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An overview of morphological types of hepatocellular carcinoma with special emphasis on emerging epidemiological trends
PATHOLOGY UPDATE 2009 ABSTRACT PUBLICATION
WHO CLASSIFICATION OF TUMOURS OF HAEMOPOIETIC AND LYMPHOID TISSUES WHAT’S NEW IN THE LYMPHOMAS?
Benhur Amanuel1, John Miliauskas2, Debra Norris3, David Ellis2 1 PathWest, Perth, Western Australia 2 Gribbles Pathology and SA Pathology, Adelaide, South Australia 3 QML Pathology, Brisbane, Queensland, Australia The World Health Organization (WHO) Classification of Tumours of the Haemopoietic and Lymphoid Tissues (4th Edition), published in 2008, incorporates new information that has emerged from basic and clinical investigation in the interval since publication of the 3rd edition. Most of the changes are incremental but some have implications for clinical management. A number of EBV-related diseases of both T-cell and B-cell lineage have been defined and included. Cutaneous lymphomas of B-cell and T-cell lineage recently defined in the consensus EORTC/WHO classification have been incorporated into what is now a single classification scheme and these account for many of the changes in the T/NK cell neoplasms. ‘Blastoid T/NK cell lymphoma’, now understood to be a tumour of plasmacytoid dendritic cell origin, is reclassified under acute myeloid leukaemia and related precursor neoplasms. In the indolent B-cell lymphomas, paediatric variants of follicular and marginal zone lymphomas have been added. In the aggressive B-cell neoplasms, diffuse large b-cell lymphoma, its many variants and its interface with Burkitt lymphoma and classical Hodgkin lymphoma has been revised and developed with the inclusion of borderline categories which have implications for both diagnosis and management.
NATIONAL ROUND TABLE FOR STRUCTURED PATHOLOGY REPORTING OF CANCER David Ellis1, Michael Legg2, Anna Burnham3 1 Royal College of Pathologists of Australasia 2 Michael Legg and Associates; Health Informatics Society of Australia 3 Cancer Institute, NSW, Australia Background: In contrast to the United Kingdom and United States, there is no national framework for the development and dissemination of structured pathology reporting protocols in Australia. The National Round Table (NRT) was established to develop this national framework in addition to a number of cancer specific structured pathology reporting (SPR) standards. Synopsis: The project is lead by the Cancer Institute NSW, the Royal College of Pathologists of Australasia (RCPA) and Cancer Australia. Expert, multidisciplinary committees have developed five specific cancer-reporting protocols (Colorectal, Lung, Lymphoma, Melanoma and Prostate) and a generic Framework for the Development of SPR Protocols. A process for the endorsement and revision of the protocols is also under development in conjunction with the Cancer Services Advisory Committee (CanSAC) of the RCPA. Following a period of public consultation the Framework and protocols will be published on the RCPA website. Standards for the secure electronic delivery of these structured reports are also being investigated as part of the project. Structured reporting of cancer cases in anatomical pathology and haematology is likely to contribute to better cancer control through improvements in clinical management and treatment planning, cancer notification, registration and aggregated analyses, and research.
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AN OVERVIEW OF MORPHOLOGICAL TYPES OF HEPATOCELLULAR CARCINOMA WITH SPECIAL EMPHASIS ON EMERGING EPIDEMIOLOGICAL TRENDS Aileen Wee Department of Pathology, National University of Singapore, National University Hospital, National University Health System, Singapore Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third leading cause of cancer-related death. The incidence rate is increasing globally with about one-half to one million new cases per year, causing 600 000 deaths annually. The incidence in eastern Asia and sub-Saharan Africa is more than five times that of North America. Major risk factors include chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and alcoholic cirrhosis. In Asia, HBV is still the leading cause for HCC. Mass vaccination programs launched against HBV in East Asia in the 1980s should lead to a decline in HCC cases in the next two to three decades. The shift towards male population and younger persons noted in the United States over the last two decades coincides with the prevalence of HCV infection. An emerging risk factor is the insulin resistance syndrome, manifesting as obesity and diabetes mellitus; and possibly acting through formation of non-alcoholic fatty liver disease. The section on the morphological overview of HCC will include: (i) liver stem cells and their implication in hepatocellular and cholangiocarcinoma, (ii) variations and variants of HCC, (iii) diagnostic utility of immunohistochemistry; and (iv) prognostic factors and molecular markers.
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALASIA QUALITY ASSURANCE PROGRAM REVIEW OF ORAL PATHOLOGY 2008 MODULE Michael Aldred Dorevitch Pathology, Melbourne, Victoria, Australia Twenty cases were circulated for the Oral Pathology QAP module in 2008. The survey was distributed to 83 participants in a range of Australian and international laboratories and all responded to at least some of the cases. There were 1541 responses out of a possible 1635, an average of 94%. 74% of responses were concordant and 18% were assessed as minor discordance. Differential diagnoses were used rarely as a response to the cases (3%). Discordant responses were a low proportion (17%) of responses. Participants had most difficulty in case DE08-05 of epithelial hyperkeratosis and moderate epithelial dysplasia (55% discordance). There were no responses that were unable to be assessed. The maximum of 20 concordant responses was obtained by six (7%) of the participants. The median values were 14 concordant responses, two minor discordance, zero differential diagnosis only and two discordant responses. 18% of participants submitted four or more minor discordant responses. 16% of participants submitted five or more discordant responses with two participants submitting the maximum of seven discordant responses. The module and selected cases will be discussed.
TWO CASES OF A PREVIOUSLY UNDESCRIBED ODONTOGENIC CYST/TUMOUR VARIANT Michael Aldred1, Anna Talacko1, Anne Gordon1, Neil Savage2, Mervyn Shear3 1 Dorevitch Pathology, Melbourne, Victoria, Australia 2 Department of Anatomical Pathology, Royal Brisbane Hospital, Brisbane, Queensland, Australia
WHO CLASSIFICATION OF TUMOURS OF HAEMOPOIETIC AND LYMPHOID TISSUES WHAT’S NEW IN THE LYMPHOMAS?
Benhur Amanuel1, John Miliauskas2, Debra Norris3, David Ellis2 1 PathWest, Perth, Western Australia 2 Gribbles Pathology and SA Pathology, Adelaide, South Australia 3 QML Pathology, Brisbane, Queensland, Australia The World Health Organization (WHO) Classification of Tumours of the Haemopoietic and Lymphoid Tissues (4th Edition), published in 2008, incorporates new information that has emerged from basic and clinical investigation in the interval since publication of the 3rd edition. Most of the changes are incremental but some have implications for clinical management. A number of EBV-related diseases of both T-cell and B-cell lineage have been defined and included. Cutaneous lymphomas of B-cell and T-cell lineage recently defined in the consensus EORTC/WHO classification have been incorporated into what is now a single classification scheme and these account for many of the changes in the T/NK cell neoplasms. ‘Blastoid T/NK cell lymphoma’, now understood to be a tumour of plasmacytoid dendritic cell origin, is reclassified under acute myeloid leukaemia and related precursor neoplasms. In the indolent B-cell lymphomas, paediatric variants of follicular and marginal zone lymphomas have been added. In the aggressive B-cell neoplasms, diffuse large b-cell lymphoma, its many variants and its interface with Burkitt lymphoma and classical Hodgkin lymphoma has been revised and developed with the inclusion of borderline categories which have implications for both diagnosis and management.
