The following Pre-conference Workshops will be held on Saturday, July 7:


Saturday July 7 Morning – 0830-1200

Saturday July 7 Afternoon – 1400-1730

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W0711 Breast Pathology: Challenges and Pitfalls
Saturday July 7, 0830-1200


Anita Bane, McMaster University

Hala Faragalla, St. Michael’s Hospital

Anna Marie Mulligan, University Health Network


Learning Objectives:

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

  • Establish an approach to effectively diagnose spindle cell lesions.
  • Accurately identify variants of invasive mammary carcinoma and understand their prognostic significance.
  • Recognize the spectrum of papillary lesions and apply an approach for classification and diagnosis.
  • Understand the pathologist’s role in molecular testing in breast cancer in the molecular era from selecting an appropriate block for testing and correlating the molecular result with histological features.
  • Effectively diagnose sclerosing lesions with emphasis on benign and malignant mimics.

This work shop is directed at anatomical pathologists, pathology residents, fellows and pathology assistants. This workshop will be provided by three subspecialized breast pathologists. The workshop will be divided into six case-based discussions to include common and uncommon lesions encountered in everyday practice including papillary lesions, spindle cell lesions and sclerosing lesions. In addition, guidelines and practical tips for interpretation and reporting predictive biomarkers will be provided.

For each clinical case, high resolution histologic virtual images of the case plus radiologic finding will be provided. The key morphological features, immunohistochemical profile, diagnostic features, differential diagnosis, mimics and pitfalls will be discussed. The clinical management and implication for each of these entities will be highlighted.

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W0712 Statistics for Pathologists: Primer on Diagnostic Accuracy Statistics
Saturday July 7, 0830-1200


Nick Myles, University of British Columbia


Learning Objectives:

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

  • Learn how to find, extract, calculate and interpret basic statistical parameters used to inform diagnostic accuracy using examples from breast, GI, ENT and gynecologic surgical pathology:
    • A. formulate answerable questions and testable hypothesis: PICO and PIRTO framing.
    • B. understand the concept of BIAS and strategies for assessment of bias in diagnostic pathology literature.
    • C. understand the differences between EXPLORATORY and CONFIRMATORY analyses in diagnostic pathology research.
    • D. understand the concept and numeric measurements of RISK.
    • E. understand the concepts and numeric measurements of DIAGNOSTIC ACCURACY and PRECISION.
    • F. understand the concept and numeric measurements of DIAGNOSTIC ACCURACY.
    • G. understand P-VALUE, its use and abuse and robust alternatives (95% CONFIDENCE INTERVALS).

Imagine you decided to:

  • use new antibody we just heard from the sponsoring company, or
  • use new out of box technology to improve diagnostic accuracy of cancer detection, or
  • wish to stop doing old way diagnostics in favour of new technology or, alternatively,
  • stop using new impressive panels of IHC and go back to H&E?

The body of pathology literature growth rapidly at incremental rapid pace, therefore practical pathologists need training and guidance on how to find the highest level medical research evidence in order to inform their daily diagnostic pathology practice across all subspecialty areas of diagnostic pathology, which is methodologically different from the medical evidence on medical interventions.

Therefore there is an ultimate need in pathology “numeracy” to enable pathologists to re-gain their status as independent critical thinkers and not passive consumers of excessive volumes of diagnostic research information. This requires development of some basic yet fundamental medical statistical skills necessary for reading and critical appraisal of modern pathology literature to inform daily diagnostic pathology practice.

The workshop will be based on real life diagnostic scenarios and data from published diagnostic pathology examples and will enable the participants to use analytical tools (online statistical calculators, software for critical appraisal and systematic reviews form open reputable peer-reviewed sources) to calculate basic statistics related to diagnostic testing in anatomical pathology (understand concepts of prevalence, pre-test and post-test probabilities, sensitivity, specificity and likelihood ratios of the tests).

The workshop director is a practicing breast and general anatomical surgical pathologist, who, in addition to his medical and pathology training, has obtained a MSC in Evidence-Based Medicine from Oxford University.

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W0713 Histopathological Application of Staging and Grading Parameters in Medical Liver Diseases
Saturday July 7, 0830-1200


Oyedele A. Adeyi, University of Toronto, University Health Network, Toronto General Hospital

Iram Siddiqui, The Hospital for Sick Children


Learning Objectives:

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

  • Appreciate importance of providing appropriate information to ordering clinicians on biopsies performed in the context of medical liver and chronic biliary diseases.
  • Utilize appropriate grading and staging parameters with emphasis on newer grading/staging systems.
  • Recognize some dilemmas of fibrosis staging and be aware of limitations.

Liver biopsies performed for various medical hepatic and chronic biliary diseases are done almost always with a view to resolve otherwise unanswered questions and/or as part of treatment guidelines. The ordering clinician sometimes has specific expectations but which are not clearly expressed on the requisition. The pathologist on the other hand is able to recognize abnormalities and report them accurately. Unfortunately accurate reporting of histopathological findings does not always, and frequently does not, translate to resolution of the clinician’s (often unexpressed) expectations. One of many areas identified in our practice accounting for this disconnection between clinician’s expectations and pathologist’s report is in the area of grading and staging of diseases. To the clinician the numbers attached to the grade or more importantly the stage of disease trigger series of responses on her/his part and are expected to correlate with disease-specific prognosis as well as inform an interventional approach, often in line with published guidelines. Therefore when appropriate disease-specific tools are not utilized to grade and stage an entity one or both of these expectations are either unfulfilled, or there could be a potentially harmful miscommunication of findings. This workshop is therefore designed to highlight the rationale behind many of the commonly used systems to grade and stage liver diseases. The importance of using diseaseappropriate staging system and language in reporting will be emphasized. Lastly common causes of false negative (under staging) or false positive (over staging) findings as they relate to fibrosis stage will be discussed.

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W0714 Tumours of the Salivary Glands / Well Differentiated Squamous Cell Carcinoma of the Upper Aerodigestive Tract – The Biopsy Challenge
Saturday July 7, 0830-1200


Tumours of the Salivary Glands

Roderick H.W. Simpson, University of Calgary, Foothills Medical Centre


Learning Objectives:

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

  • Be aware of several new entities in salivary pathology.
  • Diagnose difficult salivary tumours.
  • Know which immuno-markers are most useful in the assessment of a problematic salivary gland tumour

This is a case-based presentation in the manner of a slide seminar, and appropriate images will be made available beforehand. About 15 minutes will be spent on each case. Examples of tumours covered will include salivary duct carcinoma (including a proposed molecular classification), mammary analogue secretory carcinoma, polymorphous low grade adenocarcinoma and cribriform adenocarcinoma (touching on the recent controversial WHO classification) and sclerosing polycystic adenosis/adenoma. The presentation is aimed at the practising pathologist, describing the clinical, morphological and immunohistochemical findings, together with where molecular methods are useful.


Well Differentiated Squamous Cell Carcinoma of the Upper Aerodigestive Tract – The Biopsy Challenge

Olga Gologan, Centre hospitalier de l’Université de Montréal (CHUM)


Learning Objectives:

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

  • Increase their awareness of the morphological spectrum of the well differentiated squamous cell carcinoma.
  • Understand the differences between the H&N squamous cancer morphology and the “cervical model” of neoplastic progression.
  • Recognize the diagnostic pitfalls and the subtle morphological clues to the correct diagnosis and appreciate the importance of the clinical-pathological cooperation.
  • Develop an effective communication system between the pathologist and the clinical team – with emphasis on the diagnostic report.

This short course is designed as a practical and interactive case-based workshop focusing on commonly encountered problematic biopsies of papillary, verrucous and other well differentiated squamous cancers. Representative cases will be provided; their discussion will emphasize morphologic features, diagnostic criteria, differential diagnoses, ancillary studies where appropriate and current clinical implications and management. Reporting suggestions for difficult cases will be presented.

The course is ideal for practicing general surgical pathologists, surgical pathologists with a special interest in head and neck pathology, and pathologists-in-training.

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W0715 Immunodeficiency and Virus Associated Lymphoproliferative Disorders: Approach, Challenges and Pitfalls
Saturday July 7, 0830-1200


Carlo Hojilla, University of Toronto, Mount Sinai Hospital

Catherine A. Ross, McMaster University, Juravinski Cancer Centre and Hospital

Monalisa Sur, McMaster University, Juravinski Cancer Centre and Hospital


Learning Objectives:

  • To introduce the role of viral etiologies (e.g. EBV, HIV, HTLV) in hematopoietic neoplasms and the implications on diagnosis and prognosis.
  • To review the patient populations at risk for immunodeficiency states (e.g. virus-induced or post-transplant settings) and how this contributes to the development of the different types of lymphoma.
  • To provide an algorithmic approach to the diagnosis of virus-associated and immunodeficiency-related hematopoietic neoplasms.
  • To underscore the importance of viral etiologies in affecting diagnosis, prognosis and possible treatment modalities.
  • To demonstrate the utility of ancillary studies such as serology, flow cytometry, immunohistochemistry, in situ hybridization, and molecular studies in arriving at correct diagnosis.

The diagnostic approach to lymphoma is an ever changing landscape with newer information impacting on the precision with which diagnoses are made. The role of viruses in the development of lymphoma is increasingly recognized as an important potentiating mechanism. In fact, the WHO 2016 classification has evolved to the point that certain lesions require documentation of the presence of specific types of viruses for diagnosis. Moreover, some types of lymphoma occur with greater frequency in some patients with either viral infections or clinical conditions leading to increased susceptibility.

The workshop will address three major themes:

  1. The importance in the WHO 2016 Classification of viruses associated with and required as diagnostic criteria for certain types of lymphoma.
  2. The patient population at risk for the development of lymphoma often due to viral infection particularly chronic as well as the patient groups with immune dysfunction that put them at risk.
  3. Differentiating reactive from neoplastic lesions in immune-compromised patients; diagnoses of which lead to different management approaches.

A case-based approach using still images and digital slides, in conjunction with a PowerPoint presentation, will be employed in demonstrating the themes and objectives above. The workshop will be of interest to all trainees and fellows in anatomic, general pathology, and hematopathology residency programs, as well as practicing pathologists. Attendees will have the opportunity during the last half hour to share or discuss their own interesting cases with a similar theme with a focus on interactive discussion and practical aspects of knowledge translation.

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W0731 Recent Advances in Common Diagnostic Dilemmas in Uterine Pathology
Saturday July 7, 1330-1700


Blaise Clarke, University of Toronto, University Health Network

Blake Gilks, University of British Columbia, Vancouver General Hospital

Anna Plotkin, University of Toronto, Trillium Health Partners


Learning Objectives:

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

  • Recognize and accurately classify recently described entities in uterine pathology.
  • Understand the management/ therapeutic implications of rendered diagnoses.
  • Integrate appropriate immunohistochemical and molecular assays in assessment of endometrial pathology.
  • Recognize common iatrogenic artifacts to ensure accurate classification and staging of biopsy and resection specimens.
  • Assess precursor lesions of endometrial carcinoma and recognize mimics.

Histopathologic assessment is a critical determinant of the management of uterine disease. Despite this, numerous aspects of uterine histopathology have traditionally been limited by poor reproducibility even among experts. Recent advances in our molecular understanding have both refined morphologic criteria in uterine pathology and provided new assays allowing greater diagnostic accuracy.

We will use a case based approach to: review newly described entities; present refined morphologic criteria of established entities; and discuss the appropriate use of ancillary investigations to render accurate diagnosis. The cases will reflect contemporary practice and the course will enable pathologists to address common diagnostic dilemmas in uterine pathology.

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W0732 Are Your Residents Getting the Most of their Learning Experiences? Using Adult Learning Theories to Improve Teaching Effectiveness
Saturday July 7, 1330-1700


Ashley Flaman, University of Ottawa

Marcio Gomes, University of Ottawa, The Ottawa Hospital


Learning Objectives:

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

  • Describe and discuss some preeminent adult learning theories.
  • Apply learning theories to daily teaching activities.
  • Design effective educational activities for the classroom and workplace.

Using interactive teaching techniques, the presenters will introduce participants to three straightforward and practical adult learning theories: cognitive load, experiential learning, and zone of proximal development. The workshop will aim to provide the necessary foundations and make practical demonstrations in order to facilitate the application of these learning theories in diverse classroom and clinical settings, including the gross room, sign out, and lectures. It will provide tools to design more effective learning experiences for pathology learners, from medical students through to practicing pathologists, with particular emphasis on workplace teaching. Through discussion and active participation participants should leave the workshop better equipped to maximize learning outcomes.

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W0733 Precision Medicine in Urology: Where Does the Pathologist Fit In?
Saturday July 7, 1330-1700


Fadi Brimo, McGill University Health Centre

Michelle R. Downes, University of Toronto, Sunnybrook Health Sciences Centre

Manal Gabril, Western University, London Health Sciences Centre

Madeleine Moussa, Western University, London Health Sciences Centre

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


Learning Objectives:

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

  • Create a pattern-based approach to differentiate benign and malignant lesions in the prostate and bladder.
  • Explain how the subtypes/variants of bladder and prostate cancer can impact prognosis and what emerging biomarkers are relevant in these diseases.
  • Develop a diagnostic approach to the work up of renal neoplasms including integration of ancillary and molecular tests.
  • Describe false positive and false negative lesions in GU pathology and the role IHC can play in differential diagnosis.
  • Understand the role of pathologists in guiding the management of patients with urologic disease.

This high yield workshop will be led by five practicing urologic pathologists and will cover prostate, bladder and renal pathology in six separate lectures.

There will be three, morphology focused lectures which include images, to highlight the key features of different GU entities in prostate (false negative/positive lesions), bladder (benign mimickers of malignancy) and kidney (eosinophilic neoplasms). For each topic, index cases will be presented and discussed to enable attendees to navigate through the differential diagnosis. A major focus will be pattern recognition and the application of appropriate immunohistochemistry to differentiate mimickers of malignancy.

Each morphology talk will be paired with and followed by a lecture on an emerging relevant “hot” topic- active surveillance in prostate cancer, molecular bladder subtypes and subtyping papillary renal cell carcinomas. These have been chosen to reflect the important role pathologists can and will play in directing patient management through the integration of biomarkers and molecular data into the pathology report.

The in-conference polling app will be utilized to encourage audience participation and interaction.

This workshop is directed to anatomical pathologists, residents and fellows.

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W0734 GI Precision Oncology: Pathologists Needed!
Saturday July 7, 1330-1700


Jean Deschênes, University of Alberta, Cross Cancer Institute

Cheryl A. Mather, University of Alberta, Walter C. Mackenzie Health Sciences Centre

Cathy Streutker, University of Toronto, St. Michael’s Hospital


Learning Objectives:

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

  • Differentiate betwen the various subtypes of liver adenomas by applying the known molecular basis for these lesions to the selection of adequate ancillary testing.
  • Integrate the current knowledge on molecular sub-types of stomach cancers.
  • Perform, supervise and assess Her2-neu tests for gastric and GE junction carcinomas, with state-of-the art awareness of the relevant pitfalls and in-depth knowledge of their role in precision oncology.
  • Identify the critical molecular parameters used to characterize colo-rectal carcinomas (CRC) and their biological and clinical relevance for the detection, diagnosis and treatment of these lesions, including the interpretation of MMR IHC, the role of MSI testing and of molecular driver mutation testing, and molecular subtyping of CRC.
  • Organize and apply in diagnositc practice the most recent data of the 2016 WHO classification as it applies to GI lymphomas and their precursors.

General goal: A state of the art review of the development in precision laboratory medicine as it applies to GI oncology, and exploration of the precision oncology issues facing practicing pathologists.

Specific topics covered:

  1. Molecular subtypes of liver adenomas – what the practicing pathologist needs to know.
  2. Molecular classification of stomach cancer – microscopic clues and clinical relevance.
  3. TOGA party – Her2-neu testing in gastric/GEJ carcinomas.
  4. Molecular portraits of colorectal carcinoma – what do we know and why does it matter?
  5. Lynch syndrome and MMR/MSI testing – role of the laboratory physician.
  6. Lymphomas of the GI tract: WHO’s who in 2017?

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W0735 Towards Increased Precision – Recent Developments in Renal Pathology
Saturday July 7, 1330-1700


Iakovina Alexopoulou, McMaster University

Hallgrimur Benediktsson, University of Calgary

Laurette Geldenhuys, Dalhousie University, Nova Scotia Health Authority

Michael Mengel, University of Alberta, Alberta Health Services


Learning Objectives:

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

  • Updates on recent developments in diagnosis and treatment of select kidney diseases.
  • Review of how renal pathology diagnosis contributes to precision medicine.
  • Discuss new laboratory tools in the diagnosis of native and transplant kidney disorders.

Topics to be covered:

  • Brief overview of the main types of medical kidney disease
  • Focus on some new developments in the diagnosis and management of medical kidney disease
  • Membranous nephropathy
  • C3 nephropathy
  • Focal segmental glomerulosclerosis
  • Renal disease associated with monoclonal immunoglobulins
  • Amyloidosis
  • Anti-GBM disease
  • The critical role of pathology in managing renal transplant patients

The workshop will focus on some of the areas where recent strides have been made towards a more personalized approach to management based on advanced diagnostics.

Target audience: All levels, from Residents to Community Practice or Academic Health Sciences pathologists.

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