Workshops

Twelve Scientific Workshops will be held on Saturday July 12 and Sunday July 13.

 

SATURDAY, JULY 12, 0800-1130

 

SATURDAY, JULY 12, 1300-1630

 

SUNDAY, JULY 13, 0800-1130


SATURDAY, JULY 12, 0800-1130, W1211-W1214

 

W1211: Kidney Cancer: a Whole New Look in 2014

George Yousef, St. Michael’s Hospital and the University of Toronto, Toronto, Ontario

Andrew Evans, University Health Network and the University of Toronto, Toronto, Ontario

 

Objectives:

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

  • Recognize the updated consensus ISUP recommendation for handling and reporting kidney tumors and the proper use of IHC.
  • Understand the significance and limitations of biopsy specimens for small renal masses.
  • Be aware of the potential role of molecular analysis in improving patient management in kidney cancer.

Description:

Kidney cancer is one of the top 10 prevalent cancers in North America. The incidence of kidney cancer is increasing in the last few decades. Recently, the International Society of Urological Pathology (ISUP) identified a number of significant inconsistencies and discrepancies between pathologists regarding the reporting of kidney cancer. Furthermore, accumulating research in the field identified a number of new clinical and molecular parameters that can improve disease management. A number of international work groups were assembled to address the recent advances in this field, and in 2012, the annual meeting of the ISUP was focused on developing consensus recommendations for handing and reporting kidney cancer specimens that are consistent among pathologists. These recommendations will be published in the next few months. Moreover, a number of new entities are officially recognized during that meeting. The purpose of this workshop is to highlight the recent changes that were implemented by the ISUP especially the new and modified items that will help to reach much higher levels of consistency and uniformity among pathologists in reporting a kidney cancer.

Approximately 60-70% of renal masses < 4 cm in size are found incidentally when ultrasound examinations are performed for reasons other than signs/symptoms referable to the kidneys. As the use of ultrasound examinations by primary care physicians increases, there will be an expected increase in the incidental detection of these small renal masses (SRM). Autopsy and partial nephrectomy data demonstrate that 20% of SRM’s will be benign (typically oncocytoma or angiomyolipoma) requiring no immediate treatment. Slow growth and low progression rates of most low grade renal cancers make active surveillance with delayed intervention a viable management option, particularly for elderly patients with multiple co-morbidities. As such, needle core biopsies of these lesions can be extremely helpful in developing a management plan for the incidentally found SRM. Pathologists faced with such biopsies appreciate that there is a learning curve associated with reporting them. The objectives for this portion of the course are: to review the success rates for needle biopsies of SRM’s in terms of diagnostic yield and concordance with the final pathology in nephrectomy/partial nephrectomy specimens, to understand the pitfalls associated with limited sampling provided by needle biopsies and to understand the appropriate use and limitations of immunohistochemistry when attempting to classify renal neoplasms in needle biopsies.

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W1212: Teaching and Assessing the non-Medical Expert CanMEDS Competencies in Pathology & Laboratory Medicine

Marcio Gomes, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario

Ruth Padmore, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario

 

Objectives:

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

  • Develop a framework of teaching activities for the implementation of the CanMEDS competencies in their programs.
  • Develop a framework of evaluation tools for assessing the CanMEDS competencies in their programs.
  • Implement new teaching activities to develop the non-medical expert roles in their program.
  • Implement easy-to-apply evaluation tools to assess the non-medical expert roles in their program.

Description:

The Royal College of Physicians and Surgeons of Canada (Royal College) developed the CanMEDS framework of competencies. The framework became a mandatory requirement for accreditation. The residency programs of the different disciplines were required to implement the CanMEDS framework within their institutions. The implementation process started with the development of CanMEDS-based learning objectives. The next steps of implementation will require fully competence-based training programs, in which teaching activities and evaluation tools should be mapped to the framework, and resident’s progression along the program will depend on the acquisition/demonstration of such competencies.

Most of the Royal College documents and support material were developed for the purely clinical disciplines, and the patient-doctor relationship is in the heart of the discussions around the non-medical expert roles. Hence the application of the CanMEDS framework to pathology and laboratory medicine became a challenge to most of the residency programs, which still struggle to meet the Royal College requirements with time-consuming in-house developed solutions. This workshop intends to address some of the issues common to laboratory medicine, providing tools for immediate application by medical educators, program directors, coordinators, rotation directors, and clinician teachers.

