their diagnosis has been relatively stable for many years, but recently, new tumor types and genetic drivers (viz., PECOMA, IMT, high grade ESS, HLRCC) have been described. Consequently, our diagnostic practice must expand. This presentation will discuss the strategies and tools to enable recognition and diagnosis of the growing spectrum of uterine meschymal tumors. While doing so, we will also spotlight the underlying genetic features, particularly for smooth muscle tumors, and discuss how the gaps in our understanding of their pathogenesis impact every day pathological diagnosis.

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Symposium: Advanced Diagnostics: Molecular Pathology: New Opportunities and New Challenges
Monday June 12, 1000-1200

 

Chair: George M. Yousef, University of Toronto, St. Michael’s Hospital

 

Objectives:

At the end of this symposium, participants will be able to:

  • Obtain more understanding of the newer application of molecular testing in pathology.
  • Understand to integrate molecular findings in your pathology report.
  • Appreciate the values vs. drawbacks of cancer screening.

1000-1005

Introduction

George M. Yousef, University of Toronto, St. Michael’s Hospital

 

1005-1025

NGS Panels and Clinically Actionable Variants in Cancer

Lianna Kyriakopoulou, University of Toronto, The Hospital for Sick Children

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss cutting edge technologies that form the basis of future cancer diagnostic methods.
  • Describe the application of NGS in identifying clinically actionable results in cancer diagnostics.
  • Recognize approaches for the interpretation of germline findings and their impact on cancer evaluation.

Next generation sequencing (NGS) is used widely in cancer diagnosis, prognosis and therapy. The goal of this session is to explore current clinical applications, how germline findings contribute to cancer evaluation, and the role of clinically actionable mutations in the precision medicine effort. This session is relevant to anyone who has an interest in NGS and its clinical applications in cancer.

 

1025-1045

Advanced Diagnostics in Neuro-oncology: The Integrated Report

Jason Karamchandani, McGill University, Montreal Neurological Institute, MUHC

 

1045-1105

Cancer Screening: Heresy or a Voice of Reason!

George M. Yousef, University of Toronto, St. Michael’s Hospital

 

1105-1125

Addressing Opportunities and Challenges in Cancer Pathology through the Ontario Molecular Pathology Research Network (OMPRN)

David LeBrun, Queen’s University, OMPRN Chair and Network Leader

 

1125-1200

General Discussion: The Future of Molecular Diagnostics in Canada

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Workshop: Shifting the Focus From Professional Liability To Accountability
Monday June 12, 1330-1500

 

Tino D. Piscione, The Canadian Medical Protective Association (CMPA)

 

Reframing Canadian Pathology Practice in the Era of Patient-centred Care

This course addresses professional accountability and physician-to-physician communication in the Pathology practice setting. It will take place during the CAP-ACP Annual Scientific Meeting as two independent 90-minute facilitated, interactive workshops. Educational activities will be case-based and engage learners in large and small group discussions as well as individual reflection. Learning objectives aim at aligning attitudes and behaviours of pathologists with the model of patient-centred care. As part of the learning experience, learners will be asked to complete pre- and post- course assignments.

 

Objectives:

At the end of this session, participants will be able to:

  • Explain the difference between professional liability and accountability.
  • Describe how professional accountability may mitigate risk of patient harm and medical-legal liability.
  • Design a personal action plan that models professional accountability and safe healthcare delivery.

Case-based discussions examining: a) the relationship between liability, accountability, and patient harm; and b) attitudes and/or behaviours modelling professional accountability that may mitigate patient harm and liability. Individual and group reflective exercises to identify opportunities for improving actions and behaviours reflecting professional accountability in one’s own practice setting.

As a result of attending this workshop, the learner will have gained personal insight into the significance of professional accountability and communication in delivering safe patient care which might also mitigate medical-legal liability.

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Symposium and Kulcsar Lecture: Salivary Gland Cytopathology
Monday June 12, 1330-1700

 

Chair: Harman Sekhon, The Ottawa Hospital

 

1330-1500

Is It Time for a Tiered Classification Scheme for Reporting Salivary Gland Cytopathology: Views & Controversies

Zubair Baloch, University of Pennsylvania

 

Objectives:

At the end of this session, participants will be able to:

  • Understand the need for classification scheme for reporting salivary gland cytopathology specimens in light of literature review.
  • Discuss the various diagnostic categories of Milan System for Reporting Salivary Gland Cytopathology.
  • Recognize the effect of this new terminology on the cytologic diagnosis and risk stratification of salivary gland FNA specimens.

1500-1530 Refreshment Break

 

1530-1700

Common Challenges in Salivary Gland Cytopathology

Speaker: Martin Bullock, Dalhousie University, QEII Health Sciences Centre

 

Objectives:

At the end of this session, participants will be able to:

  • Use demographic and clinical information to guide the formulation of a differential diagnosis for a salivary gland lesion.
  • Know key histopathological features of major salivary gland tumors that can be used by cytopathologists to differentiate between lesions with overlapping cytomorphology.
  • Develop an appropriate differential diagnosis for several common cytomorphological categories of salivary gland fine needle aspirates.

Salivary gland cytopathology is challenging due to the large number of non-neoplastic and neoplastic conditions that can affect salivary glands, and the extensive overlap between entities. This session will address several common differential diagnoses in salivary gland cytopathology, using a case-based approach. Clinical and histopathological features of the entities will be emphasized, so the participant can gain a better understanding of the expected features and subtleties on fine needle aspiration. Milan system categories will be applied as appropriate, for discussion with participants. This session will be of value to pathologists who practice cytopathology, pathology residents and cytotechnologists.

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Workshop: Diagnostic Devils and Rogue Results in Molecular Pathology
Monday June 12, 1330-1700

 

Chair: David LeBrun, Queen’s University

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss pre-analytical factors that impact results obtained from molecular tests.
  • Apply rational approaches to interpreting rogue results.
  • Utilize QA and QC schemes pertinent to each test.

This workshop, developed through the Ontario Molecular Pathology Research Network, will focus on technical and interpretive challenges that arise in the application of molecular assays that are used broadly and increasingly in diagnostic cancer pathology. The session will be divided into three sections as follows:

  1. PCR-based assays for the detection of sequence variants and the quantification of aberrant transcripts
  2. Fluorescence in situ hybridization for the detection of gene copy number variation or rearrangement in routine histology sections
    • 1430-1530
    • Session Leaders:
      John Bartlett, Ontario Institute for Cancer Research
      Susan Crocker, Queen’s University
  3. Targeted gene sequencing with multi-gene panels
    • 1600-1700
    • Session Leaders:
      John Bartlett, Ontario Institute for Cancer Research
      Jane Bayani, University of Toronto
      Harriet Feilotter, Queen’s University

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Symposium: Forensic Pathology
Monday June 12, 1330-1500

 

Chair: Jacqueline Parai, The Ottawa Hospital

 

Postmortem Drug Interpretation: The Role of Pharmacogenomics and Drug Redistribution

Jeffrey Jentzen, University of Michigan

 

Objectives:

At the end of this session, participants will be able to:

  • Describe the fundamentals of pharmacogenomics.
  • Identify cases in which pharmacogenomics testing is most indicated to determine cause and manner of death.
  • Avoid the complications of an erroneous certification of death by utilizing pharmacogenomics testing.

Drug Related Deaths: How Should they be Examined and Certified

Christopher Milroy, The Ottawa Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Summarize the proposed policies to enable a uniform approach in Canada to drug death certification.
  • Describe the death investigation process of a drug related death.
  • Discuss the role of the autopsy in drug related death.

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Workshop: How to Resolve Diagnostic Disagreement Between Physicians
Monday June 12, 1530-1700

 

Tino D. Piscione, The Canadian Medical Protective Association (CMPA)

 

Reframing Canadian Pathology Practice in the Era of Patient-centred Care

This course addresses professional accountability and physician-to-physician communication in the Pathology practice setting. It will take place during the CAP-ACP Annual Scientific Meeting as two independent 90-minute facilitated, interactive workshops. Educational activities will be case-based and engage learners in large and small group discussions as well as individual reflection. Learning objectives aim at aligning attitudes and behaviours of pathologists with the model of patient-centred care. As part of the learning experience, learners will be asked to complete pre- and post- course assignments.

