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Utility of PAX8 in Diagnosis of Müllerian-derived Carcinomas of Female Genital Tract in Cytology
S54 Conclusions: These data indicate that a panel constitutive of HMGA2/ p53 positive and calretinin-negative/weak immunoreactions support the presence of serous carcinoma cells in peritoneal fluids and that HMGA2 is likely involved in the pathogenesis and progression of epithelial ovarian cancer. (Supported by OCRF Program Project Developmental Grant). 91 Utility of PAX8 in Diagnosis of Müllerian-derived Carcinomas of Female Genital Tract in Cytology Scott Whitworth, MD, Zahra Maleki, MD. Cytopathology, The Johns Hopkins Hospital, Baltimore, Maryland Introduction: Paired-box gene 8, PAX8, encodes a nuclear transcription factor protein which is expressed in neoplastic and normal tissues in a lineage-restricted manner. The reported restricted tissue expression includes kidney, thyroid, thymus, and Müllerian-derived organs of the female genital tract. In the evaluation of a metastatic adenocarcinoma, lineage-restricted immunohistochemical markers can be exploited to narrow the clinical differential diagnosis or prove a site of origin. We describe our experience with PAX8 immunohistochemistry to detect Müllerian-derived carcinomas or tissues in cell block preparations from women with a recent or remote history of carcinoma. Materials and Methods: The computerized database at The Johns Hopkins Hospital was searched for cytology specimens, from January 2009 to March 2012, in which PAX8 immunohistochemistry was performed during the diagnostic workup of female patients. 16 of 37 cases from female patients who had a recent or remote history of carcinoma of Müllerian -derived organs were selected for this study. Immunohistochemical studies were performed on cell block preparation. All cytology material including immunohistochemical stains were reviewed. PAX8, WT-1, ER, and PR were immunostains of interest while all available immunostains were reviewed. Additional surgical pathology follow-up specimens were reviewed, when available. Radiologic, clinical, and pathologic information for each patient was collected. Results: There were 16 specimens from 16 patients. Their age ranged from 9 years to 85 years (mean 59 years). The study included specimens from lymph node (6), abdominal fluid (4), pleural effusion (3), pancreas (1), lung (1), and omentum (1). All 16 cases were immunoreactive for PAX8 (nuclear staining). 5/10 cases were immunoreactive for WT-1. 7/9 cases were immunoreactive for ER and 4/8 were immunoreactive for PR. Only 2/6 cases were immunoreactive for all PAX8, WT-1, ER and PR. 15/16 PAX8 positive cases were carcinomas from the ovaries (13/16), uterus (1/16) and cervix (1/16). 6/16 cases were diagnosed poorly differentiated adenocarcinoma on cytology. Papillary features were noted in one case. Among histology confirmed tumor types were high grade serous carcinoma, clear cell carcinoma of the ovary, yolk sac tumor and endocervical adenocarcinoma. One patient had history of both high grade serous carcinoma of the ovary and ductal breast carcinoma. One case presented with a large pancreatic mass. One of 161/16 cases showed benign appearing epithelium with psammoma bodies consistent with Müllerian origin in abdominal wash. Concurrent histology showed endosalpingiosis, serous cystadenofibroam, and proliferative strüma ovarii. A number of immunostains such as PAX2, CK20, mammoglobin, GCDFP, S100, TTF-1, Napsin-A, CD10, and CK5/6 were all negative whenever they were available. Conclusions: PAX8 immunohistochemistry performed on cell block preparation from cytology specimens in female patients is a useful ancillary test. The lineage-restricted expression of PAX8 is particularly helpful in identifying carcinomas arising from the female genital tract. Addition of PAX8 to immunostaining panel along with proper clinical history can confirm the Müllerian-derived origin of carcinomas especially when mammary breast carcinomas are in differential diagnosis.
Abstracts 92 Cervical Cancer Screening in a Never or Rarely Screened Indigent Inner City Latina Population: A Collaborative Project of the CAP See, Test, and Treat Program, Diaz de la Mujer Latina and The Methodist Hospital Debora Smith, CT(ASCP)1, Sonia Robazetti Hodgson, MD, CCRC2, Mary Schwartz, MD1, Blythe Gorman, MD1, Dina Mody, MD1, Patricia Chevez-Barrios, MD1, Donna Coffey, MD1. 1Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas; 2Department of Obstetrics and Gynecology, The Methodist Hospital, Houston, Texas Introduction: Currently there are projects focusing on global cervical cancer screening in developing countries. At the same time there is a perceived sense of cervical cancer over-screening in the West. However there is significant underserved populations in the US with limited access to cancer screening and other health care. Through a collaborative effort of the College of American Pathologist (CAP) See, Test and Treat program; Dia de la Mujer Latina (DML) and Methodist Hospital we targeted women who had either never had a Pap test or had not had one in over five years in a one day single visit cervical cancer screening program. Materials and Methods: The women were seen at a community center in southwest Houston six miles from the Texas Medical Center. Weeks of careful planning preceded the event to ensure rapid turnaround. We were not required to obtain a special CLIA certificate for high complexity testing, as the cytologic evaluation was done in our hospital laboratory. Volunteers at the site included pathologists, Spanish speaking Pathology residents, gynecologists, nurse practitioners, DML Promotoras and a variety of support staff from the hospital. The women received Pap tests and clinical breast exams. There were educational sessions in Spanish provided by pathologists while the women were waiting for their pap test results. Breast FNA biopsies were provided on-site by cytopathologists for those women found to have a palpable breast mass. The ability to provide rapid Pap test results was carefully orchestrated through a team effort. A courier service supplemented by a volunteer runner from hospital ramp drop-off to the laboratory, kept specimens coming to the lab in a continuous fashion. Two cytology preparatory techs and three cytotechnologists processed and screened the liquid based Pap tests. While the entire process was focused on rapid turn-around, there was strict adherence to CLIA’88 regulations and limitations. Two cytopathologists were present in the laboratory, interpreting abnormal Pap tests and faxing reports to the community center. Women with abnormal Pap tests underwent colposcopy at the site. Results: 108 women who had never or rarely been screened received a pelvic and breast examination and a Pap test through the CAP See, Test and Treat program. Of these women, 8 had abnormal Pap tests and 5 of these underwent same day colposcopy and cervical biopsies. An additional 119 women had Pap tests with funding provided by The Methodist Hospital. The rapid screening and examination of patients was limited by the time the community center was available to the health team, with more women showing up than anticipated. Conclusions: While there is a huge need to provide screening on a global scale, charity should begin at home. Our experience demonstrates that cytology can be used effectively in a single visit see and treat program. Screening with cytologic and subsequent tissue confirmation has significant advantages over visual inspection and ablation. A well organized screening program can deliver high quality care with rapid turnaround time. As cytology professionals and members of committed organizations, we have the training and resources to organize programs to screen those in our society with limited access to health care due to lack of medical insurance or other barriers such as cultural beliefs, language barriers or unawareness of how to obtain appropriate screening.
Abstracts 92 Cervical Cancer Screening in a Never or Rarely Screened Indigent Inner City Latina Population: A Collaborative Project of the CAP See, Test, and Treat Program, Diaz de la Mujer Latina and The Methodist Hospital Debora Smith, CT(ASCP)1, Sonia Robazetti Hodgson, MD, CCRC2, Mary Schwartz, MD1, Blythe Gorman, MD1, Dina Mody, MD1, Patricia Chevez-Barrios, MD1, Donna Coffey, MD1. 1Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, Texas; 2Department of Obstetrics and Gynecology, The Methodist Hospital, Houston, Texas Introduction: Currently there are projects focusing on global cervical cancer screening in developing countries. At the same time there is a perceived sense of cervical cancer over-screening in the West. However there is significant underserved populations in the US with limited access to cancer screening and other health care. Through a collaborative effort of the College of American Pathologist (CAP) See, Test and Treat program; Dia de la Mujer Latina (DML) and Methodist Hospital we targeted women who had either never had a Pap test or had not had one in over five years in a one day single visit cervical cancer screening program. Materials and Methods: The women were seen at a community center in southwest Houston six miles from the Texas Medical Center. Weeks of careful planning preceded the event to ensure rapid turnaround. We were not required to obtain a special CLIA certificate for high complexity testing, as the cytologic evaluation was done in our hospital laboratory. Volunteers at the site included pathologists, Spanish speaking Pathology residents, gynecologists, nurse practitioners, DML Promotoras and a variety of support staff from the hospital. The women received Pap tests and clinical breast exams. There were educational sessions in Spanish provided by pathologists while the women were waiting for their pap test results. Breast FNA biopsies were provided on-site by cytopathologists for those women found to have a palpable breast mass. The ability to provide rapid Pap test results was carefully orchestrated through a team effort. A courier service supplemented by a volunteer runner from hospital ramp drop-off to the laboratory, kept specimens coming to the lab in a continuous fashion. Two cytology preparatory techs and three cytotechnologists processed and screened the liquid based Pap tests. While the entire process was focused on rapid turn-around, there was strict adherence to CLIA’88 regulations and limitations. Two cytopathologists were present in the laboratory, interpreting abnormal Pap tests and faxing reports to the community center. Women with abnormal Pap tests underwent colposcopy at the site. Results: 108 women who had never or rarely been screened received a pelvic and breast examination and a Pap test through the CAP See, Test and Treat program. Of these women, 8 had abnormal Pap tests and 5 of these underwent same day colposcopy and cervical biopsies. An additional 119 women had Pap tests with funding provided by The Methodist Hospital. The rapid screening and examination of patients was limited by the time the community center was available to the health team, with more women showing up than anticipated. Conclusions: While there is a huge need to provide screening on a global scale, charity should begin at home. Our experience demonstrates that cytology can be used effectively in a single visit see and treat program. Screening with cytologic and subsequent tissue confirmation has significant advantages over visual inspection and ablation. A well organized screening program can deliver high quality care with rapid turnaround time. As cytology professionals and members of committed organizations, we have the training and resources to organize programs to screen those in our society with limited access to health care due to lack of medical insurance or other barriers such as cultural beliefs, language barriers or unawareness of how to obtain appropriate screening.