A list of short courses that will be held at the 2026 Annual Meeting is below

Bone and Soft Tissue

Classic and Emerging Fusion-Driven Mesenchymal Neoplasms: An Overview and Practical Approach

Faculty: John Chrisinger, MD, Washington University in St. Louis and Carina A. Dehner, MD, PhD, Indiana University School of Medicine

Professional Practice Gap:

Aided greatly by advances in molecular analysis, particularly next-generation sequencing techniques, numerous fusion-driven mesenchymal tumors have been recently described. Consequently, it is harder and harder to keep up with mesenchymal tumor classification, which can be bewildering even for bone and soft tissue tumor specialists. This course provides an overview of fusion-driven mesenchymal tumors. A practical combined histologic, immunohistochemical and molecular diagnostic approach to common fusion-driven sarcomas is presented. Further, we discuss the interpretation of relevant molecular studies and their limitations. Select emerging fusion-driven mesenchymal tumors are also presented.

Learning Objectives:

  1. Recognize features commonly associated with fusion-driven bone and soft tissue tumors.
  2. Describe a practical diagnostic work-up of common fusion-driven sarcomas, including differential diagnosis, and immunohistochemical and molecular studies.
  3. Discuss the different types of molecular studies commonly used in routine practice for the work-up of suspected fusion-driven mesenchymal tumors.
  4. Become more familiar with emerging fusion-driven bone and soft tissue tumors.

 

Spinal and Paraspinal Pathology: A Backbone of Pearls for the Practicing Pathologist

Faculty: John M. Gross, MD, MS, The Johns Hopkins Medical Institutions and John D. Reith, MD, Cleveland Clinic

Professional Practice Gap:

Spinal and paraspinal pathology includes an array of neoplastic and non-neoplastic disorders including various malignancies but, perhaps more common and challenging, are the non-neoplastic disorders including degenerative arthritis, intervertebral disc-related problems, post-traumatic (fracture), and various facet-joint conditions such as synovial cysts. Although most pathologists are well aware of the importance of pathologic-radiologic correlation with the diagnosis of bone tumors arising in the extremities, this exercise does not seem to be emphasized for spinal and paraspinal neoplasms, respectively (PMID 32679051). Finally, pathologists seem to lack familiarity with the normal anatomy and histology of spinal and paraspinal tissues including intervertebral discs, cartilaginous endplate, and paraspinal ligaments. These dilemmas have resulted in various studies regarding this problem (PMID 32679051, PMID 29314220), yet many pathologists continue to find this anatomically complex region challenging often leading to expert consultation or occasional misinterpreting non-neoplastic conditions as neoplasia resulting in potential patient mismanagement.

Learning Objectives:

Upon completion of this short course, the learner will have a strong fundamental understanding of basic spinal histology, anatomy, and radiology. The learner will be exposed to the common diagnostic issues in everyday practice as well as rare diseases seen in expert consultation. The learner will be comfortable with exuberant non-neoplastic mimics and will be knowledgeable about how to handle spinal / paraspinal neoplasia including a diagnostic approach.

    • Know normal histology of the spinal and paraspinal region to include intervertebral disc, cartilaginous endplates, vertebral bone, spinal ligaments, facet joints as well as discuss normal bone and joint structure and anatomy.
    • Know basic spinal and paraspinal radiology to include X-ray, MRI, and CT scans as the leaner will have a basic “backbone” of spinal radiology.
    • Properly diagnose the wide array of non-neoplastic diseases which may occur in the spine and paraspinal soft tissues leading to diagnostic challenges and expert consultation.
    • Properly diagnose various neoplastic diseases which may affect the spine and paraspinal tissues including both primary (benign and malignant) and metastatic diseases.
Breast Pathology

A Practical Guide to Predictive and Prognostic Markers in Breast Cancer

Faculty: Benjamin C. Calhoun, MD, PhD, The University of North Carolina at Chapel Hill and Mara Rendi, MD, PhD, Hospital Pathology Associates

Professional Practice Gap:

Predictive and prognostic markers in breast cancer have become increasingly complex recently and many aspects of breast cancer care depend entirely upon specific pathologic analysis. To report these markers accurately, pathologists must be familiar with updated guidelines and data from clinical trials. Clinical colleagues often look to pathologists for guidance in appropriate test utilization in addition to interpretation and reporting. A complete understanding of the pathologic assessment of multiple predictive and prognostic markers is an essential element in the practice of breast pathology and is required for pathologists signing out breast cases in all practice settings.

Learning Objectives:

  1. Apply current guidelines and criteria in the interpretation of HER2, ER, and PD-L1 testing to accurately report these important breast cancer markers.
  2. Recognize clinical scenarios in which common molecular gene expression testing is indicated and how results impact treatment.
  3. Understand the clinical utility of ESR1 and PIK3CA mutation testing in breast cancer.
Cytopathology

Approach to the Diagnosis of Thyroid and Salivary Lesions with the Evaluation of Different Morphological Patterns in the Light of the New Editions of the Bethesda and Milan Systems

Faculty: Esther Diana Rossi, MD, PhD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore and Momin T. Siddiqui, MD, FIAC, Weill Cornell Medicine

Professional Practice Gap:

Tumors of head and neck include a wide range of benign and malignant neoplasms that often pose diagnostic challenges for both cytopathologists and surgical pathologists. Among these are tumors involving the thyroid, salivary glands. FNA of these head and neck tumors shows a range of diagnostic sensitivities and specificities depending upon a variety of factors including: FNA technique, cytologic preparation, pathologist experience, lesional heterogeneity, the presence of solid or cystic components, and different morphological patterns (I.e oncocytic, clear cells, spindle and epithelioid/basaloid patterns). FNA performs best when applied to the sampling of palpable tumors. Hence, the diagnostic evaluation of these head and neck lesions poses further problems with patient management when the appropriate reporting system is incorrectly used. This course will use a case-based approach to discuss practical aspects of diagnosing major head and neck tumors with particular emphasis given to the different morphological patterns, differential diagnosis, diagnostic problems, and pitfalls according to the recent published editions of the Bethesda system for thyroid (3rd ed) and Milan system for salivary glands (2nd ed).

Learning Objectives:

  1. Recognize the characteristic morphological patterns on cytologic and histologic samples commonly encountered as well as the challenging tumors in the thyroid and salivary glands.
  2. Formulate a differential diagnosis and discuss commonly encountered pitfalls in the cytologic and histologic diagnosis of these head and neck tumors.
  3. Assign their diagnoses of these tumors to the correct category using accepted reporting systems for cytopathology.
  4. Understand the role and limitations of FNA in the evaluation of head and neck lesions neoplasms.
  5. Effectively use ancillary techniques in the cytologic and histologic evaluation of difficult tumors involving this anatomic location.

 

The Perplexing Pathology of Pancreatobiliary Specimens: Integrating Cytopathology, Small Biopsies, and Molecular Testing

Faculty: Aatur D. Singhi, MD, PhD, University of Pittsburgh Medical Center and Christopher J. VandenBussche, MD, PhD, The Johns Hopkins Hospital

Professional Practice Gap:

The evaluation of pancreatobiliary fine-needle aspirates (FNAs) and small biopsies are among the most diagnostically challenging specimens for the practicing pathologist. These issues are largely multifactorial considering the difficulties with sampling of the pancreatobiliary system, limitations in specimen adequacy, and the morphologic overlap between numerous neoplastic and non-neoplastic entities. As a result, multiple potential diagnostic pitfalls exist, but recognition of key clinical features, morphologic findings, and judicious use of ancillary testing (e.g., immunohistochemistry, molecular testing, etc.) can aid in overcoming these pitfalls and reducing overall anxiety when encountering troublesome cases.

A common scenario is the distinction between chronic pancreatitis (e.g., autoimmune pancreatitis, type 1) and pancreatic ductal adenocarcinoma (PDAC). Both FNAs and small biopsies (e.g., Sharkcore & Acquire biopsies) are frequently characterized by scant cellularity and, in the case of small biopsies, often fragmented in the background of hemorrhage. Fragmentation of cores can lead to displacement of nonneoplastic epithelium into stromal tissue, mimicking invasion, and, conversely, detached, free-floating neoplastic epithelium can be easily overlooked. The application of a systematic approach and the appropriate use of immunohistochemical stains can breakdown the most difficult specimen types.

