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Pre-conference Workshops will be held on Saturday, June 22:

 

Saturday June 22 Morning – 0830-1200

Saturday June 22 Afternoon – 1400-1730

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CONCURRENT MORNING WORKSHOPS

 

W2211 Histopathological Application of Staging and Grading Parameters in Medical Liver Diseases
Saturday June 22, 0830-1200

 

Oydele Adeyi, University of Toronto

Iram Siddiqui, University of Toronto

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Describe the importance of providing appropriate information to ordering clinicians on biopsies performed in the context of medical liver and chronic biliary diseases.
  • Utilize appropriate grading and staging parameters with emphasis on newer grading/staging systems.
  • Recognize some dilemmas of fibrosis staging and be aware of limitations.

Liver biopsies performed for various medical hepatic and chronic biliary diseases are done almost always with a view to resolve otherwise unanswered questions and/or as part of treatment guidelines. The ordering clinician sometimes has specific expectations, but which are not clearly expressed on the requisition. The pathologist on the other hand is able to recognize abnormalities and report them accurately. Unfortunately, accurate reporting of histopathological findings does not always, and frequently does not, translate to resolution of the clinician’s (often unexpressed) expectations. One of many areas identified in our practice accounting for this disconnection between clinician’s expectations and pathologist’s report is in the area of grading and staging of diseases. To the clinician the numbers attached to the grade or more importantly the stage of disease trigger series of responses on her/his part and are expected to correlate with disease-specific prognosis as well as inform an interventional approach, often in line with published guidelines. Therefore when appropriate disease-specific tools are not utilized to grade and stage an entity one or both of these expectations are either unfulfilled, or there could be a potentially harmful miscommunication of findings. This workshop is therefore designed to highlight the rationale behind many of the commonly used systems to grade and stage liver diseases. The importance of using disease appropriate staging system and language in reporting will be emphasized. Lastly common causes of false negative (under staging) or false positive (over staging) findings as they relate to fibrosis stage will be discussed.

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W2212 Well Differentiated Squamous Cell Carcinoma of the Upper Aerodigestive Tract – The Biopsy Challenge / Tumours of the Salivary Glands
Saturday June 22, 0830-1200

 

Olga Gologan, Centre hospitalier de l’Université de Montréal

Ilmo Leivo, University of Turku

Roderick Simpson, University of Calgary

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Summarize the morphological spectrum of the well differentiated squamous cell carcinoma.
  • List the differences between the H&N squamous cancer morphology and the “cervical model” of neoplastic progression.
  • Recognize the diagnostic pitfalls and the subtle morphological clues to the correct diagnosis and appreciate the importance of the clinical-pathological cooperation.
  • Develop an effective communication system between the pathologist and the clinical team – with emphasis on the diagnostic report.

This short course is designed as a practical and interactive case-based workshop focusing on commonly encountered problematic biopsies of papillary, verrucous and other well differentiated squamous cancers. Representative cases will be provided; their discussion will emphasize morphologic features, diagnostic criteria, differential diagnoses, ancillary studies where appropriate and current clinical implications and management. Reporting suggestions for difficult cases will be presented.

The course is ideal for practicing general surgical pathologists, surgical pathologists with a special interest in head and neck pathology, and pathologists-in-training.

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W2213 Practical Approach to Mismatch Repair Testing in the Gynecologic and Gastrointestinal Tract – Not Just a Hereditary Test Anymore!
Saturday June 22, 0830-1200

 

Lien Hoang, University of British Columbia

Mary Kinloch, University of Saskatchewan

David Schaeffer, University of British Columbia

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Define mismatch repair (MMR) testing in the setting of hereditary cancers and as a prognostic marker for treatment response in immunotherapy.
  • Evaluate different testing platforms and algorithms for MMR testing.
  • Breakdown the steps for analysis of MMR interpretation for GI and GYN tumours and examine cases with difficult MMR interpretation.
  • Develop quality assurance within MMR testing.
  • Formulate an interpretative comment for clinicians using.

This pre-conference session is a practical approach to Mismatch Repair (MMR) tumour testing in gastrointestinal and gynecologic tract. Through interactive, case-based discussions, this course will illustrate the evolution of MMR from a screening IHC for hereditary cancer syndromes into a diagnostic and therapeutic tool for personalized patient cancer care. The cases will focus on the most compelling clinical scenarios surrounding MMR use in daily surgical practice including; interpretive pitfalls, testing in recurrent and synchronous tumours, implications for immunotherapy and direction for the pathologist in multi-disciplinary tumour board rounds including how to handle requests for off-label testing. This comprehensive course is a survival guide for navigating MMR testing of tumours in the GI and GYN tract.

This course is intended for pathology residents, practicing pathologists including those with special interest in GI and GYN pathology.

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W2214 Diagnostic Challenges in Assessment of Gastro-Intestinal (GI) Lymphoid Proliferations
Saturday June 22, 0830-1200

 

Christopher Howlett, Western University

Nikhil Sangle, Western University

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Recognize the morphological spectrum of various lymphoid proliferations in the upper and lower GI tract.
  • Explain the immunophenotypic differences between reactive/benign and malignant lymphoid infiltrates.
  • Differentiate between clonal proliferations with limited malignant potential (so-called indolent lymphomas) versus aggressive lymphoid neoplasms.
  • Describe the utility of immunohistochemical, in-situ hybridization and molecular testing to establish the correct diagnosis.
  • Accurately classify the GI lymphoid proliferations as per the 2016 revision of the WHO classification.

Lymphoid proliferations in the upper and lower gastro-intestinal (GI) tract are commonly encountered in daily surgical pathology practice. Given the high volume of GI biopsies in any community or academic practice, it is imperative that a confident assessment of reactive versus malignant lymphoid infiltrate be made preferably on morphological examination. This can be challenging in some cases and ancillary studies such as immunohistochemical markers become imperative to make that distinction. Also, knowledge of normal lymphoid tissue at certain sites in the GI tract is essential in deciding whether additional work-up is required or not. Through this workshop, we intend to cover the whole spectrum of normal, reactive and malignant lymphoid proliferations in the upper and lower GI tract. We will be discussing individual cases and provide differential diagnoses and judicious use of immunohistochemistry in reaching the final diagnosis. We intend to use PowerPoint (ppt) slides for a case based workshop teaching; however, we would have the slides scanned and available for preview to the participants. This can count as self-assessment module for knowledge assessment contributing to section 3 of CPD activity for RCPSC MOC.

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W2215 Diagnostic Challenges in Breast Needle Core Biopsies, Radiologic-Pathologic Concordance and Pearls
Saturday June 22, 0830-1200

 

Anita Bane, McMaster University

Hala Faragalla, University of Toronto

Anna Marie Mulligan, University of Toronto

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Integrate imaging findings in everyday practice when reviewing breast core biopsies.
  • Recognize the important role of the pathologists in radiologic-pathologic correlations.
  • Identify the limitations of needle core biopsies in certain histologic entities.
  • Establish an approach to safely handle small specimens on core biopsies while effectively directing treatment.
  • Recommend quality assurance measures for breast core biopsies in the histology laboratory.

This workshop will be provided by three subspecialized breast pathologists. Breast needle core biopsy is the procedure of choice for targeting palpable and nonpalpable breast lesions including clusters of microcalcifications, spiculated masses, focal asymmetries, areas with architectural distortion and cystic lesions. Breast biopsies are based on and guided by abnormal imaging findings. Concordance is present when pathology findings provide an explanation for the imaging features.Pathologists are integral members of a multidisciplinary team and being involved in determining rad/path concordance is necessary.Several quality assurance studies have shown that active involvement of pathologists in correlating path findings to radiologic features is considered good clinical practice for providing better patient care.

This workshop will provide an introduction to imaging including the different imaging modalities used and their indications, it will also discuss the Breast Imaging Reporting and Data system categories, the BIRADS system used by radiologists in reporting imaging findings. It will also present the different types of biopsies used including the advantages and disadvantages of each. How to handle breast core biopsies in the lab including patient safety and quality assurance measures will be highlighted. The role of the pathologists in assessing biopsies performed for microcalcifications and for masses will be discussed.

For each category, multiple cases and imaging findings will be presented, the radiologic-pathologic concordance and its importance in everyday practice will be discussed. Besides highlighting the importance of radiologic/pathologic concordance, the most common problems encountered when assessing small amount of material on core biopsy and the limitations of core biopsy in certain entities will be highlighted.

