Short Course 02: Mesenchymal Tumors of the Gastrointestinal Tract: A Practical Approach to Avoid Going Down the Tubes

Course Description

Mesenchymal tumors of the gastrointestinal tract and liver are challenging to diagnose because of significant morphologic overlap among tumor types and the difficulty of obtaining large biopsy samples. Through our exposure to a high volume of external consultation material, we have learned of practice gaps in both the diagnosis of mesenchymal tumors and the judicious application of immunohistochemistry. This course will provide a practical approach to diagnosing gastrointestinal mesenchymal neoplasms, with an emphasis on diagnostic pitfalls and the appropriate use of immunohistochemistry.

Learning Objectives:

1. To generate an appropriate differential diagnosis for spindle cell, epithelioid, and biphasic mesenchymal neoplasms of the luminal gastrointestinal tract.
2. To apply immunohistochemistry to reach a specific diagnosis for mesenchymal tumors of the luminal gastrointestinal tract.
3. To recognize the key histologic features of vascular and other mesenchymal neoplasms of the liver.

Short Course 06: Refining the Diagnosis of Vascular Anomalies: Tumors, Malformations, and Others

Course Description

The diagnosis of vascular anomalies is often challenging. Much confusion has arisen in the literature regarding the nomenclature of vascular lesions. Moreover, these entities are more frequently encountered in large pediatric hospitals; therefore, the diagnosis is especially challenging for the general pathologists. In recent years, many developments have occurred in the field of vascular anomalies, including their histopathology and molecular pathology. The most significant development was the adoption of the Mulliken and Glowacki’s proposal of subgrouping vascular anomalies into tumors and malformations by the International Society for the Study of Vascular Anomalies (ISSVA) in 1996. The ISSVA classification was most recently updated in 2018. The classification schemes provide a consistent terminology and serve as a guide for pathologists, clinicians, and researchers. This course is aim to help participants understanding the classification through case-based approach. During the course cases of vascular tumors (infantile hemangioma, congenital hemangioma, tufted angioma, Kaposiform hemangioendothelioma, and angiosarcoma) and malformation (venous malformation, lymphatic malformations, and arteriovenous malformation) will be discussed. The utilities of special stains, immunohistochemistry, and molecular testing for different vascular lesions will be discussed.

Learning Objectives:

1. Recognize the histologic features of commonly encountered vascular anomalies in the pediatric population (e.g. infantile hemangioma, congenital hemangioma, tufted angioma, Kaposiform hemangioendothelioma, PTEN hamartoma of soft tissue, and fibroadipose vascular anomaly).
2. Integrate the clinical and imaging features in rendering the diagnosis of vascular tumors and malformations.
3. Describe the key diagnostic and therapeutic molecular alterations of vascular anomalies in the pediatric population.
4. Discuss a cost-effective approach to the immunohistochemical and molecular genetic workup of these vascular lesions

Short Course 09: Heme Intruders in the Breast: Reactive, Inflammatory and Neoplastic Hematolymphoid Lesions of the Breast

Course Description

Historical experience and the surgical pathology literature gives great emphasis to evaluation of epithelial lesions of the breast.  However, inflammatory and hematolymphoid lesions are less commonly encountered conditions in the breast and often prove problematic to the practicing pathologist. This course will provide a comprehensive review of inflammatory and hematolymphoid lesions of the breast covering manifestations of, and diagnostic criteria for, autoimmune entities, granulomatous mastitis, IgG4 related sclerosing disease, Rosai-Dorfman disease, and primary breast lymphoma, with emphasis on (breast implant associated) BIA-ALCL.

Learning Objectives:

1. Recognize breast autoimmune inflammatory conditions (diabetic mastopathy, lupus mastitis, vasculitis)
2. Discriminate variants of granulomatous mastitis and understand current theories on pathogenesis of the cystic neutrophilic variant
3. Develop a differential diagnosis to approach dense breast lymphoid infiltrates; apply and interpret appropriate ancillary studies
4. Understand epidemiology, pathogenesis, diagnostic criteria, and specimen handling of suspected BIA-ALCL

Short Course 16: Pathology Perspectives of High Risk Breast Lesions

Course Description
The short course will provide a comprehensive overview of the clinical, imaging and pathology findings of high risk breast lesions with useful tips for reporting in routine surgical pathology practice. The clinical history, imaging findings and whole slide images of the high risk lesions will be provided ahead of the course. A handout incorporating the teaching points of each lesion will also be made available ahead of the session. The different types of high risk lesions that will be discussed will include flat epithelial atypia (FEA), atypical ductal hyperplasia (ADH), lobular neoplasia including atypical lobular hyperplasia and lobular carcinoma in situ, radial scar, Intraductal papilloma and mucocele-like lesion. The course will focus on morphological features of each entity, the value of radiology-pathology correlation and implications of the pathology diagnosis towards clinical management of the patient. The participants should become familiar with the current understanding of the pathology perspectives of these lesions after taking the course. The course will be presented in four sessions with time allotted for question and answer at the end of each session ; session 1 (25 min) will cover FEA and ADH ; session 2 will cover lobular neoplasia and radial scar (25 min); Break of 10 minutes; session 3 will cover (20 min) papillary lesions; session 4 (10 min) mucocele-like lesions.

