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

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Kolorektales Karzinom 2 VO-005 Translating biology of colorectal cancer into clinical applications G .A . Meijer 1 1VU University Medical Center, VU University Medical Center, Amsterdam, Netherlands Colorectal cancer (CRC) is one of the most common malignancies and represents a substantial burden for society, in terms of patient suffering as well as economically. As cancer is an evolutionary process in which genotype drives phenotype, knowledge of the biological mechanisms underlying CRC can help to improve patient outcome. Translational research in CRC mainly focuses on unmet clinical needs in three stages of the disease, i.e. early detection or screening, prognostication in primary CRC and prediction of response to drug therapy in metastatic CRC. As CRC develops over a number of years from a detectable precursor (adenoma), there is a window of opportunity for early detection and curative intervention. Our increased understanding of CRC biology, and in particular adenoma to carcinoma progression, has yielded a number of markers based on e.g. DNA or proteins that hold great promise for the next generation CRC screening tests. In primary CRC, standard UICC staging is still the most important method for stratifying patients by risk of recurrence. Yet, the substantial number of stage II patients that do develop recurrences, and the still small proportion of stage III patients that actually benefit from adjuvant therapy, underline the need for additional diagnostic arsenal. Since CRC biologically is a heterogeneous disease, it does not come as a surprise that there is a large number of markers for which some level of evidence exists that they could have additional prognostic value. The main challenge here is to make the next step to get these markers validated and implemented in routine diagnostic practice. In a similar way, much translational research has successfully translated biology of CRC into diagnostic tests that more rapidly have been implemented, like KRAS testing for anti-EGFR therapy. The fact that these predictive markers have entered the field much more rapidly than the prognostic markers most likely is associated with more efficient business development, stimulated by the companion diagnostic concept. Yet, also here challenges remain, as because of the complexity of CRC biology it is much more likely that we will have complex decision trees rather than single parameter tests to stratify patients for drug therapy. The exciting developments that will bring whole cancer genome sequencing within the reach of pathologists will eliminate current barriers for the full exploration of tumor biology for the purpose of diagnostic pathology. Keynote Lecture VO-007 Deep Sequencing - new frontiers in GI-tumor pathology N . Papadopoulos Johns Hopkins University, Baltimore, USA Inflammatory bowel diseases represent a chronic disorder accompanying mostly young people throughout their life. Thus therapeutic strategies allowing for a normal life are mandatory. Although the incidence is increasing and the research of the last decades provides a detailed view of the pathogenesis, the available therapeutic strategies are still symptomatic. The primary aim is to induce a stable remission. Depending on disease localization as well as associated complications such as fistulas, abscesses and malnutrition, the therapeutic strategies range from local applications up to systemic immunosuppressive medications. Despite the availability of highly potent agents including azathioprine, calcineurin inhibitors as well as anti-TNF antibodies, there is still a subset of patients that remains with active disease. Thus it is crucial to predict the disease course early on, in order to decide whether early aggressive therapy is required or a less aggressive treatment is sufficient. Some factors helping with this decision have already been identified. Novel data suggest that the expression profile of CD8+ cells may help in predicting the disease course. However, these data will have to be confirmed in prospective studies. Equally important is the question when immunosuppressive therapies can be paused with low risk. Do we need clinical, endoscopic or even histological remission? On a long-term view mucosal healing gains impact since it reduces the risk of developing colorectal cancer. The discussed points emphasize that therapeutic strategies in inflammatory bowel diseases represent an increasingly individualized therapy in order to allow for a high life quality of our patients. Primäre Entzündungen im GI-Trakt VO-008 Clinical view and novel therapeutic strategies in inflammatory bowel diseases B . Siegmund1 1Charité – Universitätsmedizin Berlin, Klinik