Workshops

Twelve Scientific Workshops will be held on Saturday June 8 and Sunday June 9.
 
SATURDAY, JUNE 8, 0800-1130
 
SATURDAY, JUNE 8, 1300-1630
 
SUNDAY, JUNE 9, 0800-1130

SATURDAY, JUNE 8, 0800-1130, W101-W104
 
W101: Establishing a Comprehensive Quality Assurance Program in Surgical Pathology
Raouf E Nakhleh, Mayo Clinic Florida, Jacksonville, Florida
 
Objectives:
At the end of the session, the participants will be able to:
  • Set up a comprehensive quality assurance program in surgical pathology.
  • Understand where in the test cycle is the greatest potential for risk to the patient.
  • Implement changes that would reduce the potential for error in surgical pathology.
Description:
The workshop is designed to give a comprehensive overview of an ideal quality assurance program for
surgical pathology. This will include suggestions for selecting metrics for ongoing monitors of laboratory quality as well as suggestions for policies and practices that enhance patient safety and reduce error. Material will be presented from the perspective of the different phases of the test cycle from an organizational perspective. But will also be presented from the perspective of emphasis on points with maximum risk of error. The workshop will be of value to: anatomic and histology laboratory manages, pathology residents, PA’s, general pathologists and anatomic pathologists.
 
 
W102: Practical Pathology of the Luminal Gastrointestinal Tract
Catherine J. Streutker, St. Michael’s Hospital, University of Toronto, Toronto, Ontario
David Grynspan, Children’s Hospital of Eastern Ontario, Ottawa, Ontario
 
Objectives:
At the end of the session, the participants will be able to:
  • Explain and discuss the concepts in development and appearance of dysplasia of the luminal gastrointestinal tract and the relationship between diagnosis of dysplasia and its implications with respect to treatment options.
  • Discuss inflammatory lesions of the GI tract from esophagus to colon.
  • Review benign and malignant polyps of the GI tract.
Description:
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, to include eosinophilic esophagitis, celiac disease and autoimmune disorders of the mucosa. A wide variety of polyps of the stomach, small bowel and colon (including sessile serrated adenomas) will be reviewed and discussed. The workshop will be of value to: General and Anatomic Pathologists, Pathology residents.
 
 
W103: Common Challenges of Epithelial and Mesenchymal Lesions of Uterus
Golnar Rasty, University Health Network, Toronto, Ontario
Marjan Rouzbahman, University Health Network, Toronto, Ontario
 
Objectives:
At the end of the session, the participants will be able to:
  • Know the key histological features of usual and complicated epithelial and mesenchymal lesions of uterus.
  • Recognize recently described entities and understand their clinical significance.
  • The participants will obtain an understanding of new standards, techniques, criteria and classifications in uterine pathology.
Description:
This course is designed to provide updated pragmatic, problem-solving knowledge for residents, fellows and practicing surgical pathologists who also wish to remain current with the changing trends in diagnosis and management of uterine epithelial and mesenchymal lesions. It addresses the resolution of diagnostic pitfalls relative to Gynecology pathology and histopathology. Also we present the role of immunohistochemical biomarkers and molecular profiling in assisting in typing of these groups of tumors. The workshop is designed for residents and pathologists with interest in gynecology pathology, histopathology and oncology. Selected cases will be presented as unknowns and discussed using an audience response system to facilitate audience participation. PowerPoint presentations for each topic are included in the course.
 
 
W104: Personalized Medicine: The New Landscape in Patient Management
George M. Yousef, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario
Susan J. Done, University Health Network and the University of Toronto, Toronto, Ontario
Blaise Clarke, University Health Network and the University of Toronto, Toronto, Ontario
Aaron Pollett, Mount Sinai Hospital and the University of Toronto, Toronto, Ontario
 
