ANNUAL RESEARCH DAY PROGRAM



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DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE

DÉPARTEMENT DE PATHOLOGIE ET DE MÉDECINE DE LABORATOIRE

JOURNÉE ANNUELLE

DE LA RECHERCHE

ANNUAL RESEARCH DAY

2016

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ANNUAL RESEARCH DAY PROGRAM

DEPARTMENT OF PATHOLOGY AND

LABORATORY MEDICINE

UNIVERSITY OF OTTAWA

Thursday, June 2nd, 2016

ROGER GUINDON HALL

ROOM 1007

HEALTH SCIENCES BUILDING

9:00 – 9:25 COFFEE

9:25 – 9:30 WELCOME

9:30 – 9:45 IMMUNOHISTOCHEMICAL ANALYSIS OF BENIGN AND MALIGNANT MELANOCYTIC LESIONS OF THE CONJUNCTIVA USING DOUBLE STAINING

Alexander K. Soon, Seymour Brownstein, Solin Saleh, Kailun Jiang, Joelle Levac, Paula Blanco, Jim Farmer

9:45 – 10:00 LARYNGEAL SQUAMOUS CELL CARCINOMAS ARE COMMONLY ASSOCIATED WITH DIFFERENTIATED SQUAMOUS INTRAEPITHELIAL NEOPLASIA WITH OR WITHOUT AN ADMIXTURE OF USUAL TYPE OF SQUAMOUS INTRAEPITHELIAL NEOPLASM: CLINICAL AND PATHOLOGICAL SIGNIFICANCE

Kevin Hogan, Kien T. Mai

10:00 – 10:15 PERINEURAL INVASION ON BIOPSIES WITH 3+4=7 PROSTATE CANCER IS ASSOCIATED WITH UPSTAGING AT RADICAL PROSTATECTOMY: POTENTIAL IMPLICATIONS FOR ACTIVE SURVEILLANCE

Justin Bateman, Susan J. Robertson, Nicola Schieda, Daniel T. Keefe, Eric C. Belanger, Kien T. Mai, Rodney H. Breau, Chris Morash, Trevor A. Flood

10:00 – 10:30 COFFEE BREAK

10:30 – 10:45 DO SPECIFIC GLEASON PATTERN 4 MORPHOLOGIES DETECTED ON TRANSRECTUAL ULTRASOUND (TRUS)-GUIDED BIOPSIES PREDICT UPGRADING OR UPSTAGING IN GLEASON SCORE 3+4=7 PROSTATE CANCER?

Kevin Hogan, Susan J. Robertson, Nicola Schieda, Kien T. Mai, Daniel T. Keefe, Eric C. Belanger, Rodney H. Breau, Chris Morash, Trevor A. Flood

10:45 – 11:00 ifitm1 is superior to cd10 in the evaluation of myometrial invasion in endometrial endometrioid adenocarcinoma

Aurelia Busca, Bojana Djordjevic, Shahidul Islam, Ana Giassi, Carlos Parra-Herran

11:00 – 11:15 UNRAVELING THE PARADOX: A STUDY TO IDENTIFY A MICRORNA SIGNATURE ASSOCIATED WITH COMPLETE PATHOLOGICAL RESPONSE IN PATIENTS WITH TRIPLE NEGATIVE BREAST CARCINOMA TREATED WITH NEOADJUVANT CHEMOTHERAPY

Jordan Sim, Jason Wasserman, Susan J. Robertson, Bryan Lo

11:15 – 11:30 CORE NEEDLE BIOPSIES HAVE LOWER DIAGNOSTIC YIELD AND DELAY TREATMENT FOR PATIENTS WITH LYMPHOMA: AN INSTITUTIONAL REVIEW OF ALL LYMPH NODE BIOPSIES FOR SUSPECTED LYMPHOMA

Jason K. Wasserman, Kevin Hogan, Bruce F. Burns, Iris Teo, Philip Berardi, Diponkar Banerjee

11:30 – 13:30 LUNCH AND POSTER VIEWING

Atrium (University)

13:30 – 14:30 KEYNOTE LECTURE

Dr. David Lebrun

Professor of Pathology

Queen’s University

Kingston, ON

Title: “Binding and dis-regulation of lymphopoietic enhancers in acute lymphoblastic leukemia by an oncogenic transcription factor”

14:30 – 14:45 three cases of bilateral vertebral artery dissection

Christopher G. Ball, Christopher M. Milroy

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

14:45 – 15:00 LUNG ADENOCARCINOMA WITH AEROGENOUS SPREAD: DESCRIPTION OF HISTOLOGICAL FEATURES AND RADIOLOGICAL-PATHOLOGICAL CORRELATION

Nina Chang (1), J Inacio (2), C Lai (1), A Gupta (2), CA Souza (2), HS Sekhon (1), MM Gomes (1)

(1) Department of Pathology and Laboratory Medicine, (2) Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.