 

Objectives:

At the end of this session, participants will be able to:

  • Discuss the impact of diagnostic disagreement on delivering safe patient care.
  • Provide examples of how to effectively and professionally communicate disagreement with referring physicians and/or other pathologists.
  • Apply strategies of effective communication to professionally resolve diagnostic disagreement between physicians in scenarios relevant to Pathology practice.

Case-based discussions eliciting factors that contribute to disagreement between physicians and which may directly lead to patient harm; Debriefing on a video presentation illustrating ineffective, unprofessional communication between physicians, followed by a discussion of professional communication behaviours; Small group breakout activity using case vignettes depicting scenarios relevant to Pathology practice to identify effective physician-to-physician communication strategies.

As a result of attending this workshop, the learner will have gained personal insight into the significance of professional accountability and communication in delivering safe patient care which might also mitigate medical-legal liability.

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Symposium: Neuropathology
Monday June 12, 1530-1700

 

Chair: Jason Karamchandani, McGill University

 

When to Refer an Autopsy Brain for Full NP Exam?

Marc Del Bigio, University of Manitoba

 

NP Intraoperative Assessments for Anatomical Pathologists

David G. Munoz, St. Michael’s Hospital, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Be aware of what information the neurosurgeon actually needs at the time of the frozen section, and will be able to respond appropriately.
  • Choose the appropriate techniques for handling of fresh tissue (touch preparation, smear, or frozen section), depending on the situation.
  • Recognize the common neuropathological entities presenting for intraoperative consultation.

The session is designed to prepare the anatomic pathologist for intraoperative consultations by neurosurgeons, a common occurrence in many hospitals. The emphasis is on understanding what information the neurosurgeon actually needs, and what is the appropriate interaction as a pathologist. Participants will learn how to process the sample for touch preparation, smear, or frozen section depending on the situation. They will become familiar with the most common neoplastic and nonneoplastic conditions, and the practical implications of their diagnoses on the course of surgical action. They will understand when to render the diagnosis of inadequate sample and when to request a further sample. They will learn to use the appropriate level of detail when rendering and intraoperative consultation diagnosis. The session will be of value to: pathology residents, general and anatomic pathologists.

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Cam Coady Seminar: Work-Life Integration in Pathology: Finding a Balance
Tuesday June 13, 0800-0930

 

Mary Senterman, University of Ottawa

 

This session will describe one person’s journey through a career in pathology while also trying to have a life.

 

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Symposium: Humanities and International Health Lecture
Tuesday June 13, 1000-1200

 

Chair: Laurette Geldenhuys, Dalhousie University

 

PEI’s Powerhouse Pathologists: Malcolm B. Dockerty and Lewis B. Woolner

James R. Wright, Jr., University of Calgary, Calgary Laboratory Services

 

Objectives:

At the end of this session, participants will be able to:

  • Name two important 20th century Mayo Clinic pathologists with humble origins in PEI.
  • Compare their early lives and career trajectories.
  • Discuss how poetry played important roles in both of their lives.

Malcolm B. Dockerty and Louis B. Wilson were raised in poverty on potato farms in PEI during the Great Depression and attended one-room schools. Both graduated from Prince of Wales College in Charlottetown and Dalhousie Medical School. Dockerty and Woolner obtained postgraduate training at the Mayo Clinic, where both spent their entire careers as staff pathologists. While Dockerty and Woolner became two of the greatest general surgical pathologists in the history of the Mayo Clinic, each developed subspecialty expertise as well – Dockerty in gynecologic pathology and Woolner in cytopathology, pulmonary pathology, and thyroid/parathyroid pathology. Between them, they published more than 750 peer-reviewed papers and book chapters, and many of these were highly cited. They also trained hundreds of pathology/surgery residents and fellows. Both were life-long poets, and believed that poetry was a key to their success.

This session will be of interest to anyone interested in the history of pathology or regional history of PEI.