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W1213: Effective Laboratory Utilization: Challenges and Strategies

Laurette Geldenhuys, QE II Health Sciences Centre, Halifax, Nova Scotia

David Kinniburgh, Centre for Toxicology, University of Calgary, Calgary, Alberta

 

Objectives:

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

  • Identify factors which influence laboratory utilization.
  • Identify resources, tools and approaches to promote appropriate utilization.
  • Discuss examples of effective strategies.
  • Be prepared to participate in development of laboratory utilization strategies in their own institution.

Description:

Appropriate Laboratory Utilization has become an area of intense focus as laboratory professionals, health care administrators and governments continue to search for efficiencies and improved quality and safety of patient care. The workshop will review the factors which drive and influence laboratory utilization. Potential resources, tools and approaches that can be used to promote effective utilization will be discussed. Examples of effective strategies employed will be presented, including opportunities and lessons learned in the areas of: governance, test costing information, informatics (data collection, extraction and analysis), behaviour modification (through CME, clinical pathways, pre-printed orders, practioner and test utilization profile reports) and clinical program operational impact assessments.

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W1214: 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 be able to:

  • 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.

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SATURDAY, JULY 12, 1300-1630, W1221-W1224

 

W1221: 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:

  • Know the key histological features of usual and complicated epithelial and mesenchymal lesions of uterus.
  • Recognize recently described entities and understand their clinical significance.
  • 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.

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W1222: Evidence Based Medicine for the Practicing Pathologist

Alice Lytwyn, Juravinski Hospital, McMaster University, Hamilton, Ontario

Jemila Hamid, McMaster University Medical Centre, McMaster University, Hamilton, Ontario

 

Objectives:

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

  • Understand basic concepts in evidence based medicine and how to apply them to pathology practice.
  • Know where to obtain guidelines and tools for assessing studies.
  • Understand bias and how this affects study validity.
  • Understand concepts in randomized trials, diagnostic testing, prognostic marker and prediction studies, systematic reviews, and guideline development.
  • Understand basic statistical concepts.

Description:

This course will provide the pathologist with a working knowledge of evidence based medicine both for direct application to pathology practice and for clinicopathologic interactions.

Pathology diagnoses impact on patient care, and for that reason pathologists need to know to how to assess the literature and how to determine when studies are valid and are ready for application to practice. There are also increasing demands upon pathologists to incorporate new tests and to report potential prognostic indicators; therefore there is a need for pathologists to determine which demands are appropriate and will have a positive impact on patient care. With increasing multidisciplinary decision making, pathologists need to know not only to assess their own literature but also the results of clinical trials and studies.

This course will cover basic concepts in study methodology, discuss study designs pertinent to pathology, and provide the framework for assessing studies. Using practical examples from pathology practice, this course will discuss randomized controlled trials, diagnostic testing, prognostic factor studies, prediction, systematic reviews and guideline development. Basic statistical issues will be addressed in the context of these studies.

The course will be a lecture format, but with practical examples throughout, and interactive questions and comments are encouraged at any time. At the end of the course the audience will be polled by electronic format for their answers and opinions. This course is suitable for all pathologists and residents who wish to gain knowledge of applying evidence based medicine to pathology.

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W1223: T Cell Lymphoproliferative Lesions: Trials and Tribulations, Traps and Tips: Diagnostic Pitfalls and Potential Clinical Impact

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:

  • Utilize a rational, cost effective strategy combining clinical history, morphologic, phenotype and genetic data to approach T cell malignancies and or reactive lesions.
  • Diagnose nodal and extranodal T cell lymphomas and distinguish them from reactive processes.
  • Be aware of the current status of lymphoma classification as per the WHO 2008 classification with emphasis on some newer and unusual entities.
  • Understand the clinical implications of the diagnoses.

Description:

Being relatively uncommon, T cell lymphoproliferative lesions present a considerable diagnostic challenge to the practicing pathologist. Nodal and extranodal T cell lymphomas have a morphologic spectrum that overlap considerably with reactive lymphoid hyperplasia, B cell lymphomas and Hodgkin’s lymphoma. Some T cell lymphoid neoplasms also show immunohistochemical overlap with myeloid neoplasms and can prove to be diagnostically challenging. This practically oriented course will focus on major categories of nodal and extranodal T cell lymphoproliferative lesions recognized by the WHO classification of Tumours of the Lymphoid Tissues: Representative index cases, which have significant potential to be missed or misdiagnosed, will be presented within the WHO classification. The emphasis will be on cases which may often be confused with non-hematopoietic neoplasms and or reactive conditions. In addition, cases in which the appearances and sometimes the ancillary studies can present confusion both in diagnosis and classification will be discussed. The utility of both immunohistochemistry and other studies (flow cytometry and molecular studies) as aids to diagnosis will be highlighted with emphasis on the role of flow cytometry in the diagnostic workup. Examples of newer entities within the WHO classification will be shown and discussed. The workshop will be constructed by a series of case presentations with routine H&E stains and full immunohistochemical panel and/or flow cytometry and molecular studies. Discussion will center on the differential diagnosis with highlighted points to avoid diagnostic pitfalls. Additionally, the clinical importance of these diagnoses and the impact of proper diagnosis on treatment and outcomes will be addressed.

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W1224: Sudden Cardiac Death and CV Surgical Pathology

Jagdish Butany, University of Toronto, Toronto, Ontario

Vidhya Nair, McMaster University, Hamilton, Ontario

 

Objectives:

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

  • To provide a review of the structure of the heart with particular reference to the conduction system and its examination.
  • Discuss the epidemiology and causes of SCD
  • Discuss the classification SCD with emphasis on the Cardiomyopathies

Description:

This case based course will focus on examination of the heart and the recognition of conditions causing sudden cardiac death. The course will also demonstrate the common cardiac and vascular specimen types encountered by a surgical pathologist.

The course is designed for and will be useful for the pathologist who is not an expert cardiac pathologist, and is designed for general surgical pathologists, residents and fellows. The presenters will demonstrate pictorially the common methods of examination of the heart, the need for routine sections; as well as the need for special sections in individual cases. The course will illustrate common categories of cardiovascular pathology encountered at autopsy (examination of cases of SCD). An overview of common CV surgical pathology specimens will be offered, including atherosclerosis, aortic aneurysms, cardiac tumors, native valve pathology, cardiac biopsies – diagnostic and therapeutic, and prosthetic devices.

On completing the course the participants will be familiar with the commonly encountered categories of cardiac and vascular surgical pathology as well as the workup and differential diagnosis of these specimens, as well as an approach to the workup and diagnosis of cardiac conditions leading to sudden cardiac death.

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SUNDAY, JULY 13, 0800-1130, W1311-W1314

 

W1311: Pathological Assessment of the Pancreaticoduodenectomy Specimen

David Driman, London Health Sciences Centre, University of Western Ontario, London, Ontario

Vlad Maksymov, Grand River Hospital, Kitchener, Ontario; McMaster University, Hamilton, Ontario

 

Objectives:

To review the following:

  • Surgical anatomy of the head of the pancreas and relationship to adjacent vascular structures.
  • Types of surgical specimens received.
  • Frozen section issues.
  • Margins in pancreaticoduodenectomy specimens.
  • Grossing protocols.
  • Need for standardized assessment of specimens.
  • Quality assurance issues and interdisciplinary collaboration.

Description:

In this workshop, we will review the important issues around pathological assessment of pancreaticoduodenectomy specimens including terminology, gross protocols and the need for a standardized and multidisciplinary approach to these cases. This workshop will be of value to pathologists who assess these cases, residents and pathologists’ assistants.

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W1312: Pathological Muddiness: Reflective Practice and The Art of Intraoperative consultation in Gynecologic Pathology

Matthew Cesari, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario

Nadia Ismiil, Sunnybrook Health Science Centre,, University of Toronto, Toronto, Ontario

 

Objectives:

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

  • Describe the principles of reflective practice.
  • Apply a reflective approach to the resolution of difficult/complex intra-operativeconsultations.
  • Describe pitfalls and their solutions in the performance of intra-operative consultations.
  • Participate in collaborative learning as part of a performance improvement strategy for intra-operative consultations.

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W1313: 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.

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W1314: Brain Tumours: Beyond the 2007 WHO Classification

 

Click here to download the Advance materials

 

Peter Gould, Hôpital de l’Enfant-Jésus du CHU de Québec, Quebec City, Quebec

Stephan Saikali, Hôpital de l’Enfant-Jésus du CHU de Québec, 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.

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