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 Recent Developments in Diagnostic and Therapeutic Approaches to Breast Disease Carol Reynolds, M.D. and Daniel W. Visscher, M.D., Mayo Clinic, Rochester, MN This course will review the recent developments in diagnostic and therapeutic approaches to breast diseases in the context of specimens/diagnostic issues that are encountered frequently by both academic and community pathologists. The course will consist of two components and uses a case based approach. One component will focus on clinical issues and how they affect the pathologist's approach to the handling and evaluating tissue samples received in the surgical pathology laboratory. The second component will focus on critical review and concise summary of recent literature to form a solid foundation for use in daily surgical pathology practice as it relates to breast pathology. Topics will include: (1) sentinel lymph node biopsy, (2) Her2/neu, (3) assessment of surgical margins in breast conservation patients, (4) issues in breast core biopsies, and (5) classification of recent diagnostic entities. Friday Morning, March 10th The Rational Use of Molecular Studies in Leukemias and Lymphomas Adam Bagg, M.D., University of Pennsylvania, Philadelphia, PA and Daniel A. Arber, M.D., Stanford University, Stanford, CA Molecular studies are being increasingly used in the routine evaluation of all types of pathology specimens. This is best developed in the sphere of hematopathology, and this course will use leukemias and lymphomas as a paradigm to discuss their application in routine practice. The intent is not to comprehensively review all of neoplastic hematopathology and molecular pathology; thus, participants are expected to have some general knowledge in these areas. The course is intended primarily for general pathologists, as well as specialists and trainees. The specific educational objectives are to: (1) briefly overview the molecular pathology tools currently routinely used in hematopathology, highlighting their advantages and disadvantages; (2) summarize some of the biology underlying the molecular mechanisms of leukemia and lymphoma, and how this is then applied in practice; (3) provide a rational approach as to when to order molecular assays, using a case-study approach; (4) discuss the role of these studies not only in diagnosis, but also in prognosis and monitoring [minimal residual disease]; (5) illustrate the pitfalls, both technical and biologic, of molecular assays; (6) emphasize the need to integrate these data with other pathologic studies; and (7) provide a brief overview of the future of molecular diagnostics in hematopathology. Friday Afternoon, March 10th Choose Between: Problems in Soft Tissue Pathology: Pseudomalignant and Pseudobenign Tumors and Tumor-Like Lesions Andrew L. Folpe, M.D., Emory University, Atlanta, GA and John R. Goldblum, M.D., Cleveland Clinic, Cleveland, OH Most surgical pathologists consider the diagnosis of soft tissue neoplasms to be particularly challenging, owing to their relative rarity, their protean appearances and the multiplicity of entities in this field. These difficulties are compounded by the well-known ability of benign soft tissue tumors to mimic sarcomas, and vice versa. Indeed, unlike in most epithelial tissues, which present well-defined tissue compartments and have clear-cut criteria for malignancy, many soft tissue lesions leave even experienced pathologists with such fundamental questions as: "Is this benign? Is this malignant? How can I be sure?" This course will concentrate on the histopathological diagnosis of a group of both benign and reactive soft tissue lesions that may be mistaken for sarcomas, and on a smaller group of sarcomas that by virtue of their deceptively bland histologic features may be mistaken for benign tumors or pseudotumors. Both well-established and newer entities in soft tissue pathology will be discussed. Although the principal focus of this course is on the diagnosis of these various tumors by traditional morphological methods, the use of ancillary techniques such as immunohistochemistry will also be covered in detail, including ways in which such techniques may be of assistance, and their potential pitfalls. This course will utilize a case study format and is appropriate for senior level residents, fellows and practicing general surgical pathologists. OR Tumors in the Liver: Diagnostic Problems Linda D. Ferrell, M.D., University of California, San Francisco, CA and Wendy L. Frankel, M.D., Ohio State University, Columbus, OH This course will use a case oriented approach to illustrate diagnostic problems in tumors in the liver. Six main areas will be discussed using 12 illustrative cases. The topics will include hepatocellular tumors in the cirrhotic and non-cirrhotic liver, the distinction between hepatocellular carcinoma and adenocarcinoma, bile duct lesions, spindle cell tumors, and tumors in the pediatric age group. The differential diagnosis will be presented for each case and other examples from the differential will be compared and contrasted with key diagnostic features summarized. The hepatocellular lesions will include benign masses, borderline nodules, and hepatocellular carcinoma. The clinically important issue of distinguishing hepatocellular carcinoma from metastatic adenocarcinoma and clear