Learning Objectives:

1. Recognize the morphological spectrum of changes in different types of high risk breast lesions on core biopsy.
2. Become familiar with the current understanding of the risk implied and management strategies that are dependent on the pathologic diagnosis.
3. Recognize the value of  Radiology-Pathology correlation and effort of a multidisciplinary team for personalized management of the patient based on clinical, imaging and pathologic diagnosis.

Short Course 79: Cardiovascular Pathology for the Surgical Pathologist

Course Description

Surgical pathologists in general practice may encounter a wide variety of cardiovascular specimens, including endomyocardial biopsies, heart valves, temporal artery biopsies, and aortic aneurysm resections. This case-based short course will close any knowledge gaps regarding the handling and diagnosis of common cardiovascular specimens. The Society for Cardiovascular Pathology (SCVP) and the Association for European Cardiovascular Pathology (AECVP) official recommendations for the handling and grossing of cardiovascular surgical specimens will be reviewed. The differential diagnoses and common pitfalls for each case will be emphasized. Topics that will be covered include the evaluation of native and prosthetic heart valves, native endomyocardial biopsies, aortic root resections, and temporal artery biopsies. These categories cover the specimens most likely to be encountered by the general pathologist, and will increase the practitioner’s competency and confidence.

Learning Objectives:

1. Discuss the clinical entities and differential diagnosis for which endomyocardial biopsy is commonly requested, and how to triage tissue appropriately for ancillary studies.
2. Describe common degenerative changes of heart valves, both native and prosthetic, and identify potential “red flags” for endocarditis on gross examination.
3. Explain the significance of common histologic findings in aortic root resection specimens.
4. Efficiently evaluate temporal artery biopsy specimens for signs of active or healed arteritis.

Short Course 17: Cytology and Histology of HPV-Associated Endocervical Glandular Lesions: What’s new?

Course Description

In recent years there has been vast change in the field of cervical pathology, most notably in the classification and approach to cervical glandular lesions. Simultaneously, cervical screening programs in developed nations have undergone major renewal, with transition to more sensitive HPV-based primary screening. The rate of change has been rapid, exposing pathologists to potential knowledge gaps. In this short course, through a series of case-based discussions, many of the key changes in reporting these lesions will be addressed. The cases shown will illustrate the morphological spectrum of HPV-associated endocervical glandular lesions, both on cytology and histology, and address many of the diagnostic dilemmas faced daily when signing out liquid-based cytology, small biopsies of the cervix and therapeutic excisions.

Learning Objectives:

1. Recognize and apply new classification schemes for neoplastic and pre-neoplastic endocervical glandular lesions on cytology and histology, including newly described entities.
2. Integrate ancillary diagnostic testing appropriately to maximize patient outcomes.
3. Apply the Silva pattern-based classification system when reporting endocervical adenocarcinomas and understand the clinical ramifications of this system.

Short Course 21: Children and Cytological Classification Systems: Challenging and Complicated Pediatric Cytology Cases & How to Classify Them by Current Reporting Systems (Bethesda, Milan, and More)

Course Description

In the past decade, multiple evidence-based diagnostic classification systems for reporting FNA cytopathology have been developed to standardize terminology and aid in presurgical risk stratification. Most of the studies concerning these systems are case series of adult patients, although these systems are intended for both adult and pediatric patients. In addition, unique clinical and pathologic features exist for some pediatric entities that can be challenging for cytopathologists who do not deal with such lesions in children on a regular basis. This course aims to introduce participants to the diagnostic utility of different classification systems (such as thyroid, salivary gland and pancreatobiliary cytology) for the pediatric population. Participants will also learn about the unique and challenging entities in children, with emphasis on developmental or genetic/familial conditions to be aware of, and become competent when reporting FNA cytopathology of these lesions.

Learning Objectives:

1. Discuss the value of applying the various classification systems to pediatric populations
2. Describe the differences between pediatric and adult thyroid, salivary gland, and pancreatobiliary lesions
3. Recognize the cytopathologic features of unique (common and uncommon) pediatric lesions that are rarely encountered in adults
4. Discuss the corresponding risk of neoplasm or malignancy with clinicians when utilizing these classification systems in pediatric biopsies

Short Course 22: Melanocytic Dermatopathology: Common Problems and Pitfalls and How to Avoid Them

Course Description

The aim of this course is to describe the histopathologic features of a spectrum of melanocytic tumors from nevi to melanomas with a focus on those entities that create challenges in diagnosis and / or have significant clinical implications. The course will provide a practical approach to common issues encountered in diagnosing melanocytic lesions. The audience will be presented with the salient features of each entity, a choice of relevant ancillary tests and with tips to avoid misdiagnosis. The session will be structured as a case-based presentation. Each entity will be introduced with a real case from the presenter’s experience. The course will also discuss practical applications of molecular testing in the diagnosis of melanocytic tumors and advances in the classification of melanocytic tumors.

Learning Objectives:

1. Describe the main diagnostic pitfalls associated with the diagnosis of melanocytic tumors
2. Recognize the morphologic spectrum of melanocytic tumors
3. Identify subtle histological features that are useful in diagnosing melanocytic tumors
4. Determine appropriate immunohistochemical markers that are useful in the diagnosis of melanocytic tumors
5. Describe the recent advances in the molecular biology of melanocytic tumors and apply that knowledge in routine practice
6. Describe recent changes in the classification of melanocytic tumors

Short Course 29: Coaching in Pathology: Shifting Your Role as an Educator and Providing Constructive, Actionable Feedback

Course Description

“Just keep reading.”

Who among us has not either given or received that feedback?

Studies have shown that up to an abysmal ~90% of written evaluations during residency training lack useful recommendations for areas of improvement, despite a vast majority of both teachers and learners having identified feedback as a crucial component in preparing trainees for independent practice. We can do better!

As post-graduate pathology education in North America shifts to a competency-based framework under both the ACGME in the US and RCPSC in Canada, the educator’s role is also shifting. More frequent (often daily) opportunities for assessment and evaluation of students and residents may leave educators feeling both burnt out and at a loss for how to provide useful support and feedback day after day. This workshop is designed to help educators navigate their new role as coaches and close the feedback gap by helping them to develop a skillset for providing support, guidance, and specific, actionable feedback for learners at every stage of training. In addition, while this course is primarily designed for pathologists and trainees working in an academic setting, the concepts are also readily transferable to leadership positions and other mentorship roles.

This short course will be conducted in an unconventional, predominantly non-lecture format, focusing on group discussion and collaborative learning activities. Jointly led by Drs. Marcio Gomes and Ashley Flaman, we hope to engage in an exchange of ideas among participants and all walk away with new coaching strategies and a framework for providing daily written and/or verbal feedback beyond “pleasant to work with!” and “just keep reading”. 

Learning Objectives:

1. Compare and contrast formative versus summative assessment.
2. Apply principles of coaching to workplace-based education.
3. Provide feedback that is timely, actionable, and behavior-based in both verbal and written form.

Short Course 36: The Ethical Pathologist

Course Description

Pathologists, like all physicians, are held to high ethical and professional standards by medical accreditation, licensing boards, and patients. However, the context of medical practice often differs from that of other physicians and ethical dilemmas can be difficult to navigate. This course will present some common and emerging ethical issues that arise in both anatomic and clinical pathology using an interactive and case-based approach. Topics will include genetic testing, blood product utilization, social media, and research ethics.

Learning Objectives:

1. Become aware that ethical issues are present in pathology practice
2. Implement an ethical framework to a value-based problem in pathology and research practice
3. Develop skills in using ethical reasoning as a means to solve value-based issues in pathology
4. Demonstrate how ethical principles can be used when posting pathology images on social media

Short Course 44: Challenging Follicular-Patterned Thyroid Neoplasms: To Cancer or Not To Cancer

Course Description

Our understanding of the molecular basis of thyroid neoplasia took a major shift in 2014 following the publication from The Cancer Genome Atlas on papillary thyroid carcinoma, revealing these tumors to be largely binary, either RAS-like or BRAF-V600E-like. Further, additional study via an Endocrine Pathology Society task force led to the uncoupling of the Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP), a RAS-like entity, from carcinoma. Clinicopathologic and molecular studies, including those on kinase fusion-related carcinomas, paired with therapeutic de-escalation advocated for by the American Thyroid Association, have changed our diagnostic approach to thyroid carcinomas. In light of an increased focus on molecular testing, both on aspiration biopsies (via commercial assays) and surgical specimens, pathologists are in the best position to direct diagnosis and treatment for patients presenting with follicular-patterned thyroid nodules, as well as those with advanced thyroid cancers eligible for targeted therapy. This course will place pathologist learners in the best position for identifying low-risk and high-risk neoplasms and how to direct clinical colleagues for next best steps.

Learning Objectives:

1. Identify common problems, pitfalls, and diagnostic dilemmas in follicular thyroid neoplasms.
2. Recognize diagnostic H&E features of NIFTP in comparison to papillary thyroid carcinoma and apply ancillary techniques for diagnosis if necessary. Understand differences in the molecular underpinnings of NIFTP versus classic papillary thyroid carcinoma, as well as which mutations/fusions are clinically actionable.
3. Define capsular and vascular invasion in follicular thyroid neoplasms, define subtypes of follicular thyroid carcinoma, and recognize pseudo-invasion in comparison to true invasion on H&E slides.
4. Know diagnostic features of poorly differentiated thyroid carcinoma (both Turin and MSK criteria) in comparison to well-differentiated carcinoma. Describe molecular features that may increase suspicion for aggressive behavior.

Short Course 49: Diagnostic Approach to Aggressive Variants of Follicular Cell-Derived Thyroid Cancer

Learning Objectives:

1. To examine the 2022 WHO Classification of Tumours of Endocrine Organs, highlighting the emerging concept of high-grade differentiated thyroid carcinoma
2. To recognize diagnostic features poorly differentiated thyroid carcinoma and appreciate its morphological spectrum
3. To formulate a practical immunohistochemical approach for the diagnosis anaplastic thyroid carcinoma
4. To comprehend the diagnostic and therapeutic implications of biomarker testing in advanced and aggressive widely thyroid carcinoma

Short Course 53: Pearls in the Diagnosis of GI Tract Infections: A Whirlwind Tour From Amoeba to Whipworm

Course Description

Given the variable and often less recognized morphologic features that certain gastrointestinal (GI) tract infections may present with, this lecture-based course will present illustrative patient cases (biopsies and resections) that review pertinent histopathologic findings, helpful ancillary studies, as well as the list of differential diagnoses that should be evaluated in each context. Patterns of injury examined will include co-infections, epithelial vs. non-epithelial (luminal or lamina propria) infections, intraepithelial lymphocytosis, near-normal appearance, inflammatory bowel disease mimics, pseudomembranes, parasites, autoimmunity and others. Useful take-home points will be presented throughout the course, particularly in the context of clinical presentation as well as in terms of the importance of conveying appropriate information to the submitting clinician.

Learning Objectives:

1. Recognize and diagnose the most common and important GI tract infections in pathology specimens with the help of correct and efficient usage of special stains and immunohistochemistry.
2. Approach GI tract pathology specimens in a detailed, algorithmic, and comprehensive manner and develop a differential diagnosis based on location, clinical context, and histological appearance.
3. Discuss various histopathological patterns of injury in the GI tract and recognize their clinical significance as well as recognize the importance of accurate and prompt disclosure of pertinent and critical pathologic findings to clinicians.

Short Course 56: Non-Conventional Dysplastic Lesions of the Upper and Lower Gastrointestinal Tract: A Review of Their Morphologic, Clinicopathologic, and Molecular Characteristics

Course Description

Although morphologic criteria of adenomatous/conventional dysplasia have been widely disseminated and universally accepted, the same is not true for several morphologic patterns of non-conventional dysplasia occurring throughout the gastrointestinal (GI) tract.  Pathologists may have difficulty identifying these rare dysplastic subtypes due to their uncommon nature and thus, may even overlook some of these dysplastic lesions as benign or reactive.  This course will cover the latest updates on the diagnostic criteria as well as clinicopathologic, immunohistochemical, and molecular information regarding non-conventional dysplastic subtypes in the upper and lower GI tract.  The upper GI entities covered will include: (1) esophageal foveolar, serrated, and basal crypt Dysplasias; (2) gastric foveolar, serrated, and pit Dysplasias as well as pyloric gland and oxyntic gland adenomas; and (3) duodenal pyloric gland adenoma.  The course will also cover recently described non-conventional dysplastic subtypes occurring in inflammatory bowel disease (IBD), including hyper mucinous dysplasia, crypt cell dysplasia, goblet cell deficient dysplasia, dysplasia with increased Paneth cell differentiation, traditional serrated adenoma-like dysplasia, sessile serrated lesion-like dysplasia, and serrated dysplasia, not otherwise specified.  Key differentiating features from adenomatous/conventional dysplasia will be presented.  In addition to their diagnostic criteria, the potential clinical significance of serrated epithelial change in IBD will also be reviewed.  The target audience is any pathologist (in-training or practicing) responsible for evaluating tubular GI pathology specimens for potential dysplasia.  Both practicing pathologists and residents will benefit by developing a categorical approach to the recognition of a variety of precancerous lesions. 

Learning Objectives:

1. Know and recognize the morphologic criteria of non-conventional dysplastic subtypes in the upper GI tract.  
2. Know and recognize the morphologic criteria of non-conventional dysplastic subtypes and serrated epithelial change in IBD. 
3. Know, appreciate, and apply the clinicopathologic, immunohistochemical, and molecular features of non-conventional dysplastic subtypes that can assist in the diagnosis, risk stratification, and clinical management.

Short Course 57: Misses and Misinterpretations in Gastrointestinal Pathology: Learning from Mistakes

Course Description

Errors including interpretive diagnostic errors are an inevitable part of both graduate training and Pathology practice which may have a negative impact not only on patient care but as well on the psychologic well-being of the Pathologist. Creating a safe culture to enable open conversations and discussions of these errors is extremely important for quality improvement, patient safety, continued learning, professional development and physician well-being. 

This short course will focus on actual Gastrointestinal (GI) interpretation errors discussed in a case based scenario with discussion of the actual case, followed by clinical impact and cause analyses and will provide suggestions for implementing evidence-based safe practices to prevent them in future. Each case will narrate “what went wrong” and “what could be done to prevent it in future.” By approaching these difficult conversations from a systems based manner rather than one casting “blame” on an individual, we will illustrate methods to create a supportive and safe culture to learn and problem solve.  We will discuss how to assess and handle the actual or possible impact of these errors on patient treatment and management. Importantly, we will offer effective strategies for the Pathologists in maintaining their well-being coping with errors. Effective communication skills with the entire health care team will be emphasized.

The strength and a unique aspect of this course is that we will share our experiences and insights of handling and dealing with errors and near misses in the GI subspecialty. Through this platform, we will highlight how creating a culture of supportive, safe and open discussions including effective communication can serve to not only mitigate errors through learning but also lead to increased comradery and well-being.

We are confident that this course will be beneficial to all the surgical pathologists who encounter GI specimens, irrespective of the level of training, practice setting and years of experience.

Learning Objectives:

1. Learn specifics of GI interpretation errors in surgical pathology from actual case based scenarios, discuss potential pitfalls, assess and handle actual or possible adverse patient consequences.
2. Become aware of methods to build a safe and supportive culture for difficult conversations around errors and near misses.
3. Develop skills to effectively handle the emotional challenges of making errors.

Short Course 51: Don’t Fall Through the Ice: Pitfalls and Pearls in Frozen Section Pathology

Course Description

This case-based course will cover a variety of challenging cases that a pathologist may encounter at frozen section. The role of the pathologist in guiding surgical management in these cases will be discussed, including communication with surgeons regarding difficult frozen sections in a way that still provides relevant information for intraoperative management. Particular emphasis will be placed on potential pitfalls that can lead to overcalls or undercalls. 

Learning Objectives:

1. Understand sampling of tissue and technical aspects required to best prepare quality slides for frozen section interpretation.
2. Discuss various surgical situations where frozen section is useful in management, and be aware of common challenges pathologists may encounter in these settings.
3. Identify common pitfalls encountered at frozen section across a variety of organ systems
4. Successfully report diagnoses to the surgeon and communicate relevant information and uncertainty with the clinician as necessary.

Short Course 59: Unusual Tumors of the Testis: Beyond the Typical Germ Cell Tumors of the Post-Pubertal Male

Course Description

Surgical pathologists review testicular neoplasms, but often find them to be challenging due to the infrequent nature of these tumors, as well as the ever-changing subtle histologic distinctions and pathologic classifications, particularly in the framework of the new 2022 World Health Organization classification of male genital tumours. In the testis, tumors of germ cell origin in post-pubertal males are by far the most frequent, and most continuing medical education pathology courses concentrate on this category. Therefore, using a case-based approach, we will provide examples of unusual testicular tumors, outside of the usual spectrum of germ cell tumors of the post-pubertal male with a focus on the changes in nomenclature/definitions and diagnostic criteria for each entity, including the use of ancillary testing, particularly immunohistochemistry and molecular biomarkers, and also focus on potential pitfalls in diagnosis. 

Learning Objectives:

1. Understand important clues to avoid diagnostic pitfalls in the evaluation of these uncommon testicular neoplasms.
2. Effectively utilize clinicopathological correlation and ancillary molecular and immunohistochemical studies in evaluating unusual tumors of the testis.
3. Improve diagnostic accuracy and nomenclature for guiding timely and appropriate therapy.

Short Course 69: Embracing Diversity in Bladder Cancer: What You Need to Know About Variants in Urothelial Carcinoma

Course Description

This course will cover the spectrum of histologic diversity in urothelial carcinoma with a focus on histologic subtypes and divergent differentiation. Representative cases will be utilized to show morphologic patterns to recognize, establish appropriate ancillary workups, discuss diagnostic pitfalls and ultimately create the most accurate report for the clinician and patient. H&E and immunohistochemistry from selected challenging histologic patterns will provide the foundation for discussion of diagnostic criteria, potential pitfalls and the impact on clinical decision making in patients. The course will include updates from the latest WHO classification regarding subtypes and divergence. 

Learning Objectives:

1. Define histologic subtype and divergent differentiation in urothelial carcinoma and recommendations for reporting according to the latest WHO classification
2. Identify and describe key subtypes of urothelial carcinoma and divergent differentiation, along with their potential diagnostic pitfalls and differential diagnosis
3. Demonstrate the prognostic significance and therapeutic implications of subtypes and divergent differentiation

Short Course 70: Non-Epithelial Ovarian Tumors: Contemporary Strategies for Common Dilemmas in Diagnosis and Reporting

Course Description

Accurate classification of non-epithelial ovarian tumors (germ cell tumors and sex cord-stromal tumors) is essential for clinical management, prognostication, and risk assessment for hereditary syndromes. However, these tumors may pose diagnostic challenges because many are uncommon and many may mimic a wide variety of benign and malignant tumors not only within the germ cell and sex cord-stromal tumor families, but also with benign and malignant tumors of epithelial, mesenchymal, and other cell types. This course will provide practical strategies for navigating the differential diagnosis of the more commonly encountered non-epithelial ovarian tumors, for selecting and interpreting appropriate immunohistochemical stains, and for determining when molecular testing is of value. The course will also highlight the prognostic variables and indicators of increased risk for a hereditary syndrome that merit documentation in the pathology report. Throughout the course, key updates from the recently published 5^th edition of the World Health Organization Classification of Female Genital Tumors will be integrated into the discussion.

Learning Objectives:

1. Apply the essential criteria to classify non-epithelial ovarian tumors and, when appropriate, to assign a prognostic grouping.
2. Select and interpret the most useful diagnostic immunohistochemical stains and molecular tests.
3. Navigate common diagnostic pitfalls in the differential diagnosis.
4. Recognize non-epithelial ovarian tumors that merit reporting a potential association with a hereditary syndrome.

Short Course 71: Don’t Get Stuck in the Muck – Navigating the Murky World of Mucinous Proliferations Involving the Gynecologic Tract

Course Description

Mucinous lesions are routinely encountered in gynecologic pathology and may be identified in the endometrium, cervix, ovary, or fallopian tube and include a wide range of diagnostic entities ranging from benign reactive proliferations to aggressive malignancies. Mucinous proliferations can be very challenging to classify, particularly when encountered in small biopsies but also in large specimens, as they may lack overt malignant features and/or cytologic atypia. This short course is designed for surgical pathologists and will use a case-based approach to provide a framework for classifying mucinous proliferations involving the gynecologic tract. We will emphasize the morphologic clues and adjunct immunohistochemical or molecular results that may be useful in their classification and implications for patient management as highlighted below.

• Be aware that bland superficial and limited mucinous proliferations in the endometrium may be neoplastic and highlight the utility and pitfalls of immunohistochemical stains in their classification.
• Be aware that gastric type mucinous lesions can involve the endometrium and cervix and develop an approach to their classification in small biopsy specimens.
• Outline the criteria to diagnose SMILE (stratified mucin producing intraepithelial lesions) and invasive SMILE of the cervix.
• Be aware that metastatic mucinous tumors to the ovary can resemble borderline tumors or even cystadenomas and understand the key gross, morphologic, and immunophenotypic characteristics of primary versus metastatic mucinous tumors involving the ovary.
• Be aware that mucinous tumors may arise in the setting of ovarian teratomas and characterize the typical morphologic and immunophenotypic findings of these tumors.

Learning Objectives:

1. Understand the differential diagnosis for mucinous glandular proliferations encountered in endometrial biopsies and recognize the clinical, morphologic, and immunophenotypic characteristics most helpful for further classification.
2. Classify mucinous glandular proliferations of the endocervix using the new pathogenesis-based classification scheme for endocervical adenocarcinomas, including the HPV-independent gastric type adenocarcinoma and HPV-associated invasive SMILE of the cervix and associated precursor/pre-malignant lesions.
3. Integrate gross pathologic, histologic, immunohistochemical, and molecular techniques to accurately classify mucinous neoplasms involving the ovary.

Short Course 72: Updates in Low-Grade Serous Neoplasia: Navigating Challenges in Diagnosis and Classification With an Eye to Clinical Management

Course Description

Numerous problems currently confront the proper pathologic diagnosis of low-grade serous neoplasia. Although diagnostic framework for low-grade serous neoplasia is complex, the literature supports distinct management algorithms and varying clinical outcomes for the spectrum of discrete diagnoses included within this category. However, given its ontological complexity and recent rapid evolution, pathologists struggle in the application of this complex diagnostic spectrum to individual cases. This shortfall applies not only to routine diagnosis, but to frozen section diagnosis, as well. In addition, the pathologist’s role is not only to affix diagnostic labels, but also to judiciously interpret diagnostically challenging or indeterminate cases and to guide clinical management using best available evidence. However, even among subspecialized gynecologic pathologists, appropriate diagnostic terminology in challenging cases of low-grade serous neoplasia can be evasive. This latter problem is further compounded by widespread unfamiliarity with the management implications of specific diagnoses. In this session, we will discuss the current terminology and most relevant morphologic, immunohistochemical, and molecular criteria to aid in the proper diagnosis and classification of low grade serous neoplasia, with the ultimate goal of properly guiding patient management.

Learning Objectives:

1. Discuss current morphologic criteria for diagnosis of common and uncommon variants of low-grade serous neoplasia, and distinguishing low-grade and high-grade serous carcinoma on the basis of established morphologic, immunophenotypic, and molecular criteria.
2. Discuss the terminology of stage low-grade serous neoplasia on peritoneal biopsies, with an understanding of the management implications for distinct diagnoses, including indeterminate diagnoses reserved for challenging cases.
3. Discuss management implications for distinct frozen section diagnoses of low-grade serous neoplasia, and formulate proper diagnostic language for challenging or ambiguous cases.

Short Course 73: Making a Molehill Out of a Mountain: Practical Use of Immunostains and Genetic Testing in Salivary Gland Neoplasms

Course Description

Over the past ten years, salivary gland neoplasia has evolved from a short list of diagnostic entities with very few companion diagnostic tests for discriminating tumor subtypes to a widely expanding complex array of tumor types that are distinguished by variably specific immunohistochemical and molecular features. However, the diagnosis that culminates from the tumor profiling obstacle course results in prognostic information and therapeutic options for optimal patient care. The goal for this course is to navigate the array of adjuvant testing options in order to pinpoint a seemingly ever-changing cohort of salivary tumor types, with additional emphasis on equitable patient care and accounting for disparities in optimal diagnostics for resource-challenged areas.

Learning Objectives:

1. Generate differential diagnoses of salivary gland neoplasms using a pattern-based approach.
2. Decide when to apply routine ancillary tests (immunostains) based on differential diagnosis.
3. Know when application of specialized ancillary tests (immunostains or molecular genetics) may be diagnostically important and clinically useful.
4. Generate diagnoses using up-to-date terminology that is reflective of clinical decision-making kpoints.

Short Course 74: Pediatric Lymphoma: Aggressive Entities, Reactive Mimics, and the Wisdom to Know the Difference

Course Description

Pediatric biopsy specimens are often associated with an increased sense of urgency from the clinical team with frequent requests for preliminary diagnoses. In pediatric lymphoma diagnosis, distinguishing reactive “mimics” from lymphoid neoplasm can be difficult, in part due to the decreased exposure of the general pathologist to pediatric lymph nodes and pediatric lymphoma as compared to adult biopsies. The majority of aggressive B cell lymphomas in the pediatric/young adult population have a germinal center phenotype and classification into the appropriate diagnosis is of utmost importance.  In this presentation, we will emphasize the importance of a careful and complete morphologic and immunohistochemical work-up of potential pediatric lymphoma and highlight integration of ancillary data, emphasizing the most up-to-date information on the topic. Participants will gain competence and improve their performance in the appropriate work-up of potential pediatric lymphomas, with the use of a case-based scenarios and repetition.

Learning Objectives:

1. Recognize the common and rare pediatric lymphomas and distinguish from potential mimics
2. Gain familiarity with the appropriate work-up of potential pediatric lymphomas
3. Understand the unique characteristics of pediatric aggressive mature large B cell lymphomas
4. Appreciate the limits of subclassification of pediatric mature large B cell lymphomas and the occasional necessity to provide a differential diagnosis and potential further steps.