15:00 – 15:15 PARAPHARYNGEAL NERVE SHEATH TUMORS: A CLINICOPATHOLOGICAL STUDY OF 34 CASES INCLUDING FOUR MALIGNANT PERIPHERAL NERVE SHEATH TUMORS

Jason K Wasserman1, Akeesha Shah2, Raja R Seethala2, Bibianna Purgina1

1. University of Ottawa, Ottawa, ON, Canada

2. University of Pittsburgh Medical Centre, Pittsburgh, PA, United States

15:15 – 15:45 COFFEE BREAK

15:45 – 16:00 ANNOUNCEMENT OF PRIZE WINNERS AND CONCLUSION

• Nadia Mikhael Award for Best Paper presented by a Junior Resident

• 2nd Best paper by a Junior Resident

• Virbala Acharya Award for Best Presentation by a Senior Resident or Fellow

• 2nd Best paper by a Senior Resident or Fellow

• Best Poster Presentation by a Graduate Student

• 2nd Best Poster Presentation by a Graduate Student

• Best Poster Presentation by a Resident

• 2nd Best Poster Presentation by a Resident

• Dr. M. Orizaga Award for Best Teacher

18:00 – 21:00 DINNER AT VITORIA TRATTORIA

3625 Rivergate Way (at Riverside Drive)

(613)-731-8959

POSTERS

1. A REVIEW OF INTERFACILITY BLOOD TRANSPORTATION BY AMBULANCE TO A REGIONAL TRAUMA CENTRE

Vito Sanci1, Y. Lin2, J. Callum2

1Division of Hematopathology & Transfusion Medicine, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario

2Blood & Tissue Bank, Sunnybrook Hospital & University of Toronto, Toronto, Ontario

2. DIAGNOSTIC CHALLENGE: PRIMARY ESOPHAGEAL HODGKIN LYMPHOMA

Ashish B. Rajput1, Tariq Roshan1 and Bruce Burns2

1Division of Hematopathology, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6

2Division of Anatomical Pathology, The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6

3. ROLE OF PATHOLOGIC EVALUATION OF ENDOMETRIAL ABLATION RESECTIONS IN PREDICTING ABLATION FAILURE AND PRESENCE OF ADENOMYOSIS IN HYSTERECTOMY

Aurelia Busca and Carlos Parra-Herran

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

4. PANCYTOPENIA VASCULITIS AND WIDESPREAD EPIDERMOLYSIS IN A WOMAN WITH A HISTORY OF CRACK COCAINE USE AND AUTO-IMMUNE DISEASE

Christopher G. Ball and Christopher M. Milroy

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

5. RAMAN SPECTROSCOPY TO INVESTIGATE ENDOMETRIAL CANCER

Christopher G. Ball, Girjesh Dubey, Shahidul Islam, Fabio Variola

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

6. PHOSPHATURIC MESENCHYMAL TUMOR INVOLVING THE HEAD AND NECK: A REPORT OF 5 CASES WITH FGFR1 FLUORESCENCE IN SITU HYBRIDIZATION ANALYSIS

Jason K. Wasserman1, Bibianna Purgina1, Chi K. Lai1, Denis Gravel1, Alyssa Mahaffey2, Diana Bell3, and Simion I. Chiosea2

1Department of Pathology and Laboratory Medicine, The Ottawa Hospital — General Campus, Ottawa, Ontario, Canada, 2Department of Pathology, University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA, 3Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

7. CLEAR CELL UROTHELIAL CARCINOMA: IMMUNOHISTOCHEMICAL AND TOPOGRAPHICAL STUDIES ARE SUGGESTIVE OF MESONEPHRIC DIFFERENTIATION

Justin Bateman, Jason K. Wasserman, Trevor A. Flood, Eric C. Belanger, Bojana Djordjevic, and Kien T. Mai

Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada.

8. CLEAR CELL UROTHELIAL CARCINOMA: A CLINICOPATHOLOGICAL STUDY OF NINE CASES AND REVIEW OF THE LITERATURE

Justin Bateman, Jason K. Wasserman, Trevor A. Flood, Bojana Djordjevic, Eric C. Belanger, and Kien T. Mai

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

9. CONCOMITANT BILATERAL SEROUS BORDELINE TUMOR WITH AN OVARIAN TERATOMA COMPOSED OF PRIMARY OVARIAN CARCINOID AND THYROID TISSUE, A CASE REPORT

Kianoosh Keyhanian, Mary Senterman, and Zohreh Eslami

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

10. A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED WINDOW OF OPPORTUNITY TRIAL EVALUATING CLINICAL EFFECTS OF HIGH DOSE VITAMIN D IN PATIENTS WITH BREAST CANCER

Nina Chang, K Keyhanian, Arnaout A, C Addison, M Clemons, G Pond, R Vieth, SJ Robertson

Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association & The Ottawa Hospital, Faculty of Medicine, University of Ottawa.