für Gastroenterologie, Infektiologie und Rheumatologie der Charite Campus Benjamin Franklin, Berlin Inflammatory bowel diseases represent a chronic disorder accompanying mostly young people throughout their life. Thus therapeutic strategies allowing for a normal life are mandatory. Although the incidence is increasing and the research of the last decades provides a detailed view of the pathogenesis, the available therapeutic strategies are still symptomatic. The primary aim is to induce a stable remission. Depending on disease localization as well as associated complications such as fistulas, abscesses and malnutrition, the therapeutic strategies range from local applications up to systemic immunosuppressive medications. Despite the availability of highly potent agents including azathioprine, calcineurin inhibitors as well as anti-TNF antibodies, there is still a subset of patients that remains with active disease. Thus it is crucial to predict the disease course early on, in order to decide whether early aggressive therapy is required or a less aggressive treatment is sufficient. Some factors helping with this decision have already been identified. Novel data suggest that the expression profile of CD8+ cells may help in predicting the disease course. However, these data will have to be confirmed in prospective studies. Equally important is the question when immunosuppressive therapies can be paused with low risk. Do we need clinical, endoscopic or even histological remission? On a long-term view mucosal healing gains impact since it reduces the risk of developing colorectal cancer. The discussed points emphasize that therapeutic strategies in inflammatory bowel diseases represent an increasingly individualized therapy in order to allow for a high life quality of our patients. VO-010 Microscopic colitis: clinical appearance and therapy S . Miehlke1 1Magen-Darm-Zentrum, Hamburg Microscopic colitis (MC) is a chronic inflammatory bowel disease which is increasingly recognized as a common cause of chronic, non-bloody diarrhoea. Besides watery diarrhea, many patients also suffer from abdominal pain, weight loss and fecal incontinence which severely deteriorate their quality of life. There is a female predominance with an average age at diagnosis around 60 years. Smoking appears to be a relevant risk factor. Epidemiological studies have shown a rising incidence in the last Der Pathologe · Supplement 1 · 2012 | 7
Abstracts decade and meanwhile it appears that MC is almost as common as classic IBD, i.e. Crohn‘s disease and ulcerative colitis. The endoscopic appearance of the colon is usually normal or may show only subtile alterations. The diagnosis can be made only by histology and the specific findings reveal also the subtypes of MC, lymphocytic (LC) or collagenous colitis (CC). The key histological feature is a thickened subepithelial collagenous band >10 µm in CC, and an increase number of surface intraepithelial lymphocytes >20 IEL/100 epithelial cells) in LC. Patients with chronic diarrhea not completely fulfilling the histological CC/LC criteria may have incomplete MC. The primary aim of medical therapy is to achieve and maintain clinical remission and to improve patient‘s quality of life. The strongest evidence is currently available for budesonide, a locally acting corticosteroid with an extensive first-pass metabolism in the liver. Three randomized controlled trials in CC and two in LC have proven budesonide 9 mg per day effective for induction of clinical remission with a pooled response rate of 81%, and a NNT of 2 patients. The majority of patients response rapidly and experience a substantial improvement in their quality of life. After cessation of budesonide, symptomatic relapse may occur in 60– 80% of patients. Two randomized controlled trials have now shown that clinical remission and histological response can be maintained in the majority of patients with budesonide 6 mg per day for 6 months with a pooled response rate of 83% and a NNT of 2 patients. Other drugs such as mesalazine, bismuth or loperamide are occasionally used; however, the benefit is unclear due to lack of adequate clinical trials. There is currently also no evidence to recommend immunosuppressives. However, recent case reports suggest that azathioprin or anti-TNF natibodies might be an option in individual refractory cases. VO-011 Histopathology of microscopic colitis D . Aust1 1Institute for Pathology TU Dresden, Dresden Microscopic colitis (MC) is recognized to be a common cause of chronic, non-bloody diarrhea. Numerous epidemiological studies, mainly in the USA and Sweden, have shown a rising incidence in the last decade. The diagnosis can only be made by histology and the specific histological findings define the subtypes of MC, lymphocytic (LC) or collagenous colitis (CC). As LC and CC share clinical similarities and histopathological features, and many patients with CC also fulfil the histological criteria for LC, it has been discussed whether the two are in fact different stages of disease development. Conversion of LC to CC or vice versa is infrequent, and at present LC and CC is considered two separate but related entities. In MC, the lamina propria shows increased numbers of plasma cells and lymphocytes with loss of the normal gradient, even eosinophilic and neutrophilic granulocytes may be present. But these histological features do not warrant the diagnosis of MC even though they may be responsible for the clinical symptoms. The key histological feature of LC is an increased number of surface intraepithelial lymphocytes (IEL). Usually >20 IELs/100 epithelial cells are requested to warrant the diagnosis of LC. IELs are mostly cytotoxic CD8+ T-lymphocytes. The epithelium itself can show regressive changes with focal or diffuse flattening of the columnar cells, loss of mucin, decreased goblet cells and signs of degeneration such as cytoplasmic vacuoles and pycnotic nuclei. The key histological criterion for CC is a continuous subepithelial fibrous band underneath the surface epithelium (>10 µm). Other hallmarks of CC are chronic mucosal inflammation, the collagen band contains entrapped capillaries, red blood cells and inflammatory cells. Damaged epithelial cells appear flattened, mucin depleted and irregularly oriented. Focally, small strips of surface epithelium may lift off from their basement membrane. The terms MC not otherwise specified (MCnos) or MCi (microscopic colitis incomplete) was suggested for a subgroup of patients with diarrhea 8 | Der Pathologe · Supplement 1 · 2012 and an increase in cellular infiltrate in the colonic lamina propria and either an abnormal collagenous layer and/or intraepithelial lymphocytes coming short of fulfilling the criteria for CC and LC. The histological features of MC, diagnostic algorithms and possible differential diagnoses of MC will be discussed in this talk. VO-012 Eosinophilic esophagitis: role of the gastroenterologist A . Schöpfer1 1University of Lausanne, Department of Gastroenterology and Hepatology, CHUV, Lausanne, Switzerland Eosinophilic esophagitis (EoE), first described in the early 1990’s, has rapidly evolved as distinctive chronic inflammatory oesophageal disease with increasing incidence and prevalence in the westernized countries (prevalence of about 1/2000). Currently, EoE represents the main cause of dysphagia in adult patients. EoE is defined as chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The presence of at least 15 eosinphils per high power field is considered a minimum threshold for EoE diagnosis. The disease is isolated to the esophagus, and other causes of esophageal eosinophilia should be excluded. Other diseases associated with esophageal eosinophilia are e.g. gastroesophageal reflux disease (GERD), eosinophilic gastrointestinal disorders, celiac disease, Crohn’s disease, invasive parasites, achalasia, or drug hypersensitivity. EoE is more prevalent in males and is frequently associated with allergies. It is currently under discussion to what extent and by which methods allergic testing should be performed. Therapeutic strategies for EoE can be summarized by the “3 D’s”: drugs, diet, dilation. Topical corticosteroids lead to a rapid improvement of active EoE clinically and histologically. Especially in children, elimination diets can have similar efficacy as topical corticosteroids. Oesophageal dilation of EoE-induced oesophageal strictures can also be effective in improving symptoms, but this therapy has no effect on the underlying inflammation. Neither the diagnostic nor long-term therapeutic strategies are yet defined. VO-013 The role of the pathologist in the diagnosis of eosinophilic esophagitis (EoE) C . Bussmann1 1Pathology Cantonal Hospital Lucerne, Luzern, Switzerland EoE is a chronic, immune-mediated esophageal disease with clinical symptoms and eosinophil-predominant inflammation. The diagnosis of EoE is therefore complex. It is not reflux or infectious or drug-induced. Histological cases with a high number of eosinophils are not a diagnostic problem. However, limits are of necessity in borderline cases. These must be based on the high power field (HPF) size and the percentage of squamous epithelium covering an HPF, which may greatly vary. Also, it must be considered that EoE is patchy in nature. In order to establish a reliable diagnosis a minimal number of biopsies are essential. Alongside the number of eosinophils further histological features associated with EoE, such as abscesses of eosinophils or basal layer enlargement, may be of diagnostic help in borderline cases.
