2008 Summer Meeting - Leeds - The Pathological Society of Great ...

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P71Ciliated foregut cyst of gallbladder with extensive squamousdysplasiaS Upadhye 1 ,ANayar 2 , B Haugk 11 Royal Victoria Infirmary, Newcastle upon Tyne, 2 Queen ElizabethHospital, GatesheadCiliated foregut cysts of the gallbladder are rare congenital lesions derived fromthe embryological foregut. We report a case of a 62-year-old woman whopresented with symptoms of acute cholecystitis and had a laparoscopiccholecystectomy. Histology revealed parts of a cyst wall adjacent to the cysticduct. The cyst contained bile concretions and was lined by metaplasticsquamous and transitional type epithelium with focal superficial ciliatedcolumnar cells. The metaplastic squamous epithelium showed variablecytological atypia in areas amounting to high grade dysplasia. Within the cystwall there were seromucinous glands and smaller squamous lined outpouchingswith dysplasia. The subepithelial tissues show a marked chronic inflammatorycell infiltrate with lymphoid follicles beneath which there was a well formedsmooth muscle layer. The metaplastic squamous epithelium showed variablecytological atypia in areas amounting to high grade dysplasia. There was noevidence of invasive carcinoma. The cyst appeared to focally communicatewith the gallbladder which showed features of chronic cholecystitis.Ciliated foregut cysts are rare cysts that, when discovered, deserve carefulsampling to identify possible squamous metaplasia, dysplasia or foci ofsquamous cell carcinoma. As a few cases of squamous cell carcinoma havebeen described in ciliated foregut cysts, complete surgical removal of the cyst istherefore appropriate.P73The Putative Stem Cell Marker CD133 is Variably andReversibly Expressed in Colorectal Cancer Cell LinesTMAM Elsaba 1 , L Martinez-Pomares 2 , RA Robins 2 ,RSeth 1 ,S Crook 1 , D Jackson 1 , AMA Albasri 1 ,MIlyas 11 Division of Pathology,School of Molecular Medical Sciences, QMC,Nottingham University Hospitals, UK, 2 Institute of Infection, Immunity andInflammation, School of Molecular Medical Sciences, QMC, NottinghamUniversity Hospitals, UKIntroduction:New cancer model postulated that only a minority of cells, called “cancer stemcells” (CSC), have the ability to generate new clones. Recently, data haveidentified CD133 as a marker for CSCs in many tumours including colorectalcancer. We sought to investigate the population size and biologicalcharacteristics of CD133+ cells in colon cancer.MethodsCD133 expression was evaluated by flow cytometry using two differentantibodies CD133/1 and CD133/2 to evaluate the size of the CD133+population. For functional analysis, one cell line was sorted into CD133+/- subpopulationsand each sub-population tested for their proliferation and colonyformation capacity.ResultsOut of 14 cell lines, two lacked CD133 expression; one showed CD133expression in 100% of cells and the remaining ones showed 2 - 70% of aCD133+ cell population . Sorted CD133+ cells from the SW480 colon cancercell line showed a slight but significant increase in proliferative index (36%)and higher colony forming activity (25%) than CD133- cells. PCR analysisrevealed that the CD133- cells still contained CD133 mRNA and that after 3weeks culture, CD133 surface expression could be detected in 18% of thesorted CD133- cells.ConclusionMost but not all cell lines have a dichotomous CD133+/- population. CD133-cells show proliferative and colony forming ability and so CD133 is notnecessary for this. The presence of CD133 mRNA and unexpected levels ofemergent CD133+ populations in long term cultured CD133- cells raises thepossibility of re-induction of CD133 in culture.P72Is histology required in resections for diverticular disease?SE John , CJ Richards , AH McGregor1 University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary,LeicesterThe Royal College of Pathologists document “Histopathology andcytopathology of limited or no clinical value” describes an approach to reduceworkload related to pressures in consultant staffing. Colonic resections fordiverticular disease represent specimens where the pathology is usuallystraightforward, and while not formally discussed in the College documentrepresents an area in which this approach may be useful. We audited reportingof resections for diverticular disease.350 colonic resections for diverticular disease from 2003-2007 wereidentified from the laboratory IT system. Information was collected includingthe length of resected bowel, number of blocks taken, macroscopic andmicroscopic findings and any additional pathology.20 cases showed significant other pathology (e.g. colonic carcinoma,inflammatory bowel disease) that was either clinically known or obvious onmacroscopic examination: these cases were excluded from further study. Nocases