Objectives:
At the end of the session, the participants will be able to:
  • Understand the concept of personalized medicine, and discuss its scope of applications, and its significant impact on cancer management.
  • Obtain an overview of basic principles of the most promising platforms for personalized medicine, with their advantages and limitations.
  • List specific real-life practical examples of new advances in personalized medicine in breast, gastrointestinal tract and gynecological tumors.
Description:
Personalized medicine (PM) aims to tailor management plans for each patient according to his disease aggressiveness and treatment response. We will discuss the scope of applications of PM in cancer and its impact on patient outcome. Pathologists should be familiar with the basics of the commonly used molecular approaches for PM. In the second talk, we will discuss the molecular subtypes of breast cancer and the implications for clinical testing. We will discuss FDA approved, commercially available tests focusing on the indications and value of the information they can provide in addition to standard pathological and IHC parameters. The third talk will demonstrate the role of PM in gastrointestinal tumours with a focus on colorectal carcinoma (CRC). There are several molecular pathways which can lead to the development of CRC which are associated with different behaviour, and prognosis. We will outline the role of the pathologist in recognizing and reporting CRC with microsatellite instability as well as the application and interpretation of various IHC and molecular biomarkers. We will also discuss the role of KRAS and other predictive biomarkers in guiding treatment selection. The last talk will present examples about new improvements in ovarian and endometrial cancers. Ovarian cancer is not a single disease but distinct biological subtypes. Correct subtype allocation carries implications for therapy. We will also present the role of IHC in assisting ovarian cancer subtyping. Similarly, subtype-specific treatment regimens are employed in endometrial cancer and we will review the role of the pathologist in identifying Lynch syndrome associated endometrial cancers. The workshop will be of value to: pathology residents, PAs, general and anatomic pathologists.
 

 
SATURDAY, JUNE 8, 1300-1630, W201-W204
 
 
W201: Forensic Autopsy Challenges: Part One – The Negative Autopsy; Part Two – Unexpected Infant Deaths
Alfredo E. Walker, The Ottawa Hospital General Campus, Ottawa, Ontario
Evan W. Matshes, Office of the Medical Investigator and the University of New Mexico, Albuquerque, New Mexico
 
Objectives:
Part 1 – The Negative Autopsy
At the end of the session, the participants will be able to:
  • Define the “negative autopsy” and state its prevalence.
  • Recall the stepwise logical review process of the negative autopsy to ensure that it is truly negative for a cause of death.
  • State the possible causes of death to be considered and investigated through various ancillary investigations, on a case-specific basis, on review of the negative autopsy.
  • List the range of ancillary investigations that can be employed to assist in determining the cause of death in the negative autopsy on a case-specific basis.
  • Summarize the range of specific ancillary investigations that commonly assist in determining the cause of death in negative autopsies.
Part 2 – Unexpected Infant Deaths
At the end of the session, the participants will be able to:
  • Understand the complimentary role autopsy plays in infant death investigation.
  • Understand the necessity of performing thorough autopsies.
  • Understand the strengths and limitations of various ancillary studies in infant death investigations.
Description:
Part 1 – The Negative Autopsy
The accurate determination of the medical cause of death in Medico legal and hospital autopsies is crucial to the determination of a variety of medical, civil and criminal matters. It is incumbent on pathologists to consider, entertain and explore a variety of possibilities when no cause of death is evident macroscopically at the end of the post mortem examination. The range of ancillary investigations to be considered and employed should be prioritized and pursued. Participants will glean an appreciation of the utility of specific types of ancillary investigations through case-­‐based examples. Photographs from death scenes and autopsies and photomicrographs of autopsy materials will be presented. The concealed homicide must always be borne in mind. Sudden Unexpected Deaths in Infancy will not be covered. This workshop will be of great benefit to anatomical pathology residents, forensic pathology fellows, anatomical pathologists who perform routine coroner’s autopsies and forensic pathologists.
 
Part 2 – Unexpected Infant Deaths
The public and the criminal justice system expect, demand and deserve high quality, accurate results from their systems of death investigation. Although forensic autopsies are a fundamental component of all systems of death investigation, the value of any one autopsy is highly dependent upon the pathologists’ ability to answer a broad range of anticipated and unanticipated questions. Infant death investigation is complex and the end-­‐product is often controversial. Forensic pathologists practicing in the post-­‐SIDS generation know that infants dying with truly “undetermined” causes and manners of death are rare. This is due to the prevalence of high quality death investigations that identify unsafe (“asphyxia”) environments within which many infants sleep, and to the increasing quality of infant autopsies which allow for the identification of lethal and/or contributory natural diseases. This portion of the workshop provides scope and context for the pathologist who participates in the investigation of unexpected infant death. Photographs from death scenes and autopsies, and photomicrographs of autopsy materials will be presented.
 
 
W202: Contemporary Issues in the Diagnosis and Management of Breast Disease
Anna Marie Mulligan, University Health Network and University of Toronto, Toronto, Ontario
Anita Bane, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario
 
Objectives:
At the end of the session, the participants will be able to:
  • Summarize the principles of current predictive marker testing in breast cancer, the evidence for and the challenges involved in the application ofKi67 testing in the clinical setting and the various multi gene predictors currently available.
  • Detail the importance of radiology-pathology correlation in reporting breast core biopsies, with emphasis on common pitfalls and management issues.
  • Describe the important morphologic features and classification of DClS with emphasis on the differential diagnosis.
  • Discuss an approach to the handling of gross specimens with emphasis on resections performed for DCIS and post-neoadjuvant therapy.
Description:
In this workshop, we will present an update on predictive marker testing in breast cancer which will not only focus on hormone receptor and HER2 testing, but will also include a discussion on Ki67 testing, in light of the recently published recommendations. In line with this, we will present a brief overview of Oncotype Dx and other commercially available multigene predictors. The course will also include an approach to core needle biopsies with emphasis on diagnostic pitfalls and management issues. Other topics to be discussed include DCIS, specifically, problems in diagnosis with emphasis on the differential diagnosis, and the grossing of breast specimens, with special attention to specimens with DCIS and post-neoadjuvant therapy. The workshop will be of value to: pathology residents, PAs, general and anatomic pathologists.
 
 
W203: To Be or Not to Be??? A Lymphoma-reactive Lymphadenopathy and Mimics of Hematopoietic Neoplasms
Catherine Ross, McMaster University, Hamilton, Ontario
Monalisa Sur, McMaster University, Hamilton, Ontario
 
Objectives:
At the end of the session, the participants will be able to:
  • Review the histopathologic findings of reactive lymphadenopathies, both common and uncommon.
  • Illustrate examples of reactive lymphadenopathies that may overlap with malignant hemaotologic neoplasms.
  • Discuss the use of immunohistochemistry and other ancillary studies to aid in the distinction of these entities.
Description:
Case of reactive lymphadenopathies that can have overlapping features with malignant hematoliogic neoplasms both clinically and morphologically will be presented .Special emphasis on the features that can help to distinguish these from each other will be highlighted with examples .The use of immunohistochemistry and other ancillary modalities will be shown.
 
 
W204: Practical Approach to Atypical/Malignant Cutaneous Spindle Cell Neoplasms
Danny Ghazarian, University Health Network, Toronto, Ontario
Ayman Al-Habeeb, University Health Network, Toronto, Ontario
 
Objectives:
  • To familiarize the audience with classification of atypical/malignant cutaneous spindle cell neoplasms.
  • Provide a practical approach to difficult atypical/malignant spindle cell neoplasms.
  • Emphasize the subtle morphological features.
  • Utilization of ancillary tests in challenging cases.
Description:
Atypical/malignant spindle clee neoplasms of the skin are not uncommonly encountered by practicing pathologists and in many cases are challenging due to the fact that their clinical presentation and histo-morphological features are similar and overlapping; however, proper classification and diagnosis is essential for appropriate patient management. The aims of this workshop are to familiarize practicing pathologists with the classification of the atypical and malignant cutaneous spindle cell neoplasms and provide a pragmatic approach with emphasis on the subtle histo-morphological features and the utilization of ancillary tests to reach accurate diagnoses.
 

 
SUNDAY, JUNE 9, 0800-1130, W301-W304
 
 
W301: Difficult Diagnoses in Cytology: Pancreatic FNA, Bile Duct Brushings and Lung EBUS
Catherine J. Streutker, St. Michael’s Hospital, University of Toronto, Toronto, Ontario
Hasan Ghaffar, St. Michael’s Hospital, University of Toronto, Toronto, Ontario
Vladimir Iakovlev, St. Michael’s Hospital, University of Toronto, Toronto, Ontario
 