Among the histologic entities that will be presented lobular neoplasia, flat epithelial atypia/ADH, ductal carcinoma in situ (DCIS), fibroepithelial lesions, several variants of invasive carcinoma among others.

The workshop will be divided into multiple talks including:

  1. Introduction to imaging: will discuss the different imaging modalities and the indications for each and will also discuss the BIRADS categories.
  2. Different types of biopsies and the advantages and disadvantage of each.
  3. Handling core needle biopsies in the histology laboratory: this talk will focus on handling breast biopsies in the lab and patient safety and quality assurance procedures.
  4. The role of the pathologists in assessing biopsies performed for microcalcifications: in this talk, several examples of core needle biopsies performed for benign and malignant microcalifications will be presented. For each case, the imaging features will be presented plus the histologic finding. The radiologic/pathologic concordance for each case presented will be discussed.
  5. The role of the pathologists in assessing mass lesions (benign and malignant): for this talk, imaging findings for both benign and malignant masses will be presented. For each case the radiologic findings and the histologic findings will be presented. The radiologic/pathologic concordance for each case will be discussed.

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CONCURRENT AFTERNOON WORKSHOPS

 

W2241 Recent Advances in Common Diagnostic Dilemmas in Uterine Pathology
Saturday June 22, 1400-1730

 

Blaise Clarke,

Blake Gilks, University of British Columbia; Vancouver General Hospital

Anna Plotkin, Trillium Health Partners

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Recognize and accurately classify recently described entities in uterine pathology.
  • Describe the management/therapeutic implications of rendered diagnoses.
  • Integrate appropriate immunohistochemical and molecular assays in assessment of endometrial pathology.
  • Recognize common iatrogenic artifacts to ensure accurate classification and staging of biopsy and resection specimens.
  • Assess precursor lesions of endometrial carcinoma and recognize mimics.

Histopathologic assessment is a critical determinant of the management of uterine disease. Despite this, numerous aspects of uterine histopathology have traditionally been limited by poor reproducibility even among experts. Recent advances in our molecular understanding have both refined morphologic criteria in uterine pathology and provided new assays allowing greater diagnostic accuracy.

We will use a case based approach to: review newly described entities; present refined morphologic criteria of established entities; and discuss the appropriate use of ancillary investigations to render accurate diagnosis. The cases will reflect contemporary practice and the course will enable pathologists to address common diagnostic dilemmas in uterine pathology.

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W2242 Precision Medicine in Urology: Where Does the Pathologist Fit In?
Saturday June 22, 1400-1730

 

Michelle Downes, University of Toronto

Manal Gabril, Western University

Madeline Moussa, Western University

George Yousef, University of Toronto

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Create a pattern-based approach to differentiate benign and malignant lesions in the prostate and bladder.
  • Explain how the subtypes/variants of bladder and prostate cancer can impact prognosis and what emerging biomarkers are relevant in these diseases.
  • Develop a diagnostic approach to the work up of renal neoplasms including integration of ancillary and molecular tests.
  • Describe false positive and false negative lesions in GU pathology and the role IHC can play in differential diagnosis.
  • Explain the role of pathologists in guiding the management of patients with urologic disease.

This high yield workshop will be led by five practicing urologic pathologists and will cover prostate, bladder and renal pathology in six separate lectures.

There will be three, morphology focused lectures which include images, to highlight the key features of different GU entities in prostate (false negative/positive lesions), bladder (benign mimickers of malignancy) and kidney (eosinophilic neoplasms). For each topic, index cases will be presented and discussed to enable attendees to navigate through the differential diagnosis. A major focus will be pattern recognition and the application of appropriate immunohistochemistry to differentiate mimickers of malignancy.

Each morphology talk will be paired with and followed by a lecture on an emerging relevant “hot” topic- active surveillance in prostate cancer, molecular bladder subtypes and subtyping papillary renal cell carcinomas. These have been chosen to reflect the important role pathologists can and will play in directing patient management through the integration of biomarkers and molecular data into the pathology report.

The in-conference polling app will be utilized to encourage audience participation and interaction.

This workshop is directed to anatomical pathologists, residents and fellows.

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W2243 Towards Increased Precision – Recent Developments in Renal Pathology
Saturday June 22, 1400-1730

 

Hallgrimur Benediktsson, University of Calgary

Laurette Geldenhuys, Dalhousie University

Michael Mengel, University of Alberta

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Recognize the fundamental pathomechanisms of rejection and the related pathology lesions.
  • Review recent developments in molecular transplant diagnostics.
  • Utilize a Transplant Pathology ‘Survival Guide’ for the Pathologist On Call.