Page 2 and 3: Inhalt Der Pathologe · Supplement
Page 4 and 5: Inhalt Der Pathologe · Supplement
Page 6 and 7: Editorial Liebe Kolleginnen und Kol
Page 10 and 11: Keynote Lecture VO-014 Genetic dete
Page 12 and 13: (AMACR, FASN, GOLM1, GSP-pi, ERG) t
Page 14 and 15: to assess the correct rate of R1 re
Page 16 and 17: DNA damage, and cytotoxic drugs. Au
Page 18 and 19: HCV-positive formalin-fixed and par
Page 20 and 21: well as MET activation were examine
Page 22 and 23: or BRAF mutation, c-MYC and SIRT1 e
Page 24 and 25: AG Pneumopathologie III DO-032 Remo
Page 26 and 27: immature granulopoiesis showed a st
Page 28 and 29: ned, if well-defined mantle zones,
Page 30 and 31: phomas). Most prominent gains or am
Page 32 and 33: DO-062 Tumor-associated macrophages
Page 34 and 35: DO-080 DOG1: an immunohistochemical
Page 36 and 37: AG Oralpathologie DO-087 Detection
Page 38 and 39: DO-094 Do activated fibroblasts inf
Page 40 and 41: DO-101 Histopathological analysis o
Page 42 and 43: DO-108 Identification of potential
Page 44 and 45: Conclusions. In conclusion, 454 par
Page 46 and 47: subgroup of patients with B-Raf mut
Page 48 and 49: DO-002b Impact of terminologies in
Page 50 and 51: Methods. We performed MCPyV-FISH of
Page 52 and 53: FR-013 HPV-genotype distribution in
Page 54 and 55: Methods. Three different techniques
Page 56 and 57: (i.e. investment in equipment and e
Page 58 and 59:
FR-032 COLD-PCR: a powerful tool in
Page 60 and 61:
dissection (MBLND) technique to imp
Page 62 and 63:
SO-005 Prevalence of mutations in s
Page 64 and 65:
SO-011 Methylation profiling and in
Page 66 and 67:
more effective than SAHA alone and
Page 68 and 69:
SO-022 Specialized pathology review
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SO-027 Ki-67 in mitotic score group
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nificantly associated with advanced
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liver did not correlate with the mu
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AG Paidopathologie II SO-046 Overex
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Results. Histomorphology of the ova
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p42 and p27 have not yet been inves
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SO-068 Recent advances in understan
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SO-075 A novel, dual role of CCN3 i
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Pancreatic Adenocarcinoma SG-137 Se
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sease and 30 colon cancer serum sam
Page 90 and 91:
Conclusions. Although CRC is charac
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differentiated and TNM stage III or
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pressed moderate levels of the prot
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FR-P-037 MALDI imaging reveals COX7
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in the context of therapy response
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on primary cells of wild-type and c
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chemotherapy was recommended and co
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aims are twofold: 1) to verify the
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Results. Her2/neu status in TMAs an
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prognostic impact was found in rect
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provided information on survival ti
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Methods. Biopsy specimens from 430
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the OS rate was 53% for patients wi
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FR-P-098 Immunohistological stainin
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FR-P-104 Histopathological evaluati
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within the earliest morphologic det
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Conclusions. In primary imaging a g
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fibrotic neointma development as we
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FR-P-129 Alpha-1-antitrypsin-PiZ-an
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FR-P-136 The expression of central
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cosa and in the periarterial tissue
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FR-P-149 Combination of Castleman d
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or without different concentrations
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Results. In 18 cases (79%) the caus
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FR-P-168 Autopsy findings in a 2-ye
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FR-P-174 MPGN-like glomerulonephrit
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Poster: Gynäkopathologie und Mamma
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SA-P-011 Genetic aberrations of pre
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Mechanismen, die eine Progression d
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internet server. A network of inter
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Methods. HE-gefärbte Schnittpräpa
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Conclusions. The newly released 450
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and desmoplastic reaction are diffe
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one patient revealed more than 9 mi
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situation, the V600E mutation in th
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SA-P-064 Evolution of molecular pat
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nic markers such as myf4 and MyoD1
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Conclusions. To our knowledge, this
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SA-P-085 Expression of the eukaryot
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Results. The papillary RCC type II
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SA-P-098 Male infertility: assessme
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SA-P-104 Process oriented scientifi
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Conclusions. The IBDW offers a uniq
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L Lasitschka F. DO-046 Lehmann A. F
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96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...

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