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Symposium: The Importance of Getting It Right. How the Diagnosis in Hematopathology Impacts Treatment and Prognosis
Tuesday June 13, 1000-1200

 

Chair: Catherine Ross, McMaster University

 

Pathology and New Therapies for Lymphoma: Case-based Pathology Review and Clinical Perspectives

Ronan Foley, Hamilton Health Sciences

 

Objectives:

At the end of this session, participants will be able to:

  • Understand emerging therapeutic approaches to a variety of lymphoma subtypes.
  • Highlight the critical role of hematopathology when using novel agents.
  • Review cases with attention to diagnostic challenges and potential pitfalls.

A variety of new therapeutic approaches are emerging for management of lymphoma. These targeted therapies have proven efficacious with acceptable and reduced toxicity. The mechanism of action of these new treatments highlights the need to recognize and accurately diagnose distinct WHO-based entities. This presentation will review a variety of new developments in lymphoma therapy by focusing on specific cases. Cases will comprise and link both hematopathology and clinical hematology. The session will be of value to hematology, general and anatomic pathology residents as well as staff pathologists.

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Symposium: Education
Tuesday June 13, 1330-1630

 

Chair: Marcio Gomes, University of Ottawa, The Ottawa Hospital

 

1330-1430

Engaging the 21st Century Learner with Social Media

Alireza Jalali, University of Ottawa

 

Objectives:

At the end of this session, participants will be able to:

  • Describe 21st Century learner’s characteristics and contrast them with previous generations.
  • Discuss the evidence supporting the use of social media in medical education.

1430-1500

How Different Social Media Platforms Are Used in Pathology Education

Michael Bonert, McMaster University

 

Objectives:

At the end of this session, participants will be able to:

  • Describe how social media platforms can be used in pathology education.
  • Discuss the effectiveness of different social media platforms in pathology education.

The session will examine (1) traditional social media platforms in pathology education – focusing on Facebook and Twitter, (2) touch on user generated content more generally, (3) discuss what pathology information seekers look for, and (4) discuss the measurement of social media contributions and the evidence for social media in medical education.

 

1500-1530 Refreshment Break

 

1530-1630

How to Effectively Implement Social Media into your Pathology Practice

 

Leslie Anderson, University of Manitoba

Matthew Cecchini, Western University

Elena Diana Salagean, University of Toronto

 

Objectives:

At the end of this session, participants will be able to:

  • Create new Twitter posts with educational pathology cases and participate in discussion threads using Twitter.
  • Tweet in compliance with privacy and professional guidelines.
  • Construct effective tweets for promoting pathology and stimulating discussion.

Social media is no longer just about selfies and posting pictures of your food. By the end of this session you will be comfortable with posting social media content related to pathology. The basics of using Twitter will be covered and the ethical and privacy implications of social media will be discussed to ensure that posts are compliant with ethical and privacy guidelines. The use of social media in Pathology education and in public outreach will be explored in an interactive session featuring live tweets, polling and more. Bring your laptop or smart phone to this session to participate in the activities. Please sign up for a free account on twitter at https://twitter.com/signup and learn about some of the basics at https://www.cap-acp.org/Social_Media_101.php. The presenters will be available in the break prior to the session (1500-1530) to help with setup of accounts or the basics of social media.

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Symposium: General Pathology
Tuesday June 13, 1330-1700

 

Chair: Heidi Paulin, Red Deer Regional Hospital

 

The Future of Pathology Practice: Your Business is Information Management

Christopher Naugler, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Describe the history of laboratory information systems.
  • Review the role of laboratories as custodians of the largest repositories of patient data.
  • Utilize the opportunities for laboratories to leverage our data to positively influence the healthcare ecosystem in general

The Effect of DOACs on Coagulation Testing

Allam Shawwa, Dalhousie University

 

Objectives:

At the end of this session, participants will be able to:

  • Review the mechanism of action of direct acting oral anticoagulant drugs.
  • Discuss their effect on routine coagulation testing.
  • Discuss laboratory monitoring.

This lecture will review Direct acting oral anticoagulant drugs (DOAC) from a laboratory perspective. The mechanism of action, main clinical use, effect on coagulation tests and laboratory monitoring will be discussed. The topic will of value for practicing pathologists and residents.

 

The Ethics of Blood Banking and Managing Precious Resources

Davinder Sidhu, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Identify common ethical dilemmas in blood product management.
  • Describe four ethical principles applicable to fairly and equitably manage limited blood resources.
  • Apply specific strategies to manage blood inventory at their respective centers.