NATIONAL ROUND TABLE FOR STRUCTURED PATHOLOGY REPORTING OF CANCER David Ellis1, Michael Legg2, Anna Burnham3 1 Royal College of Pathologists of Australasia 2 Michael Legg and Associates; Health Informatics Society of Australia 3 Cancer Institute, NSW, Australia Background: In contrast to the United Kingdom and United States, there is no national framework for the development and dissemination of structured pathology reporting protocols in Australia. The National Round Table (NRT) was established to develop this national framework in addition to a number of cancer specific structured pathology reporting (SPR) standards. Synopsis: The project is lead by the Cancer Institute NSW, the Royal College of Pathologists of Australasia (RCPA) and Cancer Australia. Expert, multidisciplinary committees have developed five specific cancer-reporting protocols (Colorectal, Lung, Lymphoma, Melanoma and Prostate) and a generic Framework for the Development of SPR Protocols. A process for the endorsement and revision of the protocols is also under development in conjunction with the Cancer Services Advisory Committee (CanSAC) of the RCPA. Following a period of public consultation the Framework and protocols will be published on the RCPA website. Standards for the secure electronic delivery of these structured reports are also being investigated as part of the project. Structured reporting of cancer cases in anatomical pathology and haematology is likely to contribute to better cancer control through improvements in clinical management and treatment planning, cancer notification, registration and aggregated analyses, and research.
9
AN OVERVIEW OF MORPHOLOGICAL TYPES OF HEPATOCELLULAR CARCINOMA WITH SPECIAL EMPHASIS ON EMERGING EPIDEMIOLOGICAL TRENDS Aileen Wee Department of Pathology, National University of Singapore, National University Hospital, National University Health System, Singapore Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third leading cause of cancer-related death. The incidence rate is increasing globally with about one-half to one million new cases per year, causing 600 000 deaths annually. The incidence in eastern Asia and sub-Saharan Africa is more than five times that of North America. Major risk factors include chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and alcoholic cirrhosis. In Asia, HBV is still the leading cause for HCC. Mass vaccination programs launched against HBV in East Asia in the 1980s should lead to a decline in HCC cases in the next two to three decades. The shift towards male population and younger persons noted in the United States over the last two decades coincides with the prevalence of HCV infection. An emerging risk factor is the insulin resistance syndrome, manifesting as obesity and diabetes mellitus; and possibly acting through formation of non-alcoholic fatty liver disease. The section on the morphological overview of HCC will include: (i) liver stem cells and their implication in hepatocellular and cholangiocarcinoma, (ii) variations and variants of HCC, (iii) diagnostic utility of immunohistochemistry; and (iv) prognostic factors and molecular markers.
ROYAL COLLEGE OF PATHOLOGISTS OF AUSTRALASIA QUALITY ASSURANCE PROGRAM REVIEW OF ORAL PATHOLOGY 2008 MODULE Michael Aldred Dorevitch Pathology, Melbourne, Victoria, Australia Twenty cases were circulated for the Oral Pathology QAP module in 2008. The survey was distributed to 83 participants in a range of Australian and international laboratories and all responded to at least some of the cases. There were 1541 responses out of a possible 1635, an average of 94%. 74% of responses were concordant and 18% were assessed as minor discordance. Differential diagnoses were used rarely as a response to the cases (3%). Discordant responses were a low proportion (17%) of responses. Participants had most difficulty in case DE08-05 of epithelial hyperkeratosis and moderate epithelial dysplasia (55% discordance). There were no responses that were unable to be assessed. The maximum of 20 concordant responses was obtained by six (7%) of the participants. The median values were 14 concordant responses, two minor discordance, zero differential diagnosis only and two discordant responses. 18% of participants submitted four or more minor discordant responses. 16% of participants submitted five or more discordant responses with two participants submitting the maximum of seven discordant responses. The module and selected cases will be discussed.
TWO CASES OF A PREVIOUSLY UNDESCRIBED ODONTOGENIC CYST/TUMOUR VARIANT Michael Aldred1, Anna Talacko1, Anne Gordon1, Neil Savage2, Mervyn Shear3 1 Dorevitch Pathology, Melbourne, Victoria, Australia 2 Department of Anatomical Pathology, Royal Brisbane Hospital, Brisbane, Queensland, Australia