Short Course 75: Fully Digital Sign Out, Step by Step. A Complete Guide to the Glassless and Paperless Pathologist’s Office of Today

Learning Objectives:

1. Discuss how a digital workflow is a pre-requisite to utilize artificial intelligence tools for different tasks; some of which replace some tedious tasks for humas like counting mitosis, counting cells or visually estimating the intensity of biomarkers. Some other tasks are ‘De Novo’ designed to provide aid when we needed, to arrive to the correct diagnosis, assisting us in providing better service to our patients.
2. Summarize the steps and skills needed to sign out a case using different combinations of integration between laboratory information systems (LIS) and image management systems (IMS)
3. Identify the components for a successful transition into a digital workflow

Short Course 76: New Solutions to Old Problems: Immunohistochemical and Molecular Advances in the Diagnosis of Liver Lesions

Course Description

This session will review the distinguishing features of the more common liver tumors (hepatocellular adenoma, focal nodular hyperplasia, hepatocellular carcinoma) that a practicing pathologist would likely encounter in daily practice.  We will compare them to less common tumors (combined HCC-cholangiocarcinoma, inhibin-positive cholangiocarcinoma, angiomyolipoma, epithelioid hemangioendothelioma, epithelioid angiosarcoma, hepatic small vessel neoplasm)  that should always be considered in the differential diagnosis. Useful immunohistochemical/in situ hybridization stains (glutamine synthetase, albumin, reticulin, elastic stains, Ki-67) and their strengths and weaknesses will also be reviewed for each diagnosis. The most recent molecular advancements of these entities will be discussed, as well as how and when molecular testing can be used to aid in the diagnosis. We will discuss the limitations of biopsy specimens, and review cases in which a specific diagnosis cannot be rendered, and the appropriate terminology to use when useful information can still be provided to the clinical team.

Learning Objectives:

1. Understand the histologic features of the common and more problematic liver mass lesions and recognize their mimics, particularly when dealing with a small biopsy
2. Identify the most useful immunohistochemical stains when working up liver mass lesions and understand their strengths and weaknesses
3. Recognize the molecular underpinnings of both common and rare liver lesions and how current molecular testing can be used as a diagnostic tool

Short Course 77: Pituitary Tumors in the 5th WHO Classification: A Practical Diagnostic Approach

Course Description

The 5^th Edition of the WHO Classification of Tumors of the Pituitary Gland has been recently released in 2022 (on-line) with several changes in the classification of tumors involving the pituitary gland. Notably, there have been changes in the nomenclature of tumors of neuroendocrine origin (pituitary adenomas), description of new entities, and guidelines for the classification of these tumors. In this course, we will focus on a practical review of the new WHO classification utilizing a case-basis discussion with an integrated approach of clinical and laboratory data, stepwise immunohistochemical stains, and discussion of differential diagnosis of tumors of the anterior and posterior pituitary gland.

Learning Objectives:

1. Understand the main changes recommended by the 5th Edition of the WHO Classification of Tumors of the Pituitary Gland
2. Recognize the changes in the classification of pituitary neuroendocrine tumors 
3. Recognize the changes in the classification of pituitary non-neuroendocrine tumors
4. Discuss some practical guidelines for the diagnosis of pituitary tumors

Conjunctival Melanocytic Intraepithelial Lesions (CMIL): WHO Classification System

Short Course 78: When Morphology Meets Molecular: The Evaluation of Pancreatobiliary Cytology and Small Biopsy Specimens

Course Description

With the advent of novel biopsy needles and forceps, preoperative pancreatobiliary specimens are increasingly encountered by pathologists in both academic and non-academic settings. The specimens obtained from these novel techniques enhance a pathologist’s ability to evaluate subsequent tissue for both immunohistochemical studies and molecular testing. This short course will comprehensively cover the histopathologic evaluation of these specimens with a focus on integrating current and novel immunostains as well relevant genomic alterations that can enhance not only the diagnosis of solid and cystic lesions, but also improve the management of pancreatobiliary patients.

Learning Objectives:

1. Discuss the histologic differences between pancreatic ductal adenocarcinoma and chronic pancreatitis (e.g., autoimmune pancreatitis, type 1) using SharkCore biopsy specimens.
2. Distinguish between reactive biliary epithelium and invasive adenocarcinoma using ERCP-obtained bile duct biopsies based on histomorphologic findings, ancillary immunohistochemistry and molecular testing.
3. Explain the clinical, radiographic, serologic, histologic and immunophenotypic differences between non-ductal solid pancreatic neoplasms using FNA/FNB specimens.
4. Review the key molecular findings associated with neoplastic and non-neoplastic cystic pancreatic cysts.

Short Course 80: Going Beyond “No evidence of Lymphoma/Carcinoma”: Diagnostic Approach to Transitional Pulmonary Lesions at the Crossroads of Surgical Pathology and Hematopathology

Course Description

The course will cover diagnostic approach to transitional thoracic/mediastinal lesions that border benign and malignant lesions including nodular lymphoid proliferations of lung, histiocytic/granulomatous lesions of lung (infectious vs neoplastic) as well as cystic lung lesions and fibrosing mediastinal lesions bordering on lymphoma. All entities discussed will illustrate the need for effective dialog between the surgical/ hematopathologists and treating physicians. To this end, the depicted clinical scenarios will be presented alternatively by a surgical pathologist and a hematopathologist using a case-based approach highlighting he logistical challenges around a timely and actionable diagnosis.

