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

P163Benign Vascular Invasion in Pleomorphic AdenomaR Perera 1 ,SDi Palma 1 , R Simpson 2 , A Skalova 31 Royal Surrey County Hospital, Guildford, UK, 2 Royal Devon and ExeterHospital, Exeter, UK, 3 Medical Faculty, Charles University, Plzen, CzechRepublicPleomorphic adenoma is the most common benign neoplasm of the salivaryglands. Although the histological diagnosis is relatively easy, the presence ofatypical features such as vascular invasion may pose considerable diagnosticdifficulty. Vascular invasion is a hallmark of malignancy but more recently asub-group of pleomorphic adenomas have been described exhibiting vascularinvasion without any evidence of malignancy. The significance of vascularinvasion in pleomorphic adenoma is not clear.Here we present 6 cases of pleomorphic adenomas from the parotid glandthat shows tumour emboli in vessels within and outside the capsule. There is ahistory of fine needle aspiration (FNA) in 4 cases and incisional biopsy in 2cases. We speculate that the intra-vascular tumour is a result of the traumaticdiagnostic procedure that may have dislodged the tumour cells into the vesselsrather than true vascular invasion. Furthermore pleomorphic adenomas with apredominant myoepithelial/ myxoid component may be more susceptible to thiscomplication. Review of data from the literature also appears to support ourobservation.P165Liver Histopathology in the Yorkshire Region: a NetworkModelJWyatt 1 , G Reall 2 ,RJones1 Histopathology Dept St James's Hospital Leeds, 2 Hepatology Dept,St James's Hospital LeedsThe national plan for liver services UK 2004 states "each hepatology centreshould have access to a specialised liver pathologist. Ideally this would be inthe site of the lead centre providing expertise and training for the localpathology departments within the managed clinical network."Methods: Questionnaire survey about liver biopsy reporting was sent tohistopathologists in 11 hospitals in Yorkshire.Results: Replies from 23/31 (74%) pathologists in 9 non-specialised DGHdepartments and 3/4 liver pathologists in 2 larger specialised departments(Bradford, Hull). DGH departments receive average 70 liver biopsies/year (30–150; 67% medical, 33% for tumour) representing 0.55% (0.33–1.1%) histologyrequests. Reporting is shared by all 2–6 pathologists/department. Estimated35% (5–100%) cases are discussed with the clinician during a CPC (5/9) and/orby phone (5/9). 5-10% biopsies are reviewed in Leeds. The two largerdepartments receive 120 and 170 biopsies/year shared by 2 sub-specialists. 2-5% biopsies are reviewed in Leeds. Of 26 pathologists 20 said they enjoyedliver work, 23 often read up about biopsies, and 20 discussed them with theircolleagues. 18 would like to do liver CPD, 9 had done liver CPD in the last 3years. 5 would like to refer more biopsies centrally. Only one said they wouldprefer not to do any liver work.Conclusion: Liver biopsies account for 0.5% Yorkshire DGH histopathologyspecimens. The results support a more formalised network, supportingpathologists working with their local clinicians.P164Primary olfactory neuroblastoma of the oropharynx - Casereport of a unique pathological entityG Hutchins 1 , D Sutton 2 , D Martin-Hirsch 3 ,BEyden 4 ,P Robinson 5 , W Merchant 1 ,SEdward 11 Dept. Histopathology, Leeds Teaching Hospitals NHS Trust, Leeds, UK2 Dept. Oral and Maxillofacial Surgery, Bradford Teaching Hospitals NHSFoundation Trust, Bradford, UK, 3 Dept. Otolaryngology, BradfordTeaching Hosptials NHS Foundation NHS Trust, Bradford, UK, 4 Dept.Histopathology, Christie Hospital NHS Trust, Manchester, UK, 5 Dept.Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UKOlfactory neuroblastoma, also termed esthesioneuroblastoma, is a raremalignant tumour of neuroectodermal origin that arises from proginator cells ofthe olfactory neuroepithelium. Rarely, ectopic occurances have been reported inthe maxillary sinus, sphenoid sinus and pituitary gland. Here we present aunique case of olfactory neuroblastoma arising within the oropharynx of amiddle-aged patient.A middle-aged female presented with chronic throat pain. Clinicalexamination revealed a mass localised to the left palatine fossa withinvolvement of the adjacent soft palate. Computer tomography confirmed an illdefinedtumour of the left tonsillar bed with encroachment into adjacent tissues.The nasal cavity and paranasal sinuses appeared normal with no otherabnormality identified. Surgical resection followed, yielding a 2.5 cm irregulargrey / brown tumour.Histological analysis revealed a lobular tumour consisting of small cellspossessing scant cytoplasm. Marked nuclear atypia was noted in associationwith prominent nucleoli. Mitotic activity was brisk and necrosis was evident. Aneurofibrillary background was absent and rosettes were not identified.Immunohistochemistry revealed diffuse positivity of neuron specificenolase with focal positivity for synaptophysin. All other markers werenegative. Cytogenetic analysis highlighted losses at 1p36 and 11q23. NoEWSR1 gene rearrangements or MYCN amplifications were identified.Electron microscopy showed intra-cytoplasmic neurosecretory granules andconfirmed the presence of true epithelial desmosomes.The histological, cytogenetic and ultrastructural findings confirmed thediagnosis of high grade olfactory neuroblastoma. This represents the first caseof such an entity arising within palatine fossa of the oropharynx.P166Review of liver biopsies in a hepatology centre: how often andwhy is the diagnosis changed?JWyatt 11 Department of Histopathology St James University HospitalIntroduction: 160 liver biopsies/year are reviewed in Leeds.Aim: To determine the proportion of medical biopsies where review hadresulted in a change of diagnosis.Methods: Referral reports for 100 consecutive cases were reviewed.Inclusion criteria: Referred adult medical liver biopsies where originalpathology report available. Original diagnosis was compared retrospectivelywith centre histology report (JIW). Original clinical information in referredreport was noted, together with correspondence and CPC discussion. Casescategorised as major change in category (e.g. chronic hepatitis to chronic biliarydisease), minor change in interpretation within category (eg likely aetiology,change in stage, second diagnosis), or no change.Results: Major changes occured in 25% and minor change in 24% diagnoses. .Biliary disease accounted for 40% revised diagnoses.Conclusion: Review revised the diagnosis in 49% cases. Review usuallyincluded clinic-pathological discussion, and this study is not a direct audit ofthe initial diagnosis. The study highlights areas which should be targeted inliver histopathology CPD for non-specialist histopathologists.Main biopsy diagnosis(number of finaldiagnoses)Majorchange%of majorMinorchange%of minorNochangeAcute Hepatitis (13) 4 16% 2 8% 7Granulomatous (4) 0 0% 3 13% 1Normal/Non-Specific(8)3 12% 0 0% 5Biliary (32) 10 40% 10 42% 12Chronic Hepatitis (23) 1 4% 3 13% 19Fatty Liver Disease (16) 5 20% 5 21% 6Vascular Outflow (4) 2 8% 1 4% 1Total (100) 25 100% 24 100% 51Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme73