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Value of a surgical specimen museum in teaching of pathology to medical and allied health professionals
ABSTRACTS
Aims: We examined follicular lymphoma (FL) bone marrow (BM) involvement: frequency of low extent involvement, comparison of direct area measurement and a descriptive grading system and flow cytometry performance. We also assessed clinical predictors and clinical impact of FL BM status. Methods: 151 consecutive initial staging BM biopsies were reviewed. Area assessment used digital photomicrography of one biopsy level and outlining intertrabecular spaces and FL infiltrates (AxioVision 7.4). A descriptive grading system proposed by Groupe d’Etudes Lymphomes Folliculaires (GELF) was applied. Results: 63/151 (42%) BM were positive. Area measurement in 34 positive biopsies found area <1% in 7/34 (21%) and 1–10% in 14/34 (41%). GELF grade correlated with measured extent and showed excellent inter-observer reproducibility. Flow cytometry sensitivity, 59% overall (relative to histology), reduced to 29% when BM area was <1%. Discussion: Low extent BM involvement is common in FL, without consensus guidelines for staging purposes. This has implications for the individual (stage, prognostic risk) and in clinical trial interpretation (population risk, complete response rate). The prognostic significance of low extent involvement for rituximab treated cohorts is unknown. The descriptive GELF grade, validated in this series, provides a reproducible tool suitable for prospectively addressing this question. VALUE OF A SURGICAL SPECIMEN MUSEUM IN TEACHING OF PATHOLOGY TO MEDICAL AND ALLIED HEALTH PROFESSIONALS Ruta Gupta, Elaine G. Bean, Jane E. Dahlstrom Department of Anatomical Pathology, ACT Pathology, The Canberra Hospital and ANU Medical School, Canberra, ACT, Australia Tissue specimens remain important tools in medical education despite innovative imaging techniques and web based resources. Reduction in autopsies has made acquiring specimens difficult. Aim: To create a surgical specimen museum as a teaching resource. Methods: All surgical specimens are evaluated on accession in the department and photographed. The surgeon is contacted to obtain agreement to contact their patient. Following issue of the pathology report, a letter is sent to the patient inviting them to consent to donating their specimen. Following consent the specimen is either retained as a ‘wet’ specimen or mounted. Representative histology slides are produced. The students were surveyed as to the value of this learning resource. Results: This museum was established 7 years ago. Consent has been obtained from 706/867 patients approached. The spectrum of diseases includes inflamed appendices, hydatidiform moles and other specimens which would rarely be seen at autopsy. Students rated this resource very highly and patients who have chosen to view their specimen have indicated benefit. Conclusions: The spectrum of diseases represented in this museum is diverse and clinically relevant. There is widespread support from patients for the use of their surgical specimens for education. Students and patients have benefited from its establishment.
S57
Aim: To investigate the expression of the novel anti-apoptotic markers GRP78 and MUC13 in extramammary Paget’s disease (EMPD). Method: Twelve archival cases of EMPD, accessioned from 2001 until 2010 were assessed for expression of bcl-2, GRP78 and MUC13 using standard immunohistochemical and immunofluorescent techniques. Results: Twelve cases of EMPD were examined, four of which included an invasive component. Eight of twelve cases (67%) were positive for bcl2. Eight of eleven cases (72%), and four of eight cases (50%) with available tissue were positive for GRP78 and MUC13, respectively. Discussion: Bcl2 is a well known regulator of apoptosis. GRP78 overexpression has been shown to significantly increase resistance to apoptosis in vitro and in vivo. MUC13 is overexpressed in a range of epithelial malignancies, and has poorly defined antiapoptotic properties, as well as a role in proliferation activity via the p38MAPK signalling pathway, and anti-adhesive roles promoting cell motility. Our study has demonstrated an overexpression of the anti-apoptotic markers GRP78, MUC13, and bcl2 in EMPD. Overexpression of these anti-apoptotic markers is a novel finding in this disease and likely to be important in the pathogenesis of EMPD. EVALUATION OF THYROGLOBULIN ASSAYED BY BECKMAN ACCESS Xunjun Low, Roger Johnson, Linda Henderson Department of Chemical Pathology, Labplus, Auckland City Hospital, Auckland, New Zealand Aims: To evaluate a thyroglobulin chemiluminescent immunoassay (CLIA) on the Access (Beckman Coulter) as a possible replacement for the thyroglobulin CLIA on Immulite 2000 (Siemens). Methods and Results: 20 patient samples (0.14–473 mg/L) assayed in duplicate on the Access had an average CV (of duplicates) of 1.0% with none greater than 6%. Immulite QC plus a low pool sample (range 0.14–129.8 mg/L) run (n ¼ 41) over 3 weeks gave interbatch imprecision (CV) of 3.1–11.7%. A comparison between Access and Immulite method (as reference) using 20 patient samples (up to 600 mg/L) gave a slope of 0.70 and negligible intercept by Passing-Bablok analysis; least squares linear regression gave similar information. 17 samples containing different proportions of thyroglobulin were found on the Access to be linear up to 450 mg/L, the highest concentration tested. Interference from lipaemia, icterus, or haemolysis showed a difference from control of –2.6 to 0.3%. Discussion: Access thyroglobulin immunoassay has good precision, is linear to at least 450 mg/L, and suffers negligible interference from haemolysis, icterus and lipaemia. The major disparity with the Immulite assay is a negative bias (equivalent to slope of about 0.7), giving an upper limit of the reference interval of 40 mg/L rather than 55 mg/L as at present. A CURIOUS CASE OF CRYSTALLOIDS FROM THE PAROTID
MULTIPLE NOVEL APOPTOTIC PATHWAYS ARE UPREGULATED IN EXTRAMAMMARY PAGET’S DISEASE
Joshua Ryan1, P. Stewart1, G. Watson2 1 Biochemistry Department and 2Anatomical Pathology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Fiona Lehane, Jane E. Armes, Rohan Lourie, Melissa Hillas Department of Anatomical Pathology, Mater Pathology Services, South Brisbane, Qld, Australia
Aim: The aim was to investigate a palpable lump in the right parotid region in a 67-year-old woman. Ultrasound showed a hypoechoic lesion of the right parotid gland (size 15 7 12 mm).
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Aims: We examined follicular lymphoma (FL) bone marrow (BM) involvement: frequency of low extent involvement, comparison of direct area measurement and a descriptive grading system and flow cytometry performance. We also assessed clinical predictors and clinical impact of FL BM status. Methods: 151 consecutive initial staging BM biopsies were reviewed. Area assessment used digital photomicrography of one biopsy level and outlining intertrabecular spaces and FL infiltrates (AxioVision 7.4). A descriptive grading system proposed by Groupe d’Etudes Lymphomes Folliculaires (GELF) was applied. Results: 63/151 (42%) BM were positive. Area measurement in 34 positive biopsies found area <1% in 7/34 (21%) and 1–10% in 14/34 (41%). GELF grade correlated with measured extent and showed excellent inter-observer reproducibility. Flow cytometry sensitivity, 59% overall (relative to histology), reduced to 29% when BM area was <1%. Discussion: Low extent BM involvement is common in FL, without consensus guidelines for staging purposes. This has implications for the individual (stage, prognostic risk) and in clinical trial interpretation (population risk, complete response rate). The prognostic significance of low extent involvement for rituximab treated cohorts is unknown. The descriptive GELF grade, validated in this series, provides a reproducible tool suitable for prospectively addressing this question. VALUE OF A SURGICAL SPECIMEN MUSEUM IN TEACHING OF PATHOLOGY TO MEDICAL AND ALLIED HEALTH PROFESSIONALS Ruta Gupta, Elaine G. Bean, Jane E. Dahlstrom Department of Anatomical Pathology, ACT Pathology, The Canberra Hospital and ANU Medical School, Canberra, ACT, Australia Tissue specimens remain important tools in medical education despite innovative imaging techniques and web based resources. Reduction in autopsies has made acquiring specimens difficult. Aim: To create a surgical specimen museum as a teaching resource. Methods: All surgical specimens are evaluated on accession in the department and photographed. The surgeon is contacted to obtain agreement to contact their patient. Following issue of the pathology report, a letter is sent to the patient inviting them to consent to donating their specimen. Following consent the specimen is either retained as a ‘wet’ specimen or mounted. Representative histology slides are produced. The students were surveyed as to the value of this learning resource. Results: This museum was established 7 years ago. Consent has been obtained from 706/867 patients approached. The spectrum of diseases includes inflamed appendices, hydatidiform moles and other specimens which would rarely be seen at autopsy. Students rated this resource very highly and patients who have chosen to view their specimen have indicated benefit. Conclusions: The spectrum of diseases represented in this museum is diverse and clinically relevant. There is widespread support from patients for the use of their surgical specimens for education. Students and patients have benefited from its establishment.