11. BENIGN TESTICULAR EPIDERMAL INCLUSION CYST

Tara N. Hilton, BHSc (Hons) 1, Don Wang, MD, MSc, FRCPC2

1MD Candidate 2018, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5

2Department of Pathology, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6

12. THE DEVELOPMENT AND EVOLUTION OF A MASSIVE BLEEDING POLICY IN A TERTIARY CARE PEDIATRIC CENTER - A QUALITY IMPROVEMENT INITIATIVE

Roxanne Labelle, MLT1,2, Christina Toppozini, RN, BSCN, MPH1,3, Gail Macartney, RN(EC), PhD1,3, Elaine Leung, MD, FRCPC1,3, Kimmo Murto, MD, FRCPC1,3, 1CHEO Simulation Team, Transfusion Medicine Laboratory

2Eastern Ontario Regional Laboratory Association

3Children’s Hospital of Eastern Ontario

13. ONTARIO TUMOUR BANK INITIATIVE AT THE OTTAWA HOSPITAL

H. Sekhon1, A. Arnaout1, S. Gilbert1, C.A. Jodouin2, N. Rayne3, P. Giannakouros3, J. Bartlett4, M. Albert4

1The Ottawa Hospital, 2Eastern Ontario Regional Laboratory Association,

3The Ottawa Hospital Research Institute, 4Ontario Institute for Cancer Research

WELCOME

IMMUNOHISTOCHEMICAL ANALYSIS OF BENIGN AND MALIGNANT MELANOCYTIC LESIONS OF THE CONJUNCTIVA USING DOUBLE STAINING

Soon, Alexander K1,2; Brownstein, Seymour1,2; Saleh, Solin1,2; Jiang, Kailun1,2; Levac, Joelle1; Blanco, Paula1; Farmer, Jim1,2

1. Pathology & Laboratory Medicine, The University of Ottawa, Ottawa, ON, Canada. 2. Ophthalmology, The University of Ottawa, Ottawa, ON, Canada.

Purpose: Most pigmented lesions of the conjunctiva are benign, such as nevi and primary acquired melanosis (PAM) without atypia. However, certain pigmented lesions are more prone to malignant progression, such as PAM with atypia. Currently, single immunohistochemical (IHC) staining with Melan-A (MART1, melanocyte antigen) and microphthalmia-associated transcription factor (MITF) identify all melanocytic cells, while human melanoma black 45 (HMB45) and Ki67 identify potentially proliferative cells. However, these single stains may not always identify cells that are both melanocytic and proliferative. Our study implements a novel double-staining technique to identify the most sensitive and specific combinations of Melan-A, MITF, Ki67, and HMB45 aiming to better diagnose atypical melanocytic lesions that are more prone to malignant progression.

Methods: Eight specimens of conjunctival melanoma and PAM with moderate to severe atypia were obtained from the ocular pathology registry of the University of Ottawa. Sections from each formalin-fixed paraffin-embedded specimen were double-immunostained with a combination of a cytoplasmic marker (anti-Melan-A or anti-HMB-45), and a nuclear marker (anti-MITF or anti-Ki67). These specimens also were processed using the vector red method for cytoplasmic stains and 3,3-diaminobenzidine substrate for nuclear stains. Each slide was analyzed by light microscopy and provided 0-100% staining positivity, as well as a 0 to 4+ score, for each cytoplasmic and nuclear component. Eight specimens of normal conjunctiva and of conjunctival nevi served as controls.

Results: Melan-A and MITF are strong markers for all melanocytic cells, whereas Ki67 and HMB45 provide a variable response for identifying proliferative cells. When combined with HMB45, a double-stain utilizing MITF is most effective at differentiating between malignant and benign lesions. The combination of HMB45 and MITF is best at identifying all melanocytes, while demonstrating the subpopulation of atypical cells (p36 %3+4=7 and >20 %PNI yielded sensitivity/specificity of 31.9/87.2% and 30.9/82.4%, respectively. Applying these additional thresholds to those patients eligible for AS would have excluded 28% (11/39) of patients from the RMC group who were ultimately upstaged after RP. No patients would have been excluded from the U of T group.

Conclusions: Quantitative reporting of percentage of core biopsies with PNI and sites with Gleason score 3+4=7 were predictive of non-OCD after RP. These additional criteria may help optimize enrollment into AS protocols for patients with intermediate risk prostate cancer.

BREAK AND POSTER VIEWING (ATRIUM)

DO SPECIFIC GLEASON PATTERN 4 MORPHOLOGIES DETECTED ON TRANSRECTAL ULTRASOUND (TRUS) GUIDED BIOPSIES PREDICT UPGRADING OR UPSTAGING IN GLEASON SCORE 3+4= 7 PROSTATE CANCER?

Kevin Hogan, Susan J Robertson, Nicola Schieda, Kien T Mai, Daniel T Keefe, Eric C Belanger, Rodney H Breau, Chