96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

DO-002b
Impact of terminologies in tumor pathology structured reports
G . Haroske 1 , T . Schrader 2
1 Dresden-Friedrichstadt General Hospital, Institute of Pathology, Dresden,
2 University of Applied Sciences Brandenburg, Department Informatics and
Media, Brandenburg
Aims. For information exchange and data mining structured reports in
tumor pathology have to be based on controlled vocabulary as to get a
model of meaning. So far there is no universal terminology for the wide
variety of concepts in tumor pathology. SNOMED CT will probably become
a global health terminology standard. National and international
initiatives are necessary to reach a growing agreement on particular
aspects and needs towards it. Interface terminologies are a tool for drawing
existing separate terminology systems to a finally global standard.
Methods. Controlled vocabularies in guidelines of German pathologists
for a series of tumors, in the basic tumor documentation of cancer registries,
and in the HL7 Germany have been mapped to PathLex, an interface
terminology of IHE.
Results. On average a pathology guideline describes 50 terms which have
to be registered as to fulfill the minimum documentation requirements.
PathLex provides between 30 to 40 terms per tumor entity, only 80% of
them are identical with the German guideline vocabulary. The coincidence
of PathLex with HL7 Germany vocabulary or the basic data set
of cancer registries is still lower. In contrast to PathLex there is no separation
between general and organ-specific information in the German
guideline vocabulary.
Conclusions. Although based on internationally agreed understanding,
sharing the same concepts of tumor pathology, the terminology differences
among the different sources are quite obvious. They have to be
overcome as to ascertain a reliable information exchange between different
actors in the care of tumor patients. Terminology mapping is one
solution, but not the optimal one. A closer collaboration with international
terminology bodies as well as a sharpened realization of the impact
of terminology in home made guidelines would contribute to a better
standing of German pathology. A SNOMED membership of Germany
would be very helpful.
AG Dermatopathologie und AG Zytopathologie I –
Endokrine Themen I
FR-001
Unusual HBME1-expression in a hyalinizing trabecular tumor of
the thyroid gland: a case report
D . Lenggenhager1 , E . Marques Maggio1 , B . Bösch2 , A . Elisa2 , M . Rössle1 1UniversityHospital Zurich, Institute of Clinical Pathology, Zürich, Switzerland,
2Stadtspital Triemli, Institute of Pathology, Zürich, Switzerland
Aims. Hyalinizing trabecular tumour (HTT) is a rare thyroid neoplasm
of follicular cell origin with a trabecular growth pattern, marked intratrabecular
hyalinization and nuclear features, which are typically found
in papillary thyroid carcinoma (PTC). The role of HBME1 in the diagnostic
process of PTC has been demonstrated in several studies. We
present a case of HTT with patchy, but abundant, hitherto not reported
membranous and intrabecular HBME1-positivity.
Methods. A 70-year-old woman underwent total thyroidectomy because
of cytological diagnosis of PTC. Pathomorphological investigation of the
resected specimen was performed.
Results. Histologically, the typical trabecular architecture of HTT with
elongated tumor cells, markedly hyalinized intratrabecular stroma and
oval shaped nuclei with grooves and inclusions was seen. Immunohistochemically,
tumour cells were diffusely and strongly positive for thyreoglobulin
and TTF1, focally and weekly positive for Galektin3 and
HBME1, but negative for calcitonin, ki67 and CK19. The intertrabecular
hyalinized material was positive for diastase-resistant PAS, Collagen IV,
and HBME1, exhibiting a filiform and stellate staining pattern. Mutational
analysis showed a BRAF wild type.
Conclusions. This case shows that HBME1-positivity may occur in HTT,
and therefore should be interpreted with caution in differentiating HTT
from PTC.
FR-002
Secondary tumours to the thyroid an uncommon but potentially
challenging entity: the experience of a single general hospital
C . Cacchi1 , H . Jähnig1 , G . Schenkirsch2 , M . Füller 3 , H . Arnholdt1 , B . Märkl1 1 2 Klinikum Ausburg Insitute for Pathology, Augsburg, Klinikum Augsburg,
3Klinikum Augsburg, Oncology and Hematology Unit
Aims. Despite its rich vascular supply, thyroid is a very uncommon location
of metastasis. It has been reported that secondary malignancies
representing less of 2% of thyroid tumours; the aim of these study is to
present experience of a single institution focusing on the differential histological
diagnosis.
Methods. A total of 13 (8 male and 5 female patients) cases with metastatic
disease to the thyroid have been retrieved from the archive of our
tumour-registry between 1985 and 2011. All patients have documented
histology for both primary and secondary tumour. Patient age, sex, survival,
outcome were reordered.
Results. The median age of the patients is 69.8 years, actually 4 patients
are still alive. Among the other patients only four died as consequence
of progression of the primary tumour. The operable cases (9) received
in four cases a simple lobectomy, in five cases a total thyroidectomy. A
primary tumour was identified in 11 cases: of clear cell renal carcinoma
in 6 cases, squamous cell carcinoma in 4 cases (two lung , one larynx
and one oesophagus respectively) and one small cell carcinoma of the
lung . In two cases the patients have had other malignancies (melanoma,
colorectal carcinomas and bile-pancreatic adenocarcinoma). The time
between the diagnosis of primary tumours and metastasis is interestingly
longer in case of renal carcinoma (144 months) respect to an average
value for all cases (77.5 months). Five cases have been studied pre-operative
with a fine needle aspiration (FNA), in two cases this procedure
were diagnostic.
Conclusions. Patients with metastases to the thyroid gland are an uncommon
but clinically pathologically relevant issue, particularly when
the tumor mass is evident as a single nodule (in our experience in 3 of
13 cases); for example a clear cell renal carcinoma could close mimic a
clear cell thyroid adenoma or follicular carcinoma. Moreover, neuroendocrine
tumor can metastasise to the thyroid gland simulating a primary
thyroid tumour (particularly a medullary carcinoma): a rare but
treacherous possibility. To avoid misdiagnosis and to ensure an optimal
follow-up for these patients clinical data and a comprehensive immunohistochemical
panel are mandatory.
Der Pathologe · Supplement 1 · 2012 |
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