S57
Aim: To investigate the expression of the novel anti-apoptotic markers GRP78 and MUC13 in extramammary Paget’s disease (EMPD). Method: Twelve archival cases of EMPD, accessioned from 2001 until 2010 were assessed for expression of bcl-2, GRP78 and MUC13 using standard immunohistochemical and immunofluorescent techniques. Results: Twelve cases of EMPD were examined, four of which included an invasive component. Eight of twelve cases (67%) were positive for bcl2. Eight of eleven cases (72%), and four of eight cases (50%) with available tissue were positive for GRP78 and MUC13, respectively. Discussion: Bcl2 is a well known regulator of apoptosis. GRP78 overexpression has been shown to significantly increase resistance to apoptosis in vitro and in vivo. MUC13 is overexpressed in a range of epithelial malignancies, and has poorly defined antiapoptotic properties, as well as a role in proliferation activity via the p38MAPK signalling pathway, and anti-adhesive roles promoting cell motility. Our study has demonstrated an overexpression of the anti-apoptotic markers GRP78, MUC13, and bcl2 in EMPD. Overexpression of these anti-apoptotic markers is a novel finding in this disease and likely to be important in the pathogenesis of EMPD. EVALUATION OF THYROGLOBULIN ASSAYED BY BECKMAN ACCESS Xunjun Low, Roger Johnson, Linda Henderson Department of Chemical Pathology, Labplus, Auckland City Hospital, Auckland, New Zealand Aims: To evaluate a thyroglobulin chemiluminescent immunoassay (CLIA) on the Access (Beckman Coulter) as a possible replacement for the thyroglobulin CLIA on Immulite 2000 (Siemens). Methods and Results: 20 patient samples (0.14–473 mg/L) assayed in duplicate on the Access had an average CV (of duplicates) of 1.0% with none greater than 6%. Immulite QC plus a low pool sample (range 0.14–129.8 mg/L) run (n ¼ 41) over 3 weeks gave interbatch imprecision (CV) of 3.1–11.7%. A comparison between Access and Immulite method (as reference) using 20 patient samples (up to 600 mg/L) gave a slope of 0.70 and negligible intercept by Passing-Bablok analysis; least squares linear regression gave similar information. 17 samples containing different proportions of thyroglobulin were found on the Access to be linear up to 450 mg/L, the highest concentration tested. Interference from lipaemia, icterus, or haemolysis showed a difference from control of –2.6 to 0.3%. Discussion: Access thyroglobulin immunoassay has good precision, is linear to at least 450 mg/L, and suffers negligible interference from haemolysis, icterus and lipaemia. The major disparity with the Immulite assay is a negative bias (equivalent to slope of about 0.7), giving an upper limit of the reference interval of 40 mg/L rather than 55 mg/L as at present. A CURIOUS CASE OF CRYSTALLOIDS FROM THE PAROTID
MULTIPLE NOVEL APOPTOTIC PATHWAYS ARE UPREGULATED IN EXTRAMAMMARY PAGET’S DISEASE
Joshua Ryan1, P. Stewart1, G. Watson2 1 Biochemistry Department and 2Anatomical Pathology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Fiona Lehane, Jane E. Armes, Rohan Lourie, Melissa Hillas Department of Anatomical Pathology, Mater Pathology Services, South Brisbane, Qld, Australia
Aim: The aim was to investigate a palpable lump in the right parotid region in a 67-year-old woman. Ultrasound showed a hypoechoic lesion of the right parotid gland (size 15 7 12 mm).
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.