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Pathology reporting in oral cancer: a proposed structured reporting system for Australasia
S10
Pathology (2011), 43(S1)
PATHOLOGY 2011 ABSTRACT SUPPLEMENT
organised hypertrophic zone and poorly ossified. Chromosome analysis showed a normal female karyotype, and there was a CANT1 gene mutation by direct sequencing. A subsequent pregnancy was terminated surgically at 12 weeks when ultrasound examination showed a large fetal nuchal translucency, short femurs, and small thorax suggesting a recurrence of the condition. Examination of the parts found shortened halluces. IN SITU HYBRIDISATION: BACKGROUND AND APPLICATIONS Adrienne L. Morey SydPath Anatomical Pathology, St Vincent’s Hospital, Darlinghurst, NSW, Australia In situ hybridisation (ISH) offers molecular diagnosis in a morphological context. Over the last 20 years the technique has moved from research tool to mainstream pathology test with the advent of chromogenic assays, an increasing variety of commercially available probes, and automated hybridisation platforms. The technique can be used to detect DNA or RNA depending on the hybridisation protocol, and can be applied at both light microscopy (LM) and electron microscopy (EM) levels. Troubleshooting problems requires a basic understanding of the technique including probe design and stringency. ISH offers the possibility of simultaneous detection of multiple molecular targets, and/or co-detection of gene and protein targets (via IHC), allowing phenotyping of a cell containing a molecular target, or co-analysis of a target gene and its expression. Current clinical applications include detection of virus (EBV, HPV), analysis of chromosomal translocations or losses (haematological malignancies, sarcomas, small blue cell tumours, gliomas), identification of gene amplification (HER2, EGFR), and tracking of host vs donor cells in sex-mismatched transplant patients (Y chromosome). CYSTS AND OTHER EPITHELIAL LESIONS INVOLVING OR CONTIGUOUS WITH TEETH: DIAGNOSTIC ESSENTIALS Norman Firth Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand Developmental cysts of the jaws reflect the unique process of odontogenesis and can present a diagnostic challenge. Inflammatory lesions related to the jaws and dentition can also be difficult to interpret and may not reflect the initial clinical impression. Clinical information and interpretation of radiographs and other imaging modalities are often essential to establishing a diagnosis. The purpose of this presentation is to highlight difficulties and provide discussion points to assist in the diagnosis of these lesions. PATHOLOGY REPORTING IN ORAL CANCER: A PROPOSED STRUCTURED REPORTING SYSTEM FOR AUSTRALASIA H. G. Coleman1, J. E. Dahlstrom2, N. W. Johnson3, E. Salisbury4, G. Morgan5, M. Veness6, D. Ellis7, M. Judge8 1 ICMPR, Westmead Hospital and the University of Sydney, NSW, 2 ACT Pathology, The Canberra Hospital and Australian National University Medical School, ACT, 3Griffith University, Qld, 4 SESIAHS, Prince of Wales Hospital, Sydney, NSW, 5Head and Neck Cancer Service, Westmead Hospital, NSW, 6Head and Neck
Cancer Service, Westmead Hospital and the University of Sydney, Sydney, NSW, 7SA Pathology and Flinders University, SA, and 8 Royal College of Pathologists of Australasia, Sydney, NSW, Australia Whilst schemes exist in the UK and North America, there is at present no internationally standardised instrument for reporting head and neck pathology. It can be difficult to assess and code information in reports across jurisdictions if there is lack of uniformity in content and presentation. Purpose: The aim of this protocol is to ensure that oral cancer pathology reports are uniform in their content, contain relevant information and can be easily interpreted to direct further treatment and provide a guide for discussing prognosis. Methodology: A multidisciplinary committee (comprising four pathologists, a head and neck surgeon and a radiation oncologist) was formed as part of the Cancer Services Advisory Committee of the Royal College of Pathologists of Australasia (RCPA) in 2010. Relevant stakeholders including the Australian and New Zealand Head and Neck Cancer Society will be invited to nominate a representative to review the protocol before endorsement by the RCPA. Results: The group has developed the standards and guidelines to be used. The protocol is in its final draft format and is ready for review by stakeholders. Discussion: It is envisaged that all oral cancer cases throughout Australasia will be reported according to this protocol, thus ensuring that all current histopathological prognosticators will be identified and included in a clinically and pathologically complete and standardised pathology report. MICROBIOTA OF THE HUMAN MOUTH: THE MOSTLY GOOD, OCCASIONALLY BAD. THE ROLE OF ORAL BIOFILMS IN LOCAL AND DISTANT DISEASE Newell W. Johnson Griffith University, Qld, Australia The human body carries orders of magnitude more micro-organisms on its external and internal surfaces than the number of eukaryotic cells of which we are made. A normal microflora is essential to life, and has to be protected. This is very true of the health-associated flora of the mouth, which should not be compromised by excessive oral hygiene measures, especially broad spectrum disinfectants such as are found in many commercial preparations. A full range of organisms from multicellular through unicellular paracytes, fungi, bacteria, viruses and prions are found: often in health, sometimes as pathogens. In respect of bacteria, the health-associated flora is incompletely understood: less than half of over 1000 species are cultivable, and thus their role in health and disease cannot be understood. These derive their nutrients predominantly from saliva and to a lesser extent from the serum of gingival crevicular fluid. Unusually in our knowledge of microbiology some of these commensals are capable of causing disease – notably dental caries in the presence of excess fermentable carbohydrate. Sequencing of the Salivary Microbiome reveals great diversity within and between individuals and over 60 totally unknown organisms: the microbiome of surface biofilms—‘dental plaque’ perhaps being of greatest interest because of its clear association with dental caries and with periodontal diseases—will prove to be even more complex. Such biofilms are communities with multiple synergisms and antagonisms. They exist in health and may
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2011), 43(S1)
PATHOLOGY 2011 ABSTRACT SUPPLEMENT
organised hypertrophic zone and poorly ossified. Chromosome analysis showed a normal female karyotype, and there was a CANT1 gene mutation by direct sequencing. A subsequent pregnancy was terminated surgically at 12 weeks when ultrasound examination showed a large fetal nuchal translucency, short femurs, and small thorax suggesting a recurrence of the condition. Examination of the parts found shortened halluces. IN SITU HYBRIDISATION: BACKGROUND AND APPLICATIONS Adrienne L. Morey SydPath Anatomical Pathology, St Vincent’s Hospital, Darlinghurst, NSW, Australia In situ hybridisation (ISH) offers molecular diagnosis in a morphological context. Over the last 20 years the technique has moved from research tool to mainstream pathology test with the advent of chromogenic assays, an increasing variety of commercially available probes, and automated hybridisation platforms. The technique can be used to detect DNA or RNA depending on the hybridisation protocol, and can be applied at both light microscopy (LM) and electron microscopy (EM) levels. Troubleshooting problems requires a basic understanding of the technique including probe design and stringency. ISH offers the possibility of simultaneous detection of multiple molecular targets, and/or co-detection of gene and protein targets (via IHC), allowing phenotyping of a cell containing a molecular target, or co-analysis of a target gene and its expression. Current clinical applications include detection of virus (EBV, HPV), analysis of chromosomal translocations or losses (haematological malignancies, sarcomas, small blue cell tumours, gliomas), identification of gene amplification (HER2, EGFR), and tracking of host vs donor cells in sex-mismatched transplant patients (Y chromosome). CYSTS AND OTHER EPITHELIAL LESIONS INVOLVING OR CONTIGUOUS WITH TEETH: DIAGNOSTIC ESSENTIALS Norman Firth Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand Developmental cysts of the jaws reflect the unique process of odontogenesis and can present a diagnostic challenge. Inflammatory lesions related to the jaws and dentition can also be difficult to interpret and may not reflect the initial clinical impression. Clinical information and interpretation of radiographs and other imaging modalities are often essential to establishing a diagnosis. The purpose of this presentation is to highlight difficulties and provide discussion points to assist in the diagnosis of these lesions. PATHOLOGY REPORTING IN ORAL CANCER: A PROPOSED STRUCTURED REPORTING SYSTEM FOR AUSTRALASIA H. G. Coleman1, J. E. Dahlstrom2, N. W. Johnson3, E. Salisbury4, G. Morgan5, M. Veness6, D. Ellis7, M. Judge8 1 ICMPR, Westmead Hospital and the University of Sydney, NSW, 2 ACT Pathology, The Canberra Hospital and Australian National University Medical School, ACT, 3Griffith University, Qld, 4 SESIAHS, Prince of Wales Hospital, Sydney, NSW, 5Head and Neck Cancer Service, Westmead Hospital, NSW, 6Head and Neck
Cancer Service, Westmead Hospital and the University of Sydney, Sydney, NSW, 7SA Pathology and Flinders University, SA, and 8 Royal College of Pathologists of Australasia, Sydney, NSW, Australia Whilst schemes exist in the UK and North America, there is at present no internationally standardised instrument for reporting head and neck pathology. It can be difficult to assess and code information in reports across jurisdictions if there is lack of uniformity in content and presentation. Purpose: The aim of this protocol is to ensure that oral cancer pathology reports are uniform in their content, contain relevant information and can be easily interpreted to direct further treatment and provide a guide for discussing prognosis. Methodology: A multidisciplinary committee (comprising four pathologists, a head and neck surgeon and a radiation oncologist) was formed as part of the Cancer Services Advisory Committee of the Royal College of Pathologists of Australasia (RCPA) in 2010. Relevant stakeholders including the Australian and New Zealand Head and Neck Cancer Society will be invited to nominate a representative to review the protocol before endorsement by the RCPA. Results: The group has developed the standards and guidelines to be used. The protocol is in its final draft format and is ready for review by stakeholders. Discussion: It is envisaged that all oral cancer cases throughout Australasia will be reported according to this protocol, thus ensuring that all current histopathological prognosticators will be identified and included in a clinically and pathologically complete and standardised pathology report. MICROBIOTA OF THE HUMAN MOUTH: THE MOSTLY GOOD, OCCASIONALLY BAD. THE ROLE OF ORAL BIOFILMS IN LOCAL AND DISTANT DISEASE Newell W. Johnson Griffith University, Qld, Australia The human body carries orders of magnitude more micro-organisms on its external and internal surfaces than the number of eukaryotic cells of which we are made. A normal microflora is essential to life, and has to be protected. This is very true of the health-associated flora of the mouth, which should not be compromised by excessive oral hygiene measures, especially broad spectrum disinfectants such as are found in many commercial preparations. A full range of organisms from multicellular through unicellular paracytes, fungi, bacteria, viruses and prions are found: often in health, sometimes as pathogens. In respect of bacteria, the health-associated flora is incompletely understood: less than half of over 1000 species are cultivable, and thus their role in health and disease cannot be understood. These derive their nutrients predominantly from saliva and to a lesser extent from the serum of gingival crevicular fluid. Unusually in our knowledge of microbiology some of these commensals are capable of causing disease – notably dental caries in the presence of excess fermentable carbohydrate. Sequencing of the Salivary Microbiome reveals great diversity within and between individuals and over 60 totally unknown organisms: the microbiome of surface biofilms—‘dental plaque’ perhaps being of greatest interest because of its clear association with dental caries and with periodontal diseases—will prove to be even more complex. Such biofilms are communities with multiple synergisms and antagonisms. They exist in health and may
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.