4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

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4. Hrvatski kongres kliniËke citologije / 1. Hrvatski simpozij analitiËke citologije / 2. Hrvatski simpozij citotehnologije DIAGNOSTIC CHALLENGES IN LYMPHOPROLIFERATIVE DIESASES Jakšić B, Kardum-Skelin I University Hospital Merkur, Zagreb, Croatia 46 Klinička citologija - Plenarna i pozvana predavanja Recent development in diagnostic technology brought up a number of exciting challenges in lymphoid neoplasms. Traditional diagnostics and classifications, based on morphological characteristics of involved tissue, are amended with new (non-morphological) parameters. Current WHO consensus classification includes besides morphology basis also immunological phenotype and genetic parameters combined with clinical data to assure reproducible classification that is clinically sound. However, with proliferating of new diagnostics, a number of conceptual and practical issues are emerging. On the one hand exponential increase of new data from basic research, translated in a pletora of new diagnostic parameters that are competing for clinical evaluation of diagnostic relevance, on the other hand increasing numbers of various treatments are also competing for clinical evaluation. This is resulting in a complex, multidimensional system that requires appropriate, methodologically sound clinical research. Clinical relevance for both diagnosis & treatment should be assessed in longitudinal, interventional clinical trials including prognostic and survival analysis. Each simple or composite parameter should be individually tested for clinical relevance, mutual relationship among parameters should be explored by multivariate analyses. Mere correlation among new (and old) diagnostic parameters is suboptimal. Poor or inadequate methodology often translate in biased or invalid results. Practical diagnostic challenges include failure to address the role of (typical) characteristic sample, to discriminate between „static“ and „dynamic“ parameters , to disregard kinetic parameters , to misuse the clonality concept disregarding its quantitative aspect, or failure to analyze and manage complex genetic information etc. All this is of less importance in typical, full blown cases with predominantly uniform appearance of clonal infiltration. However, especially challenging are cases with composite cellularity in which clonal cells are scanty and surrounded with polyclonal or reactive cells. For this reason lymphoproliferative diseases may serve as an intriguing research model that could help elucidate yet not fully understood interactions between clonally affected neoplastic cells and other cells in the microenvironment. Break through in the field requires combined effort of diagnostics experts and clinicians to perform high quality, productive clinical research. Those experts should be not sealed in morphological categories unprepared to think “out of box”, but should be open-minded for paradigm change to come. bjaksic@mef.hr
Clinical Cytology - Plenary and Invited Lectures CHRONIC LYMPHOCYTIC LEUKEMIA: INSIGHTS FROM LYMPH NODES & BONE MARROW AND CLINICAL PERSPECTIVES Jakšić O1 , Kardum-Skelin I2 , Jakšić B2 1 Dubrava University Hospital, Zagreb, Croatia 2 Merkur University Hospital, Zagreb, Croatia B-cell chronic lymphocytic leukemia (B-CLL) is characterized by highly variable distribution of tumor mass between peripheral blood, bone marrow and lymphoid organs which is important for staging, classification and prognosis. These clinical findings with novel data about importance of B-cell receptor and its stimulation with the support of microenvironment indicate important role of tissues (lymphoid organs and bone marrow) in the pathogenesis of B-CLL. Here is presented the novel approach of simultaneous characterization of B-CLL cells form peripheral blood, bone marrow and lymph nodes by flow cytometry and immunocytochemistry, defining inter- and intraclonal diversity with respect to various molecules. These include adhesion molecules (integrins, immunoglobulins, selectins), chemokine receptors (including CXCR-4), signaling molecules and prognostic factors (CD38 and ZAP-70), proliferation and apoptosis markers (including Ki67, AgNORs with PK index, survivin, bcl-2) and therapeutic targets (CD20 and CD52) and residual hematopoietic stem cells. A number of interesting significant interactions have been discovered, pointing to the important role of neoplastic cell microenvironment. These may in addition to insights in pathogenesis and roles of different microenvironments add to diagnosis, prognosis and treatment of B-CLL patients. ojaksic@kbd.hr 47 4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology
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4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

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