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IgG4-related sclerosing disease: a disease that may turn up in myriad (and unexpected) anatomic sites
S12
PATHOLOGY UPDATE 2010 ABSTRACTS
ensure that the reagents and instruments are working. In many cases for immunohistochemistry the controls selected are inappropriate, excessively large, show fixation variation or only reflect one level of staining. Conclusion: High quality IHC results are essential to enable treating clinicians to optimise therapy for patients. The introduction and expansion of a specific quality assurance module for immunohistochemistry has enabled an ongoing assessment of the performance of biomarkers in Australia, New Zealand and South-East Asia. Despite the extraction of large amounts of information in regards to the methodology used for staining, it is usually not possible to identify one specific method that results in optimal staining although sample methods with high marks are reported. Optimisation of retrieval for a wide range of sensitivities is considered to be the important factor in achieving satisfactory results. The development of the program has resulted in an improvement in the staining quality for a number of biomarkers. Comments in this report were prepared for and on behalf of the RCPA QAP. References 1. Regitnig P, Reiner A, Dinges HP, et al. Quality assurance for detection of estrogen and progesterone receptors by immunohistochemistry in Austrian pathology laboratories. Virchows Arch 2002; 441: 328–34. 2. Yaziji H, Barry TS, Goldstein LC, et al. Discrepancies between immunohistochemistry and fluorescence in-situ hybridization for HER-2 testing in breast cancer: The role of a quality assurance program on a cohort of 3564 patients. ASCO Annual Meeting Proceedings. J Clin Oncol 2004; 22 (Suppl): 679.
MY APPROACH TO MONOMORPHIC SPINDLE CELL PROLIFERATIONS Jesse McKenney Stanford University School of Medicine, California, United States Although a wide spectrum of entities characterised by a monomorphic spindle cell proliferation has been described, there are few general discussions of how monomorphic benign and malignant processes are distinguished histologically. We will discuss a general approach to evaluating these lesions that focuses on contrasting low power architecture, subtle cytologic differences, associated vascular patterns, and the ‘allowable’ clinical/pathologic spectrum. Much of the discussion is based on the spectrum of reactive myofibroblastic proliferations and their distinction from prototypical monomorphic neoplasms such as monophasic synovial sarcoma and low grade myxofibrosarcoma.
UTERINE SMOOTH MUSCLE TUMOURS: AN UPDATE Jesse McKenney Stanford University School of Medicine, California, United States Smooth muscle neoplasms of the uterus are classified by specific criteria that differ from those generally applied to tumours arising in other anatomic sites. This presentation will discuss the diagnostic criteria for leiomyoma, atypical leiomyoma, and leiomyosarcoma, as well as the clinical implications of each diagnostic category. The morphologic spectrum of leiomyoma, including ‘morphologic variants’ that may mimic malignancy,
Pathology (2010), 42(S1)
will be included. Distinct criteria for myxoid and epithelioid uterine smooth muscle tumours and the use of the descriptive diagnosis ‘smooth muscle neoplasm of uncertain malignant potential (STUMP)’ will also be addressed. Finally, we will discuss differential diagnostic considerations such as endometrial stromal sarcoma and uterine PEComa.
THE IMPORTANCE OF MOLECULAR AND ANATOMIC PATHOLOGY IN CANCER MANAGEMENT D. M. Thomas Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Cancers are routinely classified on anatomic and histologic criteria. Over the past 20 years, the impact of molecular classifications have become more and more fundamental to accurate diagnosis and prognosis, and increasingly, to selection of therapeutic options. The next 20 years are likely to see the development of sophisticated molecular characterisation of tumours, paralleled by access to a broad range of molecularly targeted therapeutic agents. It is already clear that the response to such agents is predicated on a full understanding of the molecular genetics of cancer. In this presentation, I will discuss the impact of molecular biology on cancer classification and treatment, with a special emphasis on sarcomas.
IGG4-RELATED SCLEROSING DISEASE: A DISEASE THAT MAY TURN UP IN MYRIAD (AND UNEXPECTED) ANATOMIC SITES John K. C. Chan Department of Pathology, Queen Elizabeth Hospital, Hong Kong IgG4-related sclerosing disease is a syndrome characterised clinically by mass lesions which commonly involve exocrine glands, elevated serum IgG4 titre, frequent presence of circulating auto-antibodies, and favourable clinical response to steroid therapy, and pathologically by lymphoplasmacytic infiltration, sclerosis, phlebitis and increased IgG4 þ plasma cells. The histologic features can be broadly categorised into three patterns: pseudolymphomatous (Pattern I), mixed (Pattern II) and sclerosing (Pattern III). These patterns may not represent distinct histologic manifestations, but probably snap-shots in the morphologic evolution of the disease. Immunohistochemistry plays an important role in confirming the diagnosis: absolute number of IgG4 þ plasma cells should be over 50 per high power field in areas with the largest number of positive cells, and the IgG4/IgG percentage should be over 40%. While the pancreas is the prototypic site of involvement (autoimmune pancreatitis), increasing sites are recognised to be involved by the disease, sometimes quite unexpectedly. Examples include hepatobiliary tree, lacrimal gland, salivary gland, lymph node, prostate, lung, kidney, soft tissue, retroperitoneum, mesentery, aorta, mediastinum, breast, pituitary, meninges, upper aerodigestive tract and skin. Most patients have disease involving two or more sites, in various combinations, with or without pancreatic involvement, although the disease can rarely be confined to one organ-system.
PATHOLOGY UPDATE 2010 ABSTRACTS
ensure that the reagents and instruments are working. In many cases for immunohistochemistry the controls selected are inappropriate, excessively large, show fixation variation or only reflect one level of staining. Conclusion: High quality IHC results are essential to enable treating clinicians to optimise therapy for patients. The introduction and expansion of a specific quality assurance module for immunohistochemistry has enabled an ongoing assessment of the performance of biomarkers in Australia, New Zealand and South-East Asia. Despite the extraction of large amounts of information in regards to the methodology used for staining, it is usually not possible to identify one specific method that results in optimal staining although sample methods with high marks are reported. Optimisation of retrieval for a wide range of sensitivities is considered to be the important factor in achieving satisfactory results. The development of the program has resulted in an improvement in the staining quality for a number of biomarkers. Comments in this report were prepared for and on behalf of the RCPA QAP. References 1. Regitnig P, Reiner A, Dinges HP, et al. Quality assurance for detection of estrogen and progesterone receptors by immunohistochemistry in Austrian pathology laboratories. Virchows Arch 2002; 441: 328–34. 2. Yaziji H, Barry TS, Goldstein LC, et al. Discrepancies between immunohistochemistry and fluorescence in-situ hybridization for HER-2 testing in breast cancer: The role of a quality assurance program on a cohort of 3564 patients. ASCO Annual Meeting Proceedings. J Clin Oncol 2004; 22 (Suppl): 679.
MY APPROACH TO MONOMORPHIC SPINDLE CELL PROLIFERATIONS Jesse McKenney Stanford University School of Medicine, California, United States Although a wide spectrum of entities characterised by a monomorphic spindle cell proliferation has been described, there are few general discussions of how monomorphic benign and malignant processes are distinguished histologically. We will discuss a general approach to evaluating these lesions that focuses on contrasting low power architecture, subtle cytologic differences, associated vascular patterns, and the ‘allowable’ clinical/pathologic spectrum. Much of the discussion is based on the spectrum of reactive myofibroblastic proliferations and their distinction from prototypical monomorphic neoplasms such as monophasic synovial sarcoma and low grade myxofibrosarcoma.
UTERINE SMOOTH MUSCLE TUMOURS: AN UPDATE Jesse McKenney Stanford University School of Medicine, California, United States Smooth muscle neoplasms of the uterus are classified by specific criteria that differ from those generally applied to tumours arising in other anatomic sites. This presentation will discuss the diagnostic criteria for leiomyoma, atypical leiomyoma, and leiomyosarcoma, as well as the clinical implications of each diagnostic category. The morphologic spectrum of leiomyoma, including ‘morphologic variants’ that may mimic malignancy,
Pathology (2010), 42(S1)
will be included. Distinct criteria for myxoid and epithelioid uterine smooth muscle tumours and the use of the descriptive diagnosis ‘smooth muscle neoplasm of uncertain malignant potential (STUMP)’ will also be addressed. Finally, we will discuss differential diagnostic considerations such as endometrial stromal sarcoma and uterine PEComa.
THE IMPORTANCE OF MOLECULAR AND ANATOMIC PATHOLOGY IN CANCER MANAGEMENT D. M. Thomas Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Cancers are routinely classified on anatomic and histologic criteria. Over the past 20 years, the impact of molecular classifications have become more and more fundamental to accurate diagnosis and prognosis, and increasingly, to selection of therapeutic options. The next 20 years are likely to see the development of sophisticated molecular characterisation of tumours, paralleled by access to a broad range of molecularly targeted therapeutic agents. It is already clear that the response to such agents is predicated on a full understanding of the molecular genetics of cancer. In this presentation, I will discuss the impact of molecular biology on cancer classification and treatment, with a special emphasis on sarcomas.
IGG4-RELATED SCLEROSING DISEASE: A DISEASE THAT MAY TURN UP IN MYRIAD (AND UNEXPECTED) ANATOMIC SITES John K. C. Chan Department of Pathology, Queen Elizabeth Hospital, Hong Kong IgG4-related sclerosing disease is a syndrome characterised clinically by mass lesions which commonly involve exocrine glands, elevated serum IgG4 titre, frequent presence of circulating auto-antibodies, and favourable clinical response to steroid therapy, and pathologically by lymphoplasmacytic infiltration, sclerosis, phlebitis and increased IgG4 þ plasma cells. The histologic features can be broadly categorised into three patterns: pseudolymphomatous (Pattern I), mixed (Pattern II) and sclerosing (Pattern III). These patterns may not represent distinct histologic manifestations, but probably snap-shots in the morphologic evolution of the disease. Immunohistochemistry plays an important role in confirming the diagnosis: absolute number of IgG4 þ plasma cells should be over 50 per high power field in areas with the largest number of positive cells, and the IgG4/IgG percentage should be over 40%. While the pancreas is the prototypic site of involvement (autoimmune pancreatitis), increasing sites are recognised to be involved by the disease, sometimes quite unexpectedly. Examples include hepatobiliary tree, lacrimal gland, salivary gland, lymph node, prostate, lung, kidney, soft tissue, retroperitoneum, mesentery, aorta, mediastinum, breast, pituitary, meninges, upper aerodigestive tract and skin. Most patients have disease involving two or more sites, in various combinations, with or without pancreatic involvement, although the disease can rarely be confined to one organ-system.