Learning Objectives:

1. Elaborate the clinical, radiological and morphological diagnostic considerations of lymphohistiocytic, cystic lesions and fibrosing lesions of the lung/mediastinum often at the crossroads of surgical pathology and hematopathology.
2. Elucidate cost-effective use of ancillary techniques (immunohistochemistry and molecular techniques) in distinguishing reactive and neoplastic lesions under the aforementioned categories.
3. Understand that even within pathology, a multi-disciplinary/intra-disciplinary approach is necessary overcoming the diagnostic barriers and use ancillary studies that most appropriately cover surgical and hematopathologic entities simultaneously.

Short Course 81: Facing the Unexpected Pink Lung Mass: What to Do When Your Biopsy Doesn’t Show Carcinoma

Course Description

Most pathologists are comfortable evaluating biopsies of a lung mass when carcinoma is seen; however, not all biopsies of lung masses show lung cancer.   Non-neoplastic fibrotic, hyalinizing, or necrotic “pink” lung masses can be diagnostically challenging.  This course will discuss a variety of non-neoplastic “pink” lung masses and offer a practical diagnostic approach to these difficult problems for the pathologist, emphasizing their clinical relevance, associated imaging findings, and ancillary testing.

Learning Objectives:

1. Describe a diagnostic approach to the biopsy of a lung mass showing dense pink fibrosis, elastosis, or sclerotic change, but no evidence of carcinoma.
2. Describe a diagnostic approach to the biopsy of a lung mass showing a light pink hypocellular appearance, but no evidence of carcinoma.
3. Describe a diagnostic approach to the biopsy of a lung mass showing a light pink appearance with bland cellularity, without evidence of carcinoma.
4. Describe a diagnostic approach to a biopsy of a lung mass with pink necrosis, but no evidence of carcinoma.

Short Course 82: The Secret Life of the Histology/Immunohistochemistry Section Director

Course Description

Well done!  You have just been named the next Histology/IHC Section Director of your lab.  The CLIA director has delegated to you responsibility of assessing and maintaining quality assurance (QA) in your lab section.  While many of us have experienced panic and confusion on what this really means and what to do next, dont’ worry!  We will explore some secrets to being a successful Histology/IHC leader.  This interactive short course will help guide you through some elements of QA leadership as a Section Director by exploring the structure and content of CLIA as it pertains to your role and the commonly delegated duties in a case-based, small group format.  We will break down rules on proficiency testing, learn how to create meaningful quality metrics, and identify ways to identify and correct non-conforming events in the Histology and IHC labs.  Lastly, we will explore the synergies and differences between leadership and management in each case to help you choose the right path for that situation.

Learning Objectives:

1. Apply CLIA rules and regulations to common practices of a histology/IHC section (medical) director.
2. Practice the role of the section (medical) director in quality assurance and non-conforming event management.
3. Discuss the differences between leadership and management and apply to specific scenarios.

Short Course 83: Essential Management: A Pragmatic Field Guide

Course Description

Most pathologists and laboratory professionals believe that management is the job of the administrative team, failing to realize that management skills are essential for our professional activities at all levels. Many of us focus on diagnostic and technical work until being promoted to an administrative position. Management skills are often learned on the job from many mistakes at the cost of precious resources and valuable time. Management is also viewed by many as “common sense” disguised by administrative bureaucracy.  There is a common false belief that our advanced medical training and/or hands-on experiences of specific individual tasks equate to our management capability. These fallacies form three major gaps (cognitive gap, knowledge gap, and skill gap) that impede our learning and on-job performance as a manager and team leader. This course is intended to close these gaps by increasing the awareness of role changes, highlighting the crucial areas to focus on, and introducing pragmatic strategies for effective management. The ultimate goal is to establish an operational framework for successful management. 

Learning Objectives:

1. Recognize the cognitive, knowledge, and skill gaps during the transition to a management role
2. Identify the fundamental areas to manage in complex clinical settings
3. Become familiar with the specific strategy to achieve management goals

Short Course 84: Help! I Want a New IHC Assay: Tips and Tools for New IHC Assay Development for All Practicing Pathologists

Course Description

Trainees and practicing pathologists order and interpret immunohistochemical and other ancillary studies constantly in surgical pathology, yet requirements, pitfalls, as well as practical and complex technical points of immunohistochemistry assay validation are obscure. Some of these issues are of great relevance during assay interpretation as well as in providing critical feedback on assay performance to IHC laboratory directors. As subspecialization increases, IHC laboratory directors are increasingly reliant on subspecialty colleagues for input in terms of IHC menu development, assay implementation, and monitoring. This course will draw from real-life examples, to cover currently relevant topics in IHC quality and process improvement, with emphasis on new antibody optimization and validation. The knowledge and tools discussed in this course will be useful to all practicing pathologists and trainees, including current and future IHC lab directors. 

Learning Objectives:

1. Understand the variable applications of IHC assays and how their implementation differs (diagnostic, prognostic, predictive; laboratory developed vs. approved kit)
2. Describe and implement the process of developing a new IHC assay
3. Make recommendations regarding appropriate control material & gold-standard comparator methods/orthogonal methods
4. Understand resources and tools for troubleshooting and monitoring IHC assays