Topics to be covered:

  • Brief overview of the main types of medical kidney disease.
  • Focus on some new developments in the diagnosis and management of medical kidney disease.
  • Membranous nephropathy.
  • C3 nephropathy.
  • Focal segmental glomerulosclerosis.
  • Renal disease associated with monoclonal immunoglobulins.
  • Amyloidosis.
  • Anti-GBM disease.
  • The critical role of pathology in managing renal transplant patients.

The workshop will focus on some of the areas where recent strides have been made towards a more personalized approach to management based on advanced diagnostics.

Target audience: All levels, from Residents to Community Practice or Academic Health Sciences pathologists.

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W2244 Pathology and Genetics of Syndromic Polyps and Carcinomas of the Gastrointestinal Tract
Saturday June 22, 1400-1730

 

Andrea Grin, Queen’s University

Andrea Guerin, Queen’s University

Corwyn Rowsell, St. Michael’s Hospital

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Recognize histologic findings suggestive of inherited gastrointestinal polyposis syndromes and describe common mimics.
  • Describe extra-intestinal manifestations of gastrointestinal polyposis syndromes.
  • Integrate relevant molecular testing and recognize limitations to testing.
  • Interpret mismatch repair protein analysis and describe diagnostic pitfalls and challenges.
  • Formulate clear, meaningful reports and comments that guide treating physicians and medical geneticists.

Gastrointestinal polyps and carcinomas are common lesions encountered by both academic and community pathologists. Most are sporadic but some may be associated with a hereditary syndrome. This workshop will focus on clues that may suggest a hereditary syndrome and consideration of referral to a medical geneticist. Additional clinical features and genetic testing that is available will also be addressed. This course will highlight the role that pathologists and medical geneticists play in the diagnosis and management of patients with inherited gastrointestinal syndromes.

Some topics to be addressed include:

  1. Hamartomatous polyps: Syndromic or sporadic? What are some clues suggestive of an inherited hamartomatous polyposis syndrome? What are common sporadic mimics?
  2. Beyond Familial Adenomatous Polyposis. What are other adenomatous syndromes to consider? What are some clues to diagnosis and what genes can be tested?
  3. Mismatch repair proteins and Lynch syndrome. Syndromic or sporadic? Is it Lynch or a Lynch-like syndrome? What are some challenges and pitfalls in MMR protein interpretation? When should BRAF immunohistochemistry be performed, and how is it interpreted?
  4. Just another hyperplastic polyp or serrated polyposis syndrome? What are the diagnostic criteria and clinical implications? What do we know about the genes involved?
  5. Reporting. When and how should I convey my suspicion of a polyposis syndrome in my report? What is the preferred terminology for reporting MMR immunohistochemistry? Interpretive comments – helpful or confusing?

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W2245 A Canadian Guideline on the Use of Next Generation Sequencing in Oncology
Saturday June 22, 1400-1730

 

Alan Spatz, McGill University

Stephen Yip, BC Cancer

 

Learning Objectives:

At the end of the session, the participants will be able to:

  • Apply methods related to the effective use of NGS in oncology.
  • Describe the limitations of NGS-based methodology in oncology.
  • Access resources to aid in the appropriate application of NGS-based results.
  • Apply methods to aid.

The workshop will be used to disseminate the Canadian next generation sequencing guidelines which are written by pathologists for oncologists. The abstract for the guidelines is attached below:

Rapid advancements in next generation sequencing (NGS) technology have created an unprecedented opportunity to decipher the molecular profile of tumors to more effectively prevent, diagnose, and treat cancer. Oncologists now have the option to order a number of molecular tests that can guide treatment decisions. However, to date, most oncologists have received limited training in genomics and are now faced with the challenge of understanding how these tests and their interpretation align with patient management.

Guidance on how to effectively use this technology is therefore needed to aid oncologists in applying the results of genomic tests. The following Canadian guideline presents best practices and unmet needs for the clinical application, assay and sample selection, bioinformatics and interpretation of reports performed by laboratories, patient communication, and clinical trials related to NGS-based testing for somatic variants in oncology.

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