This session will review ethical principles involved in the allocation of blood products to patients in the clinical setting. The target audience is General Pathologists practicing some component of Transfusion Medicine in their practices as well as General Pathology Residents to illustrate ethical as well as medical considerations involved in managing blood product resources in Canada.

 

1500-1530 Refreshment Break

 

Recognizing and Preventing Laboratory Error

Jake Yorke, Dalhousie University

 

Objectives:

At the end of this session, participants will be able to:

  • Explain the major phases of sample processing.
  • Identify the types of errors that occur in each phase.
  • Describe strategies to combat errors in each phase.

The presentation will include a brief overview of the three major phases of sample processing (pre-analytic, analytic, post-analytic) and the types of errors that occur in each phase. There will also be an overview of two other areas with potential for laboratory error, namely the clinical decision making “pre-pre” and “post-post” analytic phases, with examples of common errors in these phases. There then will be discussion on how to avoid these errors using specific examples. The session will be of value to: Pathology residents, laboratory technicians, general, anatomic and hemato-pathologists.

 

Epstein-Barr Virus (EBV) and Cancer: A New Perspective on an Old Virus

Pavandeep Gill, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Briefly outline Epstein-Barr Virus (EBV) virology and diagnostic testing .
  • Review some of the current literature on EBV-associated B-cell lymphoproliferative disorders (BLPDs).
  • Interpret this novel study assessing EBV-specific genomic variation among different subtypes of EBV-driven BLPDs.

Biotin Supplementation and its Interference with Laboratory Testing

Marcia Abbott, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Compare the indications for biotin intake and supra-therapeutic biotin supplementation.
  • Review the features of biotin deficiency.
  • Identify potential biotin interference of immunoassays and develop potential solutions to mitigate these effects.

This session will briefly review a few cases that instigated investigation into testing interferents at one diagnostic laboratory, namely biotin when taken in high doses. Information is given about current biotin intake guidelines. True biotin deficiency is discussed in terms of etiologies and associated sign and symptoms. In addition, supra-therapeutic doses for real and not-so-real indications of biotin are mentioned. Diagrams are utilized to explain the mechanism of biotin interference with biotin-streptavidin assay testing. Finally, clinical implication are explored with regards to types of tests affected, patient consequences, and potential solutions.

The session will be of value to: general pathology residents and pathologists.

 

Emergency Transfusion of Uncrossmatched O Positive Blood: An Opportunity to Improve Resource Utilization

Amy Thommasen, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Summarize the pathophysiology of anti-D alloimmunization and resulting transfusion reactions.
  • Recognize the relative scarcity of O negative blood and importance of proper utilization in Canada.
  • List key studies from the literature pertaining to the emergent transfusion of uncrossmatched blood.
  • Apply the results of Calgary Lab Services utilization data and recommendations from organizations such as Canadian Blood Services, Choosing Wisely Canada, and Canadian Society for Transfusion Medicine to improve utilization management of uncrossmatched blood.
  • Recognize the indications for transfusion of O positive blood in two specific subpopulations.

This session will provide an overview of emergency transfusion of O positive uncrossmatched blood including anti-D alloimmunization and resource utilization considerations. Key studies from the literature will be discussed. Quality improvement data from the emergency transfusion of uncrossmatched blood in the Foothills Medical Centre Emergency Department in Calgary, Alberta, for five years from 2011 to 2016 will be presented. This session will be of value to pathologists who practice transfusion medicine, general pathology residents, hematopathology residents, and laboratory technicians.

 

Vitreous Fluid Analysis – A Change in Methodology

Akash Gupta, McMaster University

 

Objectives:

At the end of this session, participants will be able to:

  • Understand the use of vitreous fluid analysis for forensic pathology cases.
  • Describe the methodology behind the measurement of common electrolytes.
  • Explain the process to validate a new methodology in a clinical chemistry laboratory.

Background: The post-mortem examination of vitreous fluids can provide key information in a death investigation. The analytes found within remain fairly stable after death and can often reflect blood levels prior to death. Analysis of the vitreous fluid sample is complicated by its viscous nature, which is due to the presence of mucopolysaccharides. Direct vitreous fluid is unable to be run through an analyzer without pre-treatment with dilution, boiling, high speed centrifugation, or treatment with hyaluronidase. For the last 20 years, the Hamilton Health Sciences core lab has been preparing aliquots of hyaluronidase dissolved into deionized water for pre-treatment of vitreous fluid samples. This method was presumably developed to standardize the amount of enzyme that was added to each patient sample.
Methods: We compared the results of analyses of 25 patient vitreous humour specimens with pre-treatment of the hyaluronidase and deionized water solution versus direct addition of the hyaluronidase enzyme.
Results: Direct treatment with hyaluronidase enzyme demonstrated adequate reduction of viscosity for analysis as well as the presence of a possible dilution effect due to the addition of deionized water. Comparison of the two methodologies demonstrated a significant positive bias with the new method.
Conclusion: We have proposed and implemented a change in the methodology for analysis of vitreous fluid samples at the Hamilton Health Science with a remarkable improvement in results so far. This session will be of value to pathology residents, forensic pathology fellows, biochemists, and forensic pathologists.

 

Quality Assurance is for Babies

Lucy Bradley, University of Calgary

 

Objectives:

At the end of this session, participants will be able to:

  • Define quality assurance.
  • Understand some of the challenges to quality assurance in a tertiary care center.
  • Appreciate the role of interdepartmental communication and coordination in quality assurance.

A case presentation of the quality assurance challenges raised by STAT Hepatitis B surface antigen testing for neonates in Calgary.

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Workshop: A Practical Approach to Renal Biopsy
Tuesday June 13, 1330-1500

 

Huma Fatima, University of Alabama at Birmingham

 

Objectives:

At the end of this session, participants will be able to:

  • Develop an approach to evaluating kidney biopsy specimens that integrates light, immunofluorescence, and electron microscopic findings.
  • Recognize various patterns of glomerular, tubulo-interstitial, and vascular injury, and their differential diagnoses.
  • Assess the non-neoplastic renal parenchyma of tumour nephrectomy specimens.

This short course provides a practical approach to renal biopsy in medical diseases of the kidneys. The evaluation of pathologic changes in the small biopsies from this complex organ can be difficult, challenging and sometimes intimidating. The course is designed for junior surgical pathologists and pathologists in training. The aim is to develop proficiency in interpretation of medical renal biopsies, by learning assimilation of light, immunofluorescence and electron microscopy findings and how to triage small biopsies for multiple essential studies. The morphologic features in medical renal diseases, particularly by light microscopy, mostly depicts a pattern of injury rather than specific disease entity e.g., cellular crescents or segmental glomerulosclerosis etc. Therefore, clinicopathologic correlation remains one of the essential approaches to diagnostic work up of medical renal diseases. In addition, the course will inevitably help the participants in the assessment of non-neoplastic parenchyma of the tumor nephrectomy specimen, as non-neoplastic kidney diseases are emerging as the most important diagnosis to establish during the evaluation of tumor nephrectomy specimens with low grade tumors and good 5 year survival.

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Symposium: CAP-ACP Workload Model
Tuesday June 13, 1530-1700

 

Raymond Maung, University of British Columbia

Martin Trotter, Providence Health Care, St. Paul’s Hospital

 

Objectives:

At the end of this session, participants will be able to:

  • Calculate their clinical workload based on the CAP-ACP workload formula.
  • Discuss the different components of CAP-ACP workload model.
  • Apply principles of the CAP-ACP workload model to calculate their total workload.

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Closing Keynote Speaker: Technology, Social Media and the 21st Century Pathologist: Waste of Time or Free Wellness Tool?
Tuesday June 13, 1700-1800

 

Chair: Marcio Gomes, University of Ottawa, The Ottawa Hospital

 

Speaker: Alireza Jalali, University of Ottawa

 

Objectives:

At the end of this session, participants will be able to:

  • Describe how various social media tools (Facebook, Twitter, LinkedIn, Instagram, etc) are used by different generations to communicate.
  • Summarize the advantages and perils of these tools for Pathologists: in clinic, research, education and personal wellness.
  • Discuss appropriate professional behaviour and time management in the digital world.

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