Similar issues arise in the preoperative setting of pancreatic cysts, such as intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), serous cystadenomas (SCAs), cystic well-differentiated pancreatic neuroendocrine tumors (PanNETs), and non-neoplastic cysts. Pancreatic cyst fluid specimens can be scant, but knowledge and interpretation of corresponding ancillary studies, such as molecular testing and, in certain scenarios, immunohistochemical stains can be a useful adjunct to their evaluation.

Learning Objectives:

  1. Review an integrative algorithmic approach to the evaluation of solid and cystic pancreatobiliary lesions based on clinical, morphologic, and ancillary findings.
  2. Discuss the cytologic/histologic differences between chronic pancreatitis and PDAC using FNA and small biopsy specimens.
  3. Present the utility of existing and novel immunohistochemical stains for the evaluation of cellular neoplasms (e.g., PanNETs, PanNECs, cPanNETs, ACCs, etc.).
  4. Explain current clinical data regarding key molecular alterations associated with neoplastic and non-neoplastic cystic lesions of the pancreas.

 

Diagnostic Challenges in the Cytology of Serous Effusions

Faculty: Adebowale J. Adeniran, MD, Yale School of Medicine

Professional Practice Gap:

Evaluation of serous fluids contributes significantly to clinical management, in primary diagnosis of patients with benign and malignant conditions, and in staging and follow-up of patients with malignancies. The interpretation of microscopic findings in serous fluids can be challenging. How the report is worded to convey areas of concern is very important especially in grey areas and cases without sufficient morphologic features for classification into definite benign or malignant categories, thus leading to equivocal diagnoses. Prior to the adoption of the International System for Reporting Serous Fluid Cytopathology, there was no consensus on the meanings assigned to diagnostic terminologies and interpretations were fraught with clinical misunderstandings that tended to undermine therapeutic decisions. The non-uniformity of criteria for reporting also meant that there was no meaningful cytology-histology correlation, and all of these had frequent negative implication for patient management and quality of clinical care. Despite the established guidelines in the new reporting system, it is frequently observed that there is lack of standardization in how the criteria are broadly applied to each of the diagnostic categories. A good number of serous fluids are difficult to assess by morphology alone. The use of immunohistochemistry and molecular markers helps to confirm and refine diagnoses and they are now routinely done. Likewise, utility of predictive markers is now commonplace in the evaluation of patients in certain malignancies. The purpose of this course in addition to stratifying cases into different diagnostic categories using proper diagnostic terminologies, will also be to fill the practice gaps by discussing the significance of a positive diagnosis, the most reliable criteria for a diagnosis of malignancy, and the common pitfalls in the cytology of serous effusions. Using specific examples, the course will also discuss cases to emphasize when to be cautious, when to look hard for the foreign cells and how to deal with problematic cases.

Learning Objectives:

  1. Describe an algorithmic approach for reaching a definitive diagnosis when evaluating effusion cytology.
  2. Discuss key cytomorphologic features and diagnostic pitfalls.
  3. Perform appropriate critical ancillary studies to evaluate differential diagnoses.
  4. Demonstrate knowledge of established and emerging diagnostic, prognostic and predictive biomarkers.
    Dermatopathology

    Don’t Sweat the Details: Practical Tips and New Tools for the Diagnosis of Cutaneous Sweat Gland Neoplasms.

    Faculty: Eleanor Russell-Goldman, MD, PhD, Brigham and Women’s Hospital, Harvard Medical School and Thomas Brenn, MD, PhD, FRCPath, Michigan Medicine, University of Michigan

    Professional Practice Gap:

    The diagnosis of cutaneous adnexal tumors is often challenging, due to both the significant morphologic overlap that exists among this group of tumors and their broad morphologic spectrum. This is particularly true of those tumors that derive from, or recapitulate, components of the sweat gland apparatus, with diagnostic discrepancies occurring most frequently in this group (PMID: 35090811). Additionally, in contrast to malignant tumors at other sites, cutaneous adnexal tumors with aggressive behavior can display surprisingly banal histologic features, yet conversely may appear atypical despite the absence of malignant potential (PMID: 16446719, PMID: 31558783, PMID: 37335840). These characteristics, in combination with the relative rarity of these tumors, contribute to their diagnostic challenges. Until recently, morphology alone has been the mainstay for the diagnosis of cutaneous adnexal tumors. However, the field of cutaneous adnexal neoplasia is currently evolving as new molecular and immunohistochemical insights now facilitate more precise classification (PMID: 35158743, PMID: 35167714, PMID: 37505808). Considering the rapidly changing landscape of the classification of cutaneous adnexal neoplasms, especially those of sweat gland origin, this course will provide timely updates and guidance for those pathologists who may encounter these difficult cases in practice.

    Learning Objectives:

    1. Develop a stepwise approach for the evaluation of cutaneous adnexal sweat gland tumors.
    2. Recognize the key features of select cutaneous sweat gland tumors that distinguish them from morphologic mimics.
    3. Become familiar with new immunohistochemical and molecular techniques available to aid in the diagnosis of challenging cases.

     

    Cutaneous Histiocytoses: A Systematic Approach to Diagnosis

    Faculty: Ryanne Ashley Brown, MD, MBA, Stanford Medicine/Stanford University and Atif Saleem, MD, Stanford University

    Professional Practice Gap:

    The 2016 revised classification of the histiocytoses consolidated and simplified insights into this poorly understood category of neoplasms; however, many pathologists are not yet familiar with the key molecular findings with therapeutic relevance and systemic associations that are critical to communicating clinically meaningful findings in this diagnostic group.

    Learning Objectives:

    1. Classify cutaneous histiocytoses into specific diagnostic entities based on clinical, histomorphologic, immunohistochemical, and potentially molecular findings.
    2. Identify when molecular interrogation is merited in cutaneous histiocytoses.
    3. Recognize when cutaneous histiocytoses may represent a manifestation of extracutaneous disease, including hematologic malignancy
    Endocrine

    Deciphering the Differences Amongst Well-Differentiated, Differentiated High-Grade, and Poorly Differentiated Thyroid Carcinomas

    Faculty: Rumeal D. Whaley, MD, Mayo Clinic and Lori A. Erickson, MD, Mayo Clinic

    Professional Practice Gap:

    High-grade follicular cell-derived non-anaplastic thyroid carcinoma is new category introduced in the 5th edition of the WHO Classification of Tumors. Poorly differentiated thyroid carcinoma falls under this category. This entity presents its own set of challenges/diagnostic pitfalls. Solid growth, nuclear features, mitotic activity, and necrosis are relativity straight forward parameters to evaluate. However, in practice many caveats arise that cause consternation even amongst experienced pathologists. Differentiated high-grade thyroid carcinomas have a worse prognosis than well-differentiated carcinomas and without methodical analysis of thyroid neoplasms this prognostic information may be lost.

    Learning Objectives:

    1. Understand the new diagnostic terminology of follicular cell derived neoplasia.
    2. Know the diagnostic parameters and common issues associated with them.
    3. Covey the appropriate level of risk of associated with thyroid gland neoplasia.

     

    The Impact of Molecular Data on the H&E Diagnosis of Common Multifocal Endocrine Pathologies: A 5th Edition WHO Update

    Faculty: Ozgur Mete, MD, University Health Network, University of Toronto and Sylvia L. Asa, MD, PhD, Case Western Reserve University/University Hospitals Cleveland Medical Center

    Professional Practice Gap:

    The inconsistent use of diagnostic criteria and language has resulted in considerable confusion with respect to the pathologic diagnosis of common endocrine disorders.

    Learning Objectives:

    1. Employ proper diagnostic terminology for multifocal proliferations of parathyroid, thyroid, adrenal cortex and neuroendocrine cells of the epithelial and non-epithelial neuroendocrine systems.
    2. Know diagnostic criteria for thyroid, parathyroid and adrenal neoplasms and distinguish them from their non-neoplastic mimics.
    3. Apply criteria to distinguish multifocal primary neoplasia from metastatic malignancy.
    4. Recognize and understand how to determine the presence of genetic predisposition as a feature of multifocal endocrine neoplasia.
    Gastrointestinal Pathology

     

    What is up with Barrett’s Esophagus? An Update on Current Definitions, Diagnosis, and Management

    Faculty: Alexandros D. Polydorides, MD, PhD, Icahn School of Medicine at Mount Sinai and Lysandra Voltaggio, MD, Johns Hopkins Hospital

    Professional Practice Gap:

    While the incidence of esophageal adenocarcinoma (EAC) continues to rise every year and the prognosis of advanced EAC remains dismal, with 5-year survival around 10%, surveillance and treatment efforts are now being focused towards these patients with Barrett esophagus (BE) who are most likely to benefit, i.e., progress (PMID: 23303625, 29749623). The presence of columnar epithelium with goblet cells in the tubular esophagus is the major risk factor for the development of EAC. The assessment and grading of dysplasia in this context via biopsies and examination of H&E slides remains the gold standard for risk stratification. In particular, the presence of high-grade dysplasia (HGD) is a marker of high cancer risk (11151865). Nevertheless, there is substantial intraand inter-observer variability among pathologists in the diagnosis and grading of dysplasia in BE and most guidelines recommend that all diagnoses of dysplasia in this setting be confirmed by a second pathologist, preferably one with special expertise in gastrointestinal (GI) pathology. Interestingly, consensus diagnosis of low-grade dysplasia (LGD) among GI pathologists increases the risk of progression to HGD and EAC, but differences, sometimes substantial, remain and vary according to the practice setting, for example between US and European pathologists and between general and GI pathologists (11151865, 27818167, 17543082, 18671819, 10385717). In addition, given uniform recommendations that visible lesions of HGD and intramucosal carcinoma (IMC) are best managed by endoscopic (mucosal) resection, pathologists are depended upon to completely and accurately evaluate such specimens, including determination of the deep margin of resection. Finally, esophagectomy (a complicated surgical procedure usually requiring thoracotomy which is associated with significant morbidity) is recommended for EAC with certain staging characteristics, knowledge of which is necessary among pathologists who evaluate these specimens.

    Learning Objectives:

    1. Define BE, CLE, and IM of the gastric cardia and recognize their significance in terms of neoplastic progression risk and patient management.
    2. Articulate diagnostic criteria for LGD and its differential diagnosis from indefinite dysplasia and incorporate appropriate use of ancillary studies in this distinction.
    3. Recognize advanced neoplasia in BE (HGD and IMC), the importance of handling pathology specimens with such lesions, and the required elements in the ensuing report.
    4. Discuss the necessary parameters during the staging of EAC and the clinically significant biomarkers that need to be evaluated in this context

     

    Diagnosis and Evaluation of Digestive Tract Neuroendocrine Neoplasms: Case-Based Challenges and Solutions

    Faculty: Raul S. Gonzalez, MD, Emory University and Monika Vyas, MBBS, Beth Israel Deaconess Medical Center, Harvard Medical School

    Professional Practice Gap:

    The field of neuroendocrine neoplasia has experienced numerous advances in recent years, including updated diagnostic and grading criteria and renaming of certain entities. The results of a recently published international survey demonstrated a wide variability in pathologists’ approach to several issues regarding digestive tract neuroendocrine neoplasms (NENs), sometimes as a result of unclear or nonexistent guidance in the literature. Even when established guidelines do exist, such as how to calculate Ki67 proliferative indices, many pathologists reported practice patterns at odds with those guidelines. This professional practice gap results in inconsistent reporting, potentially impacting patient care. This case-based course will cover numerous challenges in diagnosing and reporting NENs, emphasizing practice guidelines when available and otherwise providing recommendations using the best available evidence.

    Learning Objectives:

    1. Diagnose and grade digestive tract neuroendocrine neoplasms using the latest WHO nomenclature and criteria.
    2. Utilize immunohistochemistry to identify and classify neuroendocrine neoplasms and, if needed, identify site of origin.
    3. Evaluate and report digestive tract well-differentiated neuroendocrine tumors with key clinicopathologic risk factors in mind.

     

    Easy to Digest Gastric Neoplasia: A Practical Guide to Gastric Intestinal Metaplasia, Dysplasia, and Carcinoma

    Faculty: Changqing Ma, MD, PhD, Barnes-Jewish Hospital/Washington University

    Professional Practice Gap:

    Recent clinical practice guidelines from the American Gastroenterology Association (AGA) recommend histologic subtyping of gastric intestinal metaplasia to identify patients who might benefit from gastric cancer surveillance. Since the publication of these guidelines, pathologists have received increased requests for reporting the subtypes of intestinal metaplasia in gastric biopsies, a task that has not been performed frequently in the past. When asked, pathologists may not know the morphologic features in distinguishing subtypes of intestinal metaplasia and/or the terminology for reporting. Furthermore, gastric intestinal metaplasia is most often associated with either Helicobacter pylori infection or autoimmune metaplastic atrophic gastritis (AMAG). These two types of gastritis have distinct etiologies that warrant specific clinical management tailored to etiology as stated by the most recent AGA clinical practice guideline. Pathology reporting of intestinal metaplasia should include additional comments on histopathology findings in the background gastric mucosa. Pathologists are aware of Helicobacter pylori associated gastritis, but AMAG remains underdiagnosed despite widespread knowledge of the existence of this disease. Histologic features of AMAG are often overlooked, especially in the early stages of the disease and on random gastric biopsies.

    Diagnosing gastric dysplasia remains challenging with significant interobserver disagreement, particularly for rare types of gastric dysplasia. For example, gastric foveolar dysplasia, a rare type of gastric dysplasia, was either never or only rarely diagnosed by seven (54%) of the 13 pathologists participated in the study by Serra et al. Even with the two-tier grading system and dysplasia subtyping in the last two versions of WHO, many pathologists continue to find gastric dysplasia diagnosis difficult. Distinguishing gastric dysplasia from reactive/chemical gastropathy can be rather problematic. The epithelial atypia associated with reactive changes often show moderate atypia and depleted surface foveolar mucin that can be misinterpreted as dysplasia by pathologists who are not familiar with it. In the past 10 years Gastroenterology societies have developed new clinical guidelines on managing gastric dysplasia, comparable to clinical management recommendations for colitis-associated dysplasia. This is based on the concept that most gastric dysplasia is arising in a background of chronic gastritis, i.e., gastritis-associated dysplasia. Pathologists may not be aware of this concept or the updated clinical management recommendations.

    Diagnosis of gastric carcinoma on biopsy specimen is straightforward for most gland forming adenocarcinomas but may be challenging for diffuse-type gastric adenocarcinoma, such as signet ring cell adenocarcinoma and the mucin-poor, eosinophilic variant of diffuse-type gastric adenocarcinoma, which can be confused with benign, reactive or regenerative processes. On the other hand, majority of patients with gastric carcinoma are diagnosed at an advanced clinical stage and thus require either peri/pre-operative, neoadjuvant, or systemic therapy. Biomarker testing is recommended in all newly gastric carcinoma by NCCN. Pathologists should be aware of the biomarkers for treatment and prognostic stratification of gastric carcinoma and facilitate biomarker testing. Gastrectomy specimens for carcinoma are not as frequent as resection specimens for colorectal carcinoma and, thus, partial or complete gastrectomy specimens for carcinoma with or without pre-surgical therapy can be challenging to handle at times. Pathologists may not be fully aware of margins associated with each type of gastrectomy (antrectomy, subtotal gastrectomy, versus total gastrectomy), or the number of lymph nodes required to harvest. Gross and microscopic evaluation of gastrectomy specimen for treated gastric carcinoma also present its own challenges when there are treatment effects such as acellular mucin pools at margin or in lymph nodes.

    Learning Objectives:

    Intestinal metaplasia

    1. Understand the clinical implications of gastric intestinal metaplasia in the United States population.
    2. Perform histologic subtyping of intestinal metaplasia in gastric specimens when needed, with confidence.
    3. Provide clinically relevant, accurate and succinct pathology diagnosis that can facilitate clinical decision making in future follow-up of gastric intestinal metaplasia in individual patients.

    Dysplasia

    1. Recognize histologic features helpful in differentiating dysplasia from reactive epithelial changes in gastric mucosa.
    2. Recognize subtypes of gastric dysplasia and employ proper diagnostic terminology.
    3. Understand updated guidelines for management of gastric dysplasia.

    Carcinoma

    1. Recognize salient features of rare but challenging histologic subtypes of gastric carcinomas (such as the mucin-poor, eosinophilic variant of diffuse type gastric carcinoma).
    2. Perform and report biomarker testing for gastric carcinoma according to updated clinical guidelines.
    3. Gross gastric carcinoma resection specimens properly and formulate pathology reports that follow current reporting guidelines for gastric carcinoma.

     

    Beyond Appendicitis: Appendiceal Pathologies that You Can’t Miss, with a Focus on WHO and AJCC Updates

    Faculty: Sarah E Umetsu, MD, PhD, University of California, San Francisco and Kwun Wah Wen, MD, PhD, University of California, San Francisco

    Professional Practice Gap:

    There have been major updates in the grading and staging schemes for appendiceal neoplasms in the AJCC 8th edition and the WHO 5th edition in 2019. Additionally, Version 9 in the AJCC for the appendix is now available. Such changes and the relatively rare nature of appendiceal neoplasms have created practical knowledge gaps in the terminology and diagnostic criteria, as witnessed by several publications and intramural and extramural consultation in our daily academic practice. A recent publication highlights that almost 65% of appendix cases sent for consultation are questions regarding low-grade appendiceal mucinous neoplasms (LAMNs) or goblet cell adenocarcinoma (Arnold CA et al). Studies from our group and others have shown that pathologists frequently use variations of what is now outdated terminologies (e.g. goblet cell carcinoid and mixed adenoneuroendocrine carcinoma) and sometimes graded and staged these tumors as carcinoids/neuroendocrine tumors (NET). From our consultation practice, we have also noticed that some pathologists are still not aware of the unique AJCC staging scheme for low-grade appendiceal neoplasms (LAMN) or of the histologic distinction between LAMN and high-grade appendiceal neoplasms (HAMN). This has led to misunderstandings by the treating clinicians. Benign mimics

    such as post-inflammatory mucosal hyperplasia and appendiceal diverticula can be mistaken for LAMN. As such, there is a need for:

    • Better understanding of the histologic spectrum of appendiceal neoplasms with recognition of benign histologic mimics in order to avoid over-treatment.
    • Improved utilization of the updated terminology, accurate diagnostic criteria, and appropriatesynoptic comments so that pathologists can clearly communicate the relevant information to the clinicians to ensure proper treatment and prognostication.
    • Better understanding of appropriate gross sampling so that neoplasms can be evaluated and staged appropriately

    Learning Objectives:

    1. Describe updated terminology, diagnostic criteria, and classification of low and high grade appendiceal mucinous neoplasms and goblet cell adenocarcinomas, as described in the 5th edition WHO.
    2. Recognize the challenges in grading and staging of appendiceal neoplasms and be cognizant of the recent updates.
    3. Incorporate the relevant changes in the AJCC updated edition and European Neuroendocrine Tumor Society (ENETS) synoptic comments into pathology reports for staging appendiceal NET.
    4. Importantly, attending this session will provide the learner with the ability to comfortably diagnose these neoplastic entities in the appendix without sending the cases for consultation by a specialist.
    Genitourinary Pathology

     

    A Practical Approach to the Evaluation of Chemo-Naïve and Post-Chemotherapy Testicular Germ Cell Tumors

    Faculty: Shivani Kandukuri, MD, University of Southern California, Keck School of Medicine of USC and Andres Martin Acosta, MD, Indiana University Health

    Professional Practice Gap:

    Germ cell tumors are a fascinating yet diagnostically challenging group of tumors that occur in gonads as well as in extragonadal sites. In the testis, more than 90% of neoplasms are of germ cell origin, making this the most frequent solid malignancy in men aged 20-40 years. Nonetheless, these neoplasms are relatively rare when compared with other genitourinary tumors, such as prostate and bladder cancer. Therefore, except for large academic centers, most pathology practices have limited exposure to these neoplasms. Another problem is that retroperitoneal lymph node dissection is frequently performed at a few referral centers in the United States; consequently, most pathologists in the community have very limited experience with post-chemotherapy germ cell tumor phenotypes. Testicular germ cell tumors are divided into two broad groups for clinical management: seminomas and non-seminomas. Non-seminomas are composed of single or multiple histologic subtypes, which include yolk sac tumor (postpubertal-type), choriocarcinoma, and teratoma (postpubertal-type) that are the most frequent; however, other trophoblastic tumors (e.g., cystic trophoblastic tumor, epithelioid trophoblastic tumor), “somatic-type” malignancies of germ cell origin, certain aggressive subtypes of yolk sac tumor (sarcomatoid) and spermatocytic tumor are relatively rare and may be missed by pathologists that do not have enough exposure to them. Recognizing these unusual phenotypes is relevant because they have implications for prognostication and clinical management. In the setting of metastatic GCT, biopsies often yield limited diagnostic tissue, hindering the assessment of histologic subtypes. Familiarity with morphologic variants and ancillary tests (including immunohistochemistry) is needed to render accurate diagnoses in this context. Further problems associated with GCT that present at metastatic sites include the occurrence of so-called teratoma with secondary “somatic-type” malignancies. Pathologists need to be aware of morphological features indicative of progression to “somatic-type” malignancies, since (as mentioned above) this often dictates clinical management. Post-chemotherapy resections of lymph nodes and metastatic foci represent another specimen that can be diagnostically challenging, because post-chemotherapy phenotypes may demonstrate significant differences with chemo-naïve GCTs. Importantly, it is crucial to distinguish subtypes that are biologically equivalent to teratoma (e.g., cystic trophoblastic tumor, differentiated rhabdomyomatous tumor) from those that will require additional systemic treatment (e.g., “somatic-type” rhabdomyosarcomas). As mentioned above, given that retroperitoneal lymph node dissections are performed most commonly at referral centers, these can be daunting to evaluate for the community pathologists who encounter these specimens infrequently and may find them diagnostically challenging. Immunohistochemistry and select molecular testing are useful for the diagnosis of unusual subtypes of GCT. These ancillary tests can be very helpful, but interpretation of their results requires expertise, and an incorrect assessment may lead to inaccurate diagnoses. Moreover, it is important to understand the diagnostic limitations of these assays, since none are entirely specific, requiring correlation with histologic and clinical findings. Accurate staging of testicular tumors is critical for treatment planning. The pathologists must assess the extent of tumor spread which requires a thorough examination of the gross /orchiectomy specimen. Finally, the advances in testicular pathology techniques, diagnostic criteria, and staging for testicular tumors continue to evolve. Keeping up with these advances and ensuring standardized diagnosis across institutions can be challenging. Despite these challenges, accurate pathology diagnosis is essential for guiding treatment decisions and predicting patient outcomes. With this goal, we aim to help the community pathologist improve the accuracy and reliability of testicular tumor diagnoses using histology and immunohistochemistry-based algorithmic approach along with increasing awareness of diagnostic pitfalls.

     

    Learning Objectives:

    1. Discuss updates introduced in the 5th edition of the 2022 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs.
    2. Learn about the proper use and interpretation of ancillary studies for chemotherapy-naïve and post-chemotherapy GCTs.
    3. Provide a simplified algorithmic approach to help guide the workup and diagnosis of GCTs in daily practice.
    4. Understand the clinical implications of the different pathologic diagnoses, focusing on those that determine treatment

     

    The Genitourinary Pathology That No One Talks About

    Faculty: Sean R. Williamson, MD, Cleveland Clinic and Giovanna A. Giannico, MD, University of California Irvine

    Professional Practice Gap:

    Among genitourinary cancers, the vast majority of primary neoplasms represent clear cell or papillary renal cell carcinomas of the kidney, acinar adenocarcinoma of the prostate, urothelial carcinoma of the urinary system, and squamous cell carcinoma of the penis. However, apart from the common cancers and emerging cancer types that require novel IHC markers or molecular confirmation, there are a number of other entities and patterns in genitourinary pathology that are rarely discussed in CME lectures. In fact, certain organ sites are rarely discussed in CME activities, despite being not uncommon specimens, such as the adrenal gland, penis and scrotum, ureter/renal pelvis, and paratesticular/intrascrotal. This educational activity will address a potpourri of diagnostic genitourinary entities that are commonly encountered in practice but rarely discussed. The course will address these gaps with emphasis on practical implications and current guidelines from evidence-based medicine. Through selected case scenarios, this course will encompass a broad spectrum of diagnostically challenging areas with emphasis on differential diagnosis and work-up of unusual morphologic variants.

    Learning Objectives:

    1. Recognize and differentiate benign lesions of the testis and paratesticular region from neoplastic mimickers.
    2. Differentiate benign lesions of the kidney from neoplastic mimickers.
    3. Work-up non-neoplastic lesions of the prostate.
    4. Differentiate benign lesions of the penis and urinary tract from neoplastic mimickers and discuss reporting.
    Gynecologic Pathology

     

    Crossing the Lines between Borderline and Malignant Ovarian Epithelial Neoplasia: How to Land on the Right Side

    Faculty: Charles “Matt” Quick, MD, University of Arkansas for Medical Sciences and Carlos Parra-Herran, MD, Brigham and Women’s Hospital, Harvard Medical School

    Professional Practice Gap:

    Proper diagnosis of borderline tumors of the ovary, and their distinction from carcinoma, constitutes one of the most challenging and controversial tasks within the realm of gynecologic surgical pathology. Historically, the distinction between borderline and malignant is a moving target that relies on subjective features, such as retraction vs. true invasion, and unwieldly size criteria that have changed over time. This latter feature is best exemplified by so-called “expansile invasion” in mucinous borderline tumors, which is based on subjective histologic identifies such as “back-to-back glands” and “lack of stroma.” Discernment of carcinoma is further complicated by additional, variably significant, histologic features such as “microinvasion,” “micro-invasive carcinoma,” “intra-epithelial carcinoma,” and peritoneal “implants,” all of which may be applied to tumors still classified as borderline. While there was some relief in the form of the 2014 iteration of the WHO Classification of Female Genital Tumors which removed the category of “invasive implants” (incorporating them into low grade serous carcinoma), there is still much confusion on what constitutes invasion, especially when faced with a non-invasive desmoplastic variant.  Despite modest advances in our understanding of these lesions, pathologists still demonstrate much confusion when faced with these lesions based on the consultation files of the course directors.

    Learning Objectives:

    1. List and describe histologic features associated with each (common) histotype of ovarian epithelial neoplasia that warrant a diagnosis of carcinoma.
    2. Identify various histologic features associated with borderline tumors (e.g. microinvasion, intraepithelial carcinoma, implants, etc.) and describe the clinical significance of each.
    3. Effectively communicate the findings and prognostic impact associated with the discussed.

     

    Mucinous Carcinomas of the Gastrointestinal and Gynecological Tract: Getting Comfortable in the Gray Areas

    Faculty: David F. Schaeffer, MD, Vancouver General Hospital and Marilyn A. Kinloch, MD, FRCPC, University of Saskatchewan

    Professional Practice Gap:

    Carcinomas with mucin production are one of the most easily recognizable entities in surgical pathology. Yet, the evolution of site of origin, pathogenesis, terminology, cytological atypia in low-grade disease, signet ring cells versus signet ring cell-like morphology, and treatment implications have created many gray areas in this prominent area traversing gynecologic and GI practice. The course is designed to update practicing surgical pathologists and pathologists-in-training on the variety of histologic diagnoses and features associated with mucinous neoplasms by giving participants practical solutions to common issues encountered in the assessment of mucinous carcinomas that span the gynecological and gastrointestinal tract. Particular focus will be placed on cross-over knowledge from gynecologic and gastrointestinal experts to provide an intersection of understanding from both parties’ points of view on anatomy, pathogenesis, and communication to clinicians through a clear and concise pathology report to facilitate patient management. Using a series of case presentations, this course includes the following common scenarios: Peritoneal biopsy of a mucinous carcinoma without known primary, Low-Grade and High-Grade Appendiceal mucinous neoplasms diagnosis and management pathways, pseudomyxoma peritonei versus mucinous adenocarcinoma, mucinous borderline tumors compared to invasive mucinous ovarian carcinomas. Each case presentation will encompass histopathological features, differential diagnosis, ancillary diagnostic techniques and sample pathology reports.

    Learning Objectives:

    1. Identify diagnostic criteria for mucinous carcinomas between Gastrointestinal and Gynecologic primaries with particular emphasis on distinguishing low-grade and high-grade cytology.
    2. Integrate the histologic, IHC, and molecular diagnostics for determining the site of origin.
    3. Formulate interpretative comments for clinicians using clear nomenclature to guide management and trigger appropriate follow-up measures.

     

    Uterine Smooth Muscle Tumors: Spectrum and Conundrums in Small and Partial Samples


    Faculty: Amanda L Strickland, MD, Northwestern University Feinberg School of Medicine and Jian-Jun Wei, MD, Northwestern University Feinberg School of Medicine

    Professional Practice Gap:

    Uterine leiomyoma is the most common type of tumor among women of reproductive age, is frequently associated with decreased quality of life and subfertility. Surgery has traditionally been used to manage medically refractory uterine fibroids, with the laparoscopic approach becoming more common in treating symptomatic patients in recent years. Laparoscopy and hysteroscopy, minimally invasive surgical approach has been broadly used in treating symptomatic fibroids with careful patient selection and typically involves very low rates of complications. While the incidence of occult leiomyosarcoma at the time of benign gynecologic surgery is overall low, “fibroids” can present a wide spectrum of grossing and cellular patterns, which can cause of diagnostic challenge. For example, nuclear atypia, unusual cytology and histologic presentation, varied cell types and differentiation, and many fibroid mimics are frequently encountered in myomectomy specimens. Such unusual findings in daily practice presents a conundrum in surgical pathology for diagnosis of a wide range of uterine smooth tumor variants as well as the mimics of mesenchymal neoplasms and subsequent management of the patient. Overlapping histologic features among these subtypes and the lack of specific biomarkers further complicates reaching a definitive diagnosis for these entities

    Learning Objectives:

    1. Recognize the gross and histologic spectrum of uterine smooth muscle pathology in myomectomy specimens and develop a differential for this group of diseases.
    2. Discuss the available immunohistochemical and molecular tools available for such diagnoses.
    3. Understand the clinical significance of each diagnosis.
    4. Know what our clinical colleagues are looking for in our reports.

     

    Practical Staging in Endometrial Cancer: Weathering the FIGO Staging Storm


    Faculty: Amy S. Joehlin-Price, MD, Cleveland Clinic and Stephanie M. McGregor, MD, PhD, University of Wisconsin-Madison

    Professional Practice Gap:

    Pathologic stage is the largest factor in driving clinical decision-making, but the lack of formal literature and inconsistent use of diagnostic criteria has resulted in longstanding and considerable difficulty in assessing the various parameters that comprise pathology reports and define stage (1-3). This difficulty is compounded by conflicting society guidelines and continuing evolution in clinical staging, as demonstrated by the recently released 2023 FIGO staging, which now incorporates lymphovascular invasion and molecular classification (4). This course, using numerous well-photographed/illustrated examples, will address the divide between the written recommendations and how to apply them in real life cases, highlighting changes in the most recent staging and how they will affect clinical management. Care will also be taken to address issues of resource availability with respect to incorporating molecular classification.

    Learning Objectives:

    1. Correctly assign EC stage using the FIGO 2023 staging system.
    2. Describe the clinical implications encompassed in histotyping EC, quantifying LVI, assessing myometrial invasion, and measuring lymph node metastases.
    3. Recognize the variation in institutional practices in methods of molecular classification and ultrastaging sentinel lymph nodes and evaluate these practices in the context of the resources available within their own practices.
    Head & Neck Pathology

     

    Beyond Squamous Cell Carcinoma: A Practical Approach to Diagnosing Spindle Cell Lesions of the Head and Neck

    Faculty: Esther Diana Rossi, MD, PhD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Università Cattolica del Sacro Cuore and Jason L. Hornick, MD, PhD, Brigham and Women’s Hospital, Harvard Medical School

    Professional Practice Gap:

    Diagnostic challenges in head and neck cytology are well documented, particularly for cases with spindle cell features. Fine needle aspirates of these lesions when encountered in cytology practice are often reported using a descriptive diagnosis, which is unhelpful for clinical management. We are not aware of many prior cytology courses, nor of comprehensive review articles in the cytology literature, that address this challenging topic. Therefore, we aim to close this gap by offering a course that will provide the participant with a practical approach to handling spindle cell lesions of the head and neck.

    Learning Objectives:

    1. Illustrate key cytomorphologic features and diagnostic pitfalls for spindle cell lesions of the head and neck.
    2. Review the correlative histological findings of spindle cell lesions of the head and neck.
    3. Discuss the utility, efficacy, and limitations of ancillary studies for spindle cell lesions of the head and neck.

     

    What’s New and Improved in Salivary Gland Pathology

    Faculty: Lisa Rooper, MD, Johns Hopkins Hospital and Justin A Bishop, MD, UT Southwestern Medical Center

    Professional Practice Gap:

    Salivary gland pathology has always been one of the most challenging areas of head and neck pathology due to the large number of tumors that exist and the extensive histologic and immunohistochemical overlap between seemingly distinctive groups. In recent years, the description of multiple additional novel and rare salivary gland entities and subtypes have compounded these challenges. Several entirely new entities have been introduced with and even after the publication of the 5th Edition WHO classification, many supported by unique molecular findings, including microsecretory adenocarcinoma, microcribriform adenocarcinoma, and palisading adenocarcinoma. Additionally, several previously proposed but controversial categories have been confirmed or refined based on novel molecular findings, including mucinous adenocarcinoma, striated duct adenoma, intercalated duct lesions, and keratocystoma. Finally, new subtypes of existing salivary gland entities have also been recognized or clarified with the assistance of molecular data including metatypical adenoid cystic carcinoma, adenoid cystic carcinoma with striking tubular eosinophilia, frankly invasive carcinoma ex intraductal carcinoma, and salivary duct carcinoma with rhabdoid features. These rapidly evolving categories compound the existing challenges in correct classification of salivary gland neoplasms.

    Learning Objectives:

    1. Recognize the diagnostic features of newly-described salivary gland tumors and subtypes.
    2. Understand how existing salivary gland entities have been confirmed and refined based on molecular analysis.
    3. Apply immunohistochemistry and molecular testing in a cost-effective manner to assist with these diagnoses.
    Hematopathology

     

    Near Misses: True Confessions of a Hematopathologist

    Faculty: Elizabeth Courville, MD, University of Virginia Health System and Daniel Boyer, MD, PhD, University of Michigan

    Professional Practice Gap:

    Interpretive diagnostic errors in pathology happen. Errors occur in the interpretive phase of the pathology testing cycle just as they occur in the technical and administrative aspects of laboratory practice (Packer, Ravinsky, and Azordegan, 2022). A goal for improving diagnosis in health care from the Institute of Medicine (https://nap.nationalacademies.org/resource/21794/DiagnosticError_ReportBrief.pdf) is to develop and deploy approaches to identify, learn from, and reduce diagnostic errors and near misses in clinical practice. In our experience, discussions of real-life near-misses are uncommon and may not be a part of institutional culture. By presenting and discussing such cases, this short course will provide the audience the opportunity to learn from our near-misses as well as introduce the terminology of diagnostic errors/near misses and model appropriate discussion of diagnostic errors/near misses.

    Learning Objectives:

    1. Discuss the current literature on interpretive diagnostic error in pathology.
    2. Recognize potential areas for diagnostic error in hematopathology.
    3. Describe strategies to mitigate these areas of potential diagnostic error.
      Informatics

       

      LLMs in Anatomic Pathology: What the Everyday Pathologist Needs to Know

      Faculty: Christopher A. Garcia, MD, MSc, Mayo Clinic and Thomas Erol Tavolara, PhD, Mayo Clinic

      Professional Practice Gap:

      Large language models (LLMs) like GPT-4 and Med-paLM 2 have exploded in popularity in recent years and show promise for transforming many tasks in healthcare and biomedical research. While LLMs are not yet widely used in anatomic and clinical pathology workflows, gaining early familiarity with these tools will help pathologists stay at the forefront of emerging technologies in the field and make educated decisions on what tools they use and how they use them. LLMs have already demonstrated utility for automating aspects of pathology report drafting, extracting information from free text pathology notes, and showing potential for augmenting analysis of histology slides. As LLM research and its translation into viable clinical tools progresses, LLMs integrated into digital pathology systems may aid pathologists by highlighting relevant findings, generating differential diagnoses, and synthesizing complex data from multiple modalities.

      Learning Objectives:

      1. Understand the fundamental concepts of larger language models (LLMs), including LLM architectures and training methodologies.
      2. Explore current (in-use) and future LLM applications in anatomic pathology (AP), including their strengths and limitations.
      3. Gain hands-on experience fine-tuning LLMs for AP tasks.
      4. Develop skills for evaluating LLM performance on AP tasks.
        Liver Pathology

        Biliary Tract Disorders Across the Lifespan: Key Entities in Children and Adults

        Faculty: Juan Putra, MD, Boston Children’s Hospital and Maria Isabel Fiel, MD, MS, Icahn School of Medicine at Mount Sinai

        Professional Practice Gap:

        Liver pathology is a challenging field, particularly for many pathologists who lack exposure to this subspecialty. In addition, the evaluation of liver pathology in children often requires a different approach from that in adults. Therefore, educational activities to address these diagnostic challenges are necessary. In this short course, we will discuss the key pathologic findings and practical approach of bile duct disorders in different age groups. Biliary atresia is the most common cause of neonatal cholestasis for which surgery (hepatoportoenterostomy) is indicated. In neonates with biliary atresia, successful management requires timely diagnosis for superior outcome. However, the liver biopsy findings may overlap with other entities, such as total parenteral nutrition effect and alpha-1-antitrypsin deficiency (1). Practical approach to distinguish these entities will be discussed. In addition, less common and diagnostically challenging entities such as ductal plate malformation, Alagille syndrome and progressive familial intrahepatic cholestasis will be included in the discussion (2).   In a recent study evaluating extramural consultation for challenging liver pathology cases, primary biliary cholangitis (PBC) was a frequent diagnostic dilemma (14%) second only to general classification of a hepatitic pattern of injury (37%) (3). This was likely due to the broad spectrum of histopathology seen in PBC. The same challenges are applicable to primary sclerosing cholangitis (PSC), another autoimmune cholangiopathy seen in older children and adults. Ductopenia (bile duct paucity) is another challenging diagnosis for many pathologists due to its subtle findings and association with various etiologies (4). Diagnostic approach to these entities will be discussed in this short course.

        Learning Objectives:

        1. Describe the key histologic features of common biliary tract diseases in the pediatric population.
        2. List the differential diagnosis of extrahepatic biliary atresia.
        3. Describe the important histologic features of primary biliary cholangitis and primary sclerosing cholangitis.
        4. Discuss different etiologies of bile duct paucity in adults.

         

        Integration of Molecular Results into Routine Diagnoses of Hepatic Surgical Pathology Cases

        Faculty: John A. Hart, MD, University of Chicago and Namrata Setia, MD, University of Chicago

        Professional Practice Gap:

        The optimal sign out of routine liver biopsy and resection cases, both for neoplastic and non-neoplastic conditions, increasingly requires the proper integration of the results of molecular analyses performed on the specimens, or prior or concurrent germline testing. The interpretation of these results can inform subsequent patient management and prognosis in significant ways. The value added by integration of molecular data into surgical pathology reporting helps demonstrate the continued relevance of tissue biopsy in medical practice and the key role of surgical pathologists.

        Learning Objectives:

        1. Identify the histologic features of steatohepatitis, the situations where molecular testing is warranted, and how molecular test results impact patient prognosis and management.
        2. Recognize the histologic subtypes of hepatocellular adenoma and how an immunohistologic stain panel and NGS panel results can be helpful in arriving at a diagnosis and help exclude the possibility of hepatocellular carcinoma.
        3. Develop an approach to the work up of possible cases of drug induced liver injury and identifysituations where molecular testing may be helpful in narrowing the differential diagnosis.
        Molecular Pathology

        Demystifying Emerging Methods in Molecular Pathology: How to Order the Right Test for the Right Patient at the Right Time

        Faculty: Vera Ashley Paulson, MD, PhD, University of Washington Medical Center

        Professional Practice Gap:

        Molecular diagnostics have become essential to modern pathology practice, with molecular findings incorporated into formal W.H.O. classification of multiple tumor types (1-3). Emerging molecular methods, including whole-exome and whole-genome DNA sequencing and anchored multiplex PCR with RNA sequencing for fusion detection, offer the potential to establish a definitive diagnosis –and, in many cases, identify actionable findings for targeted therapy – when conventional morphologic and immunophenotypic methods are insufficient (4-6). As even more advanced molecular techniques (including comprehensive transcriptional profiling and single-cell analysis) make their way from the laboratory to the clinic in the coming years, the arsenal of molecular assays available to the pathologist is certain to expand further. With so many choices available, deciding on the appropriate molecular test(s) to order can be challenging even for experienced pathologists. Research in social sciences and economics has demonstrated that having too many choices can paradoxically result in suboptimal decision-making, a phenomenon known as “choice overload” or “decision paralysis” (7-8); these findings have been extended to clinical settings as well (9-10). Compounding the problem, many clinicians (particularly those practicing in community settings) are uncomfortable with, or non-receptive to, incorporation of molecular diagnostics in diagnosis and patient care (11-12). This likely reflects limited training in application of molecular approaches in the clinical setting; per one study, the majority of senior pathologists had no training in molecular pathology (13-14). Since poor decision-making with respect to molecular test ordering can result in delayed diagnosis and suboptimal patient care, particularly when tissue quantity is limiting, it is critical that practicing pathologists understand the menu of available molecular tests, and their relative advantages and limitations, to ensure that the optimal test is ordered, and the correct diagnosis rendered. In this short course, led by two experienced molecular pathologists and educators with complementary expertise in adult and pediatric molecular pathology, we will survey the current landscape of molecular tests available to the practicing pathologist faced with a diagnostic dilemma, with a focus on methods that have recently become widely available (including whole-exome and whole-genome sequencing, anchored multiplex PCR for fusion detection, and cell-free DNA testing). We will focus on the practical implications of each method: what information is likely to be gained, and at what cost in money, tissue, and time? These issues will be explored through a series of short presentations, interspersed with interactive case studies with audience participation. Participants will leave the course armed with the knowledge and expertise to determine the optimal test to order in a challenging clinical scenario, and to educate their colleagues about the benefits and limitations of emerging molecular assays.

        Learning Objectives:

        1. Understand the science behind emerging methods in molecular diagnostic pathology, including whole-exome and whole-genome sequencing, anchored multiplex PCR-based fusion detection, and cell-free nucleic acid analysis.
        2. Compare and contrast novel emerging molecular diagnostic assays in terms of clinical utility, turnaround time, and cost.
        3. Identify the most appropriate molecular test(s) to order for a given clinical situation in which conventional histopathologic evaluation is insufficient to establish a diagnosis.
        4. Discuss potential pitfalls in interpretation of advanced molecular assays.
        Neuropathology

        Brain Tumor Diagnosis in the Molecular Era, What the Neurosurgeon and Neuro-Oncologist Need to Know

        Faculty: Leomar Y. Ballester, MD, PhD, The University of Texas MD Anderson Cancer Center and Chirag B Patel, MD, PhD, The University of Texas MD Anderson Cancer Center

        Professional Practice Gap:

        A limited understanding of the critical information that the pathologist needs to provide to the neurosurgeon and neuro-oncologist for the management of brain tumor patients contributes to miscommunication, delays in treatment, and has a negative impact on patient care.

        The incorporation of molecular alterations in the diagnosis and grading of brain tumors requires general pathologists to modify long-standing clinical practices regarding the evaluation and reporting of infiltrating gliomas. The number of reports received in our large tertiary referral cancer centers suggest that there is a knowledge gap in the approach to the diagnosis of infiltrating gliomas. In many cases, rendered diagnoses continue to follow outdated criteria and fail to accurately incorporate current nomenclature and key elements required by neurosurgeons, neuro-oncologists, and radiation oncologists to treat patients.

        Learning Objectives:

        1. Learn key MRI features that are helpful to the pathologist in the pre-operative differential diagnosis of infiltrating gliomas.
        2. Learn key histologic findings for the diagnosis of glioblastoma IDH-wildtype; astrocytoma IDH-mutant; and oligodendroglioma-IDH-mutant and 1p/19q codeleted.
        3. Learn about the important molecular alterations that influence diagnosis and grading of infiltrating gliomas and when molecular testing is required.
        4. Learn important aspects of evaluating and reporting cases in which surgery is performed to distinguish recurrent tumor (true progression) vs. radiation necrosis (pseudoprogression).
        Pediatric Pathology

        Pathology of Disorders of Sex Development (DSD): State of The Art

        Faculty: Katja Gwin, MD, UTSouthwestern Medical Center and Miguel Reyes-Múgica, MD, UPMC Children’s Hospital of Pittsburgh

        Professional Practice Gap:

        There is evidence in the literature and in daily practice that many pathologists are unfamiliar with the pathology of disorders of sex development and its implications for patient management.

        Learning Objectives:

        1. Enumerate the major groups of Disorders of Sex Development (DSDs) using modern accepted terminology.
        2. List the 5 histologic testicular compartments to evaluate in patients suspected of suffering DSDs.
        3. List the main differences between streak gonads, dysgenetic testes and ovotestes.
        4. Recognize the significance of evaluating disorders of sex development specimens properly for appropriate patient care.
          Professional Development

          Women in Pathology and Leadership: Next Generation Strategies for Gender Equity

          Faculty: Catriona A McKenzie, MBBS, Royal Prince Alfred Hospital, Wendy Cooper, PhD, MBBS, FRCPA, Tissue Pathology, Royal Prince Alfred Hospital and Caroline L. Cooper, MBBS, FRCPA, Pathology Queensland

          Professional Practice Gap:

          The proportion of women in the medical workforce has been steadily increasing yet women are currently under-represented in senior leadership roles as well as in key metrics needed for professional success and promotions including scientific publications, grant recipients, editorial boards, key conference presentations, and professional awards. This is not unique to pathology and is seen in the broader medical and academic community. Barriers to gender equity and equality in pathology, medicine and academia include gender stereotypes, gender-based discrimination, structural and organizational barriers as well as broader social and cultural barriers. Implementing strategies to overcome these is vital as healthcare delivery is increasingly becoming patient centric requiring diverse and inclusive teams for optimal care.

          Learning Objectives:

          1. Understand current gender gaps in pathology, medical and academic leadership.
          2. Recognize factors that contribute to gender inequity including gender stereotypes, conscious and unconscious bias, structural and organizational barriers as well as societal barriers.
          3. Recognize the impacts of institutional strategies to address gender equity in pathology and leadership.
          4. Understand strategies to maximize opportunities for success in a pathology career.
          5. Develop evidence-based strategies to achieve gender equity at organizational and individual levels.

           

          Tools of the Trade: Career Development & Navigating Feedback

          Faculty: Rondell P. Graham, MBBS, Mayo Clinic and Laura W. Lamps, MD, University of Michigan

          Professional Practice Gap:

          Issues such as time and energy management, personal wellness, mentoring, and burnout are some of the most frequently discussed topics on social media, in print, and between colleagues (see references, below). Physicians today are facing unprecedented demands to balance work and home life, compounded by the additional burdens of email, promotion requirements, and challenging relationships at work. Virtually none of us were trained to navigate any of these issues in medical school. We surveyed multiple junior faculty at our institutions to gather ideas and feedback for topics for this short course. In addition, we previously taught a USCAP course for junior faculty (“Getting Started in Academics,” together with Dr. Rhonda Yantiss and Dr. Raul Gonzalez) that was extremely successful. The Question & Answer segments often ran over because of keen interest and resulted in follow-up conversations after the course had ended. Because of these experiences, we hope that developing a course such as this will be timely, helpful and engaging for participants.

          Learning Objectives:

          1. Describe basic principles of time and energy management.
          2. Develop a personal plan for identifying activities that bring fulfillment and align with career goals.
          3. Formulate strategies for effective networking, communication with senior colleagues and departmental leadership, and being an effective advocate for oneself.
          4. Plan strategies for navigating difficult interpersonal relationships at work, having challenging conversations, and giving and receiving feedback.

           

          Being a Lab/AP Director: What I Didn’t Learn in Residency!

          Faculty: Kristin C. Jensen, MD, VA Palo Alto Health Care System and Ann K. Folkins, MD, Stanford Medicine/Stanford University

          Professional Practice Gap:

          Laboratory and/or Anatomic Pathology Directorship encompasses a protean and evolving set of leadership, professional and interpersonal skills that simply are not addressed in post-graduate training. Leadership courses, even those dedicated to medicine, fail to provide background and skills specific to ongoing changes in the field of diagnostic pathology. Introduction to leadership strategies and abilities that can prepare current and future pathology directors will narrow this professional practice gap.

          Learning Objectives:

          1. Engage with relevant organizational stakeholders to optimize the value and performance of their laboratories.
          2. Employ individual and laboratory strategies to adapt to evolving diagnostic landscapes.
          3. Critically evaluate human and other available resources to create a resilient and efficient workplace.

           

          Dissecting a Path to Academic Success: Teaching Portfolios Under the Microscope

          Faculty: Jason Jarzembowski, MD, PhD, Medical College of Wisconsin and Paritosh Kaul, MD, Children’s Hospital of Wisconsin, Medical College of Wisconsin

          Professional Practice Gap:

          Submission of a promotion portfolio is a fundamental requirement for professional advancement at all academic institutions. The teaching portfolio (TP) is the cornerstone of the Promotion Portfolio, especially for those on the clinician-educator track. Faculty development offerings are prevalent across academic institutions; however, faculty report they are often unable to participate in these initiatives due to time limitations and competing priorities. In addition, there need to be many sources of evidence to assess academic impact/success in the promotion portfolio, and these can differ amongst medical specialties. The creation of a TP may thus appear daunting and ambiguous to early faculty, forestalling their advancement. To ensure academic success of all junior faculty in pathology we need to create effective faculty development programs that are based on adult educational principles with active learner engagement. Xierali, et al. reviewed the promotion process in US medical schools over ten years and found that promotion rates varied not only by faculty rank but also by faculty sex, race/ethnicity, department, tenure status, and degree type. The differences were more pronounced for assistant professors than associate professors. Under-represented in medicine (URM) faculty members, particularly assistant professors, were promoted at lower rates than their White and Asian peers.

          This hands-on workshop will guide participants through this critical step in the academic maze of the promotion process. The deliberate, guided facilitation will walk early career pathologists through the steps required to prepare, organize, and best present their academic accomplishments in support of their teaching portfolio. Although each institution has unique requirements for formatting and compiling the TP, this workshop will focus on key principles, generalized approaches, and tips and tricks that any faculty will be able to utilize, regardless of the specific process they will need to follow.

          Learning Objectives:

          1. Summarize the value of a teaching portfolio as part of the promotion packet, and its importance to academic promotion.
          2. Develop your teaching portfolio.
          3. Create your own personalized “Teaching Statement” to enrich your teaching portfolio.

           

          The Struggling Pathology Trainee: Strategies and Tools for Academic Faculty to Recognize and Classify Deficiencies on the Road to Clinical Competency

          Faculty: Elizabeth Courville, MD, University of Virginia Health System and Sara L Zadeh, MD, The University of Virginia Health System

          Professional Practice Gap:

          Medical education is a rigorous and demanding journey that requires not only academic prowess but also practical clinical competence. However, some medical learners find themselves struggling to bridge the gap between theory and practice, which can impede their path to becoming proficient clinicians (Minter RM 2014; Guerrasio J 2018). Academic faculty members play a pivotal role in identifying and addressing the challenges these learners face. Unfortunately, only a minority of academic faculty members contain advanced degrees in education and faculty development in assisting struggling learners is neither standardized nor universally available. Increased emphasis on competency-based education (Lee GB 2022; Ten Cate O 2017; Touchie C 2016), amplifies both the ability to identify and the obligation to assist struggling learners.  There is a body of literature on competency based assessment in the medical environment as well as the identification and a approach to the struggling learner in the medical environment (for example, Carraccio CL 2008, Audetat M-C 2013, Parsons AS 2022, Peterson BD 2022); however, there is a more limited body of literature specific to pathology and its subspecialties (for example, Han R 2022, Moiz B 2019, White K 2021, Cotta CV, Bryant BH 2021, Ju JY 2020, McCloskey CB 2017). In our experience, the application of pathology specific published assessment tools is limited due to the wide spectrum of clinical practice habits among academic medical centers, subspecialties, and pathologists.  We aim to close this gap by facilitating a workshop that will allow participants the framework, time, and peer support to start to develop a personalized approach to resident assessment and struggling learners, within the context of each participant’s unique work environment.

          Learning Objectives:

          1. Appreciate the dynamics of the teacher-student relationship, the prevalence of struggling learners within medical education, and potential contributors to deficiencies in clinical competence.
          2. List domains involved in being a competent medical professional and give practical examples of each domain in pathology and in your subspecialty.
          3. Have increased confidence in their ability to identify, assess, and assist a potential struggling learner.

           

          Marrying Pathology and Science: How Pathologists Can Forge Effective, Fulfilling, and Mutually Beneficial Scientific Collaborations

          Faculty: Ashwini Jambhekar, PhD, Harvard Medical School

          Professional Practice Gap:

          As pathology has become central to personalized medicine, pathologists have come to play an essential role in transmitting discoveries from bench to bedside and are increasingly valued as collaborators in scientific research. Modern science is an interdisciplinary enterprise: collaborative research efforts, particularly in molecular diagnostics and therapeutics, incorporate contributions from basic life scientists, clinical researchers, and practicing pathologists and clinicians across academia, industry, and community-based practice. Many such efforts have resulted in discoveries that have changed clinical practice and improved patient outcomes, leading to what has been described as a “golden age for medicine” (1). However, there have been few, if any, formal efforts to help pathologists navigate the conceptual, logistical, and technical differences that impede effective collaboration. Initiatives to promote interdisciplinary research have generally focused on training future physician-scientists, rather than fostering effective collaboration between established physicians and scientists (2-4). There have been attempts to encourage scientists to engage in collaborative research (5, 6), including initiatives for collaborations between academic scientists and community practitioners (7); but there have not, to our knowledge, been any efforts to train pathologists or basic scientists to navigate the conceptual and technical differences that can impede collaboration. The differences in priorities, goals, and timelines between pathologists and scientists are substantial, but far from insurmountable (5).  Effective training programs to help both parties navigate these differences could play a vital role in catalyzing both basic discovery and development of novel diagnostics. Existing trainings focus on governance of collaborative projects or management of conflicting career goals (8), rather than on scientific priorities, technical approaches, and their associated timelines.

          In this course, co-led by an academic pathologist and scientist who have collaborated effectively for over a decade, we will survey the intellectual approaches and methods employed in basic, translational, and clinical science, and offer practical strategies that pathologists can use to forge mutually beneficial collaborations with scientists to advance both science and pathology. We will first focus on conceptual differences between basic and clinical sciences, as well as the challenges and time frames of technical approaches commonly used in basic and translational research. We will then use case studies to illustrate the process of bringing basic science discoveries into the realm of clinical practice. Participants should leave the course armed with the knowledge and tools to forge effective collaborations that will benefit their professional development, as well as the health of future patients.

          Learning Objectives:

          1. Understand the differences in intellectual approach between basic, translational, and clinical research, and the role that a pathologist collaborator can play in each.
          2. Learn the advantages and disadvantages of common methods employed in clinically relevant research, and the time scales and effort required for the execution of each.
          3. Recognize the various types of personnel that a pathologist might interact with in the course of pursuing a research collaboration, and describe their roles, responsibilities, and degree of autonomy.
          4. Identify situations in which misaligned goals and expectations between researchers and
          5. pathologists hinder effective collaboration and learn to take proactive steps to prevent and resolve such conflicts.
            Pulmonary Pathology

            A Practical Approach to Lymphoid Neoplasm of the Lung and Pleura: Lessons from a Pulmonary Pathology Consultation Service

            Faculty: Katalin Kelemen, MD, PhD, Mayo Clinic

            Professional Practice Gap:

            Most pathologists evaluate a large number of lung biopsies with carcinoma and are familiar with the diagnosis and ancillary testing in this context. However, lymphoid proliferations in lung and pleura represent a challenge. The diagnosis of lymphoma has a profound impact on the clinical management. Pathologist should be equipped with a practical diagnostic approach and should understand how to use ancillary tests efficiently. Our experience in a high-volume pulmonary pathology consultation practice shows that lung biopsies with lymphoid proliferations are often submitted for expert consultation and represent a diagnostic challenge for many pathologists. Furthermore, pathologists struggle with the selection of appropriate ancillary tests, sometimes exhausting limited samples before a diagnosis can be reached.

            Learning Objectives:

            1. Describe a diagnostic approach to the biopsy of a lung mass showing a lymphoid infiltrate composed of small lymphocytes and plasma cells, using immunohistochemistry and an appropriate B-lymphoid clonality testing for the diagnosis of pulmonary MALT lymphoma, and to differentiate from another type of low-grade B-cell lymphoma.
            2. Describe a diagnostic approach to mass lesions that may be associated with MALT lymphoma in the lung, including amyloidosis, light chain deposition disease, and crystal storing histiocytosis.
            3. Describe a diagnostic approach to the diagnosis of diffuse large B-cell lymphoma in the lung, with or without a concomitant pulmonary MALT lymphoma.
            4. Describe a diagnostic approach to classic Hodgkin lymphoma in the lung.
            5. Discuss the clinical spectrum of EBV-positive large B-cell lymphomas that occur in the lung and describe a diagnostic approach to these types of lymphomas. Acquire knowledge of the new terminology assigned by WHO-5 and ICC classifications.
            6. Describe a diagnostic approach to large cell lymphomas occurring in pleural fluid and explain how to differentiate between HHV8+ and HHV8- primary effusion lymphomas versus other types of large cell lymphomas in this context.