showed unexpected pathology on microscopic evaluation. The meannumber of blocks has reduced significantly over the period of study (11.45 in2003, 7.52 in 2007); the mean length of bowel resected has not changed.Diverticular disease is usually obvious on macroscopic examination of thebowel, and this study has not identified any cases with unexpected microscopicfindings. While the mean amount of work per case has reduced (less blockstaken) there is no evidence that the quality of reports is reduced. There is noevidence to support extensive block-taking in diverticular disease: it may bepossible to take minimal or no blocks in cases of otherwise straightforwarddiverticular disease.P74The pathological and radiological findings of mesorectalexcision specimens after radical pre-operative chemoradiationtherapy: The Harlow experienceV Sundaresan 1 , S Sreehari 1 , S Hafeez 1 ,SVivek 1 ,OLalude 1 ,L Melcher 1 , J Bridgewater 2 , W Partridge 1 ,SRedla 1 , J Campbell 1 ,JLeake 11 Princess Alexandra Hospital Harlow, 2 University College HospitalLondonWe describe the clinical and pathological findings of 30 of 200 patients withrectal carcinoma treated with pre-operative radical chemo-radiation therapy(CRT) at PAH. Pre-operative MRIs have been carried out before and after CRTwith T2 to T4 disease, some with clear evidence of nodal metastasis.Here, we present data to indicate evidence of clinical down staging of diseaseand in some cases evidence of complete cure. A majority of cases however,have residual disease with a variety of histo-pathological changes, ranging frommucosal ulceration, remnants of pools of mucin, fibrosis and residual disease.This range of histo-pathological changes will be quantified. In addition, EGFRexpression in the index biopsies, a previously described predictive marker ofresponse to CRT, will be correlated with tumour down-staging by MRI andpathological assessment.50 Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme
P75Intrarenal multiple and multilocular epidermoid cystspresented as an end stage kidney diseaseAAbdou 1 , N Asaad 11 Pathology Department, Faculty of Medicine, Menofiya UniversityThis report describes a case of large multiple and multilocular epidermoid cystsaffecting the left kidney of 67 old male. The condition is accidentallydiscovered during investigations for left loin pain complaint. Ultrasonographyrevealed enlarged left kidney with the picture of hydronephrosis. Grossly, thekidney is distorted by these cysts that were filled by cheesy like material. Thehistologic picture of an end stage kidney disease was apparent in thecompressed renal parenchyma by these cysts that were identical to anepidermoid cyst elsewhere. In conclusion, although of the rarity of anepidermoid cyst of the kidney, it could cause serious kidney damage leading toeventual end stage kidney disease. Epidermoid cyst of the kidney could bepresented as hydronephrosis at least for nephrologists and radiologists so,awareness of the occurrence of this cyst would broaden the differentialdiagnostic categories.P77Testicular Cancer Reporting Before and After Introduction ofthe RCPath Minimum DatasetDA Moore 1 ,NJ Mayer 11 Department of Histopathology, University Hospitals LeicesterIntroduction: Pathological reporting of orchidectomy specimens providesimportant information affecting treatment and prognosis of testicular cancer.The Royal College of Pathologist’s (RCPath) Minimum Dataset for thereporting of testicular cancer was first published in April 2000. Thisretrospective audit was performed to examine whether the publication of thisdataset has been associated with an improvement in the reporting of datasetitems relevant to clinical management of testicular cancer.Methods: An APEX database search was performed to identify all testiculargerm cell tumours reported in our Department in the year 1999 (prior topublication of the dataset) and the year 2006. Inclusion in reports of thefollowing dataset items were audited: tumour type, tumour size, completenessof excision, vascular space invasion, invasion of adjacent structures, ITGCN,British / WHO classification, TNM Stage.Results: 7 out of 8 of the dataset items were mentioned in over 95% of reportsfrom 2006 (n=25), compared with only 4 out of 8 from 1999 (n=24). Thenumber of Consultants reporting testicular tumours decreased from 6 in 1999 to3 in 2006, with the number of cases double-reported increasing from 17% (n=4)to 32% (n=8).Conclusion: Following publication of the original (2000) RCPath minimumdataset for reporting testicular cancer, there has been an improvement in thenumber of dataset items recorded in our Pathology reports. During this timethere has been a move towards specialist reporting and the number of casesdouble-reported has also increased.P76Three Genetic Developmental Stages of Papillary Renal CellTumours: Duplication of Chromosome 1q Marks FatalProgressionA Szponar 1 , D Zubakov 1 ,RKuiper 2 , A Geurts Von Kessel 2 ,GKovacs 1 .1 University of Heidelberg, Germany, 2 University of Nijmegen, TheNetherlandsClinico-pathological studies suggested that papillary renal cell carcinomas(RCC) have a good prognosis. However, no markers distinguishing betweenpapillary renal cell adenomas (RCA) and RCCs were available. We have nowanalysed the genetic alterations in 60 papillary renal cell tumours (RCT) with atleast 8 years follow-up. Based on the complexity of genetic changes weseparated three groups of tumours. In the first group (18 cases), all tumoursdisplay a combined trisomy of chromosomes 7 and 17. Tumours of the secondgroup (33 cases) showed the alterations characteristic for the first group andtrisomies of chromosome 3q, 8q, 12q, 16q and 20q as well. In addition to thegenetic alterations found in the first two groups, the third group of papillaryRCCs (9 cases) displayed duplication/gain of chromosome 1q, deletion/loss of6q, 9p and 14q. Only one of the patients died due to disease in the secondgroup, whereas 7 of the 9 tumours in the third group showed fatal clinicalprogression. We suggest that the first group of tumours are papillary RCAs, thesecond group are papillary RCCs and the third group of tumours are papillaryRCCs with an aggressive clinical behaviour. As the cellular phenotype ofpapillary RCTs is variable from case to case and also within a given tumour, thegenetic analysis offer a better system to classify the developmental stages ofclinical significance.P78Histopathological Evaluation of Residual Tumour inCystectomy SpecimensG Kemp 1 , A El-Sherif 11 Royal Victoria Infirmary, NewcastleBackground: Improved survival rates have been reported in the absence ofresidual carcinoma in cystectomy specimens. However, there are no formalguidelines specifying the block number required to identify residual tumour notvisible on macroscopic examination.Aims: To assess the proportion of cystectomy specimens with no residualtumour, and the number of blocks examined; also to compare the stage ofresidual malignancy in cystectomies with the highest stage in previous biopsies.Methods: Eighty-two cystectomies for primary bladder carcinoma received byDepartment of Cellular Pathology, Royal Victoria Infirmary in 2005-2006 wereidentified by SNOMED coding. Data were analysed using Excel.Results: Fifty-two (64%) cystectomies had residual invasive carcinoma and five(6%) showed carcinoma-in-situ; 11/52 patients with residual invasive tumourwere excluded from staging correlation due to missing biopsy data. In thirtyeight(93%) the previous biopsy showed the same (15/41) or lower tumourstage (23/41) than in the cystectomy; in 3 (7%) the biopsy showed tumour onestage higher than in the cystectomy. Twenty-five (30%) cystectomies showedno residual invasive or in-situ tumour. Median block number was 31 (range13-60).Conclusion:· Guidelines specifying the minimum block number needed to confirm presenceor absence of residual tumour are required.· Staging of bladder biopsies was predictive of high stage tumour in thecystectomy in most (93%) cases. Inadequate sampling/sampling errors mayexplain the few cases (7%), where tumour stage was higher on previous biopsythan in the cystectomy.Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme51
Page 2 and 3: PROGRAMME ACKNOWLEDGEMENTSPublished
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Page 29: PL5Identification of Key Breast Can
Page 32 and 33: P1Distinction of Fibroadenoma & Phy
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Page 36 and 37: P17Specimen Handling of Screen-Dete
Page 38 and 39: P25Mib1 Tumour Growth Fraction Asse
Page 40 and 41: P33What is the Real Incidence of HE
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Page 44 and 45: P49CTEN positively regulates cell m
Page 46 and 47: P57Meta-clustering of Small Intesti
Page 48 and 49: P65Colovesical Fistula - Complicate
Page 52 and 53: P79Evaluation of survivin expressio
Page 54 and 55: P87Incompletely Differentiated (Unc
Page 56 and 57: P95Ovarian Neuroblastoma Arising Wi
Page 58 and 59: P103Biopsy Pathology in HIV in the
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Page 64 and 65: P127The effect of inhaled carbon di
Page 66 and 67: P135Clinical significance of miR-21
Page 68 and 69: P143Streamed Internet Video for Pat
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Page 72 and 73: P159Immunohistochemistry Biomarker
Page 74 and 75: P167Presence of stem cell traits in
Page 76 and 77: P175Systematic Random Sampling with
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Page 88 and 89: S1Virtual slides in research and di
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2008 Summer Meeting - Leeds - The Pathological Society of Great ...

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