cell carcinoma will be addressed. The discussion of spindle cell tumors will include primary and metastatic lesions and include vascular and stromal tumors. The usefulness of immunohistochemistry will be emphasized and updated to include recent developments. Bile duct lesions will be addressed and will include the problems in distinguishing adenomas from hamartomas and from adenocarcinomas. Intraductal and cystic masses will be covered. Finally problems in neoplasms in the pediatric age group will be addressed. The course will be directed at general surgical pathologists and residents in pathology. Saturday Morning, March 11th Choose Between: Practical Issues in Endocrine Pathology Sylvia L. Asa, M.D., Ph.D., University Health Network, University of Toronto, Toronto, ON and Virginia A. LiVolsi, M.D., University of Pennsylvania, Philadelphia, PA Endocrine disorders are complex lesions that require interpretation of both structure and function of the tissue. The limitations of morphological evaluation are complicated by the additional lack of hard criteria for many pathological entities, and by the often subtle alterations that can mislead the pathologist. This course will offer practical hints that will aid in the diagnosis of endocrine cytology, intraoperative consultations, as well as histology, with conventional histopathology and immunohistochemical tools. In addition, the course will offer a practical approach to deal with several unresolved issues, such as the distinction between endocrine hyperplasias and neoplasms, and criteria for malignancy in tissues that are notorious for their ability to camouflage malignancy. Using a case study approach, the course will address the following 7 areas of interest: 1) the value and limitations of aspiration cytology of endocrine tissues; 2) the role of intraoperative consultations, with frozen sections and cytologic touch preparations; 3) the criteria for and significance of distinguishing endocrine hyperplasia from neoplasia; 4) definitions of capsules and capsular invasion as a criterion of malignancy in endocrine tumors; 5) the significance of mitoses, nuclear atypia, necrosis and ploidy alterations in endocrine tumors; 6) the definition and significance of oncocytic change in endocrine cells and tumors; and 7) the numerous histochemical and immunohistochemical markers of cell differentiation, function and behavior in endocrine lesions. OR Diagnostic Immunohistochemistry: Application in Gynecologic Pathology Robert A. Soslow, M.D., Memorial Sloan-Kettering Cancer Center, New York, NY and Christina Isacson, M.D., Virginia Mason Medical Center, Seattle, WA This course will discuss the use of immunohistochemistry as an adjunct to histologic evaluation in female genital tract pathology. The differential diagnosis of common and difficult gynecologic lesions will be organized by site to include: pagetoid lesions of the vulva; squamous intraepithelial lesions of the lower genital tract; cervical and endometrial adenocarcinomas; atypical endometrial surface proliferations; stromal tumors versus smooth muscle tumors of the uterus; uterine sarcomas; ovarian carcinoma versus mesothelioma; ovarian surface-epithelial tumors versus metastatic lesions; ovarian surface-epithelial tumors versus sex cord-stromal and germ cell tumors; and the differential diagnosis of ovarian small round cell tumors. Trainees and general pathologists will benefit most from this course. Educational objectives include understanding the applications and limitations of immunohistochemistry in diagnostic gynecologic pathology. More specifically, we anticipate that the participants will be able to effectively use the following antibodies in narrowing the differential diagnosis of the entities listed above: Ki-67, ER, PR, p53, desmin, CD10, h-caldesmon, inhibin, hPL, hCG, AFP, CD117, calretinin, cytokeratins 5/6, 7, and 20, S100, HMB45, Melan-A, TTF-1, EMA, CD45, and CD30. Sunday Morning, March 12th Non-Neoplastic Disorders of the Intestines Laura W. Lamps, M.D., University of Arkansas for Medical Sciences, Little Rock, AR, Audrey J. Lazenby, M.D., University of Alabama School of Medicine, Birmingham, AL and Joel K. Greenson, M.D., University of Michigan Hospitals, Ann Arbor, MI Non-neoplastic gastrointestinal diseases constitute a major component of the workload for the general surgical pathologist. Many new and variant forms of inflammatory bowel disease have been described in recent years; several of these enter the differential diagnosis of chronic idiopathic inflammatory bowel disease (Crohn's disease and ulcerative colitis). The primary objectives of this course are to present an update and review of the "atypical" colitides (including collagenous colitis, lymphocytic colitis, and diversion colitis), prolapse injury, drug-related and iatrogenic enterocolitides, ischemic enterocolitis, and selected infectious enterocolitides. New patterns and controversies in ulcerative colitis and Crohn's disease will also be covered. The discussion will include histologic criteria as well as clinicopathologic and endoscopic correlates, new diagnostic techniques, and reporting issues. This course is intended primarily for practicing general surgical pathologists and residents in training with an interest in non-neoplastic disorders of the intestines.
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