Objectives:
At the end of the session, the participants will understand:
  • Bile duct brushing cytology – challenges in making definitive diagnoses.
  • Pancreatic FNA cytology – differentiating between benign and malignant lesions.
  • EBUS – cytology of lung and lymph nodes of the mediastinum – criteria for diagnoses.
  • How to evaluate and process cytology specimens for lymphoma.
Description:
This workshop will cover practical issues of cytology in the challenging areas of pancreatic FNA specimens, bile duct brushings and lung/mediastinal FNAs performed by endoscopy (EBUS). Increased use of endoscopic ultrasound-guided fine needle aspiration of lesions at these sites has rendered this a significant area of medical/non-gynecologic cytology, and one in which many pathologists possess limited training. The risks of over- and under-diagnosis are significant; we review the cytologic appearance of benign and reactive changes in comparison with the neoplastic/malignant lesions expected. We will review the following information in a case-based PowerPoint presentation: clinical history, diagnostic imaging findings, fine needle aspiration cytology (Diff Quick and Pap stained), cell blocks/core biopsies, ancillary studies and pertinent literature reviews. The role of rapid on-site cytologic evaluation for triaging samples will also be discussed. The workshop will be of value to: pathology residents, cytotechnologists, general and anatomic pathologists.
 
 
W302: Dilemmas in Diagnosis and Classification of Myelodysplastic Syndromes
David Good, Kingston General Hospital and Queen’s University, Kingston, Ontario
Alden Chesney, Sunnybrook Health Sciences Centre, Toronto, Ontario
 
Objectives:
At the end of the session, the participants will be able to:
  • Summarize the current classification of myelodysplastic syndromes.
  • Demonstrate an approach to problem cases and to achieve a diagnosis in cases not meeting classical diagnostic criteria.
  • Discuss common problems and pitfalls in the diagnosis of myelodysplastic syndromes.
Description:
The workshop will include a brief description the current classification of myelodysplastic syndromes with emphasis on disease biology and evolution of classification as further understanding was achieved. Key diagnostic pearls and the use of appropriate ancillary tests will then be discussed, with focus on how this pertains to the practicing pathologist. A series of cases will be presented including those not meeting diagnostic criteria and those overlapping with other syndromes to help emphasize a practical approach to diagnostic management. Aspects of novel treatments including associated bone marrow changes will also be discussed. This workshop will be of value to pathology residents, hematopathologists, general and anatomic pathologists.
 
 
W303: Diagnostic Challenges in Cytology and Histology of Uterine Cervix
Golnar Rasty, University Health Network, Toronto, Ontario
Marjan Rouzbahman, University Health Network, Toronto, Ontario
 
Objectives:
At the end of the session, the participants will:
  • 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.
  • Obtain an understanding of new standards, techniques, criteria and classifications in pathology of uterine cervix and Gynecologic cytopathology.
Description:
This course is designed to provide updated pragmatic, problem-solving knowledge for residents, fellows and practicing surgical pathologists who also wish to remain current with the changing trends in diagnosis and management of uterine epithelial and mesenchymal lesions. It addresses the resolution of diagnostic pitfalls relative to Gynecology cytopathology and histopathology. Also we present the role of immunohistochemical biomarkers and molecular profiling in assisting in typing of these groups of tumors. The workshop is designed for residents and pathologists with interest in gynecology pathology, histopathology and oncology. Selected cases will be presented as unknowns and discussed using an audience response system to facilitate audience participation. PowerPoint presentations for each topic are included in the course.
 
 
W304: Brain Tumours: Beyond the 2007 WHO Classification
Peter V. Gould, Hôpital de l’Enfant-Jésus and Université Laval, Quebec City, Quebec
Stephan Saikali, Hôpital de l’Enfant-Jésus and Université Laval, Quebec City, Quebec
 
Objectives:
At the end of the session, the participants will be able to:
  • Describe the current histologic classification of CNS tumours.
  • Summarize recent advances in the molecular classification of CNS tumours.
  • Understand the potential for specific molecular based therapy.
  • Recognize newly described entities.
Description:
The 2007 WHO Classification of Tumours of the Central Nervous System has been widely adopted. Nevertheless, as time goes by, advances in the molecular classification of brain tumours have given rise to new ways to categorize these tumours, particularly low-grade gliomas and medulloblastomas. New entities such as malignant gliomas with PNET –like components and embryonal tumor with multilayered rosettes (ETMR) have also been described. Future classifications are likely to incorporate more and more molecular data in order to guide patient therapy. This course is designed to expose residents, fellows and practicing surgical pathologists to the current practice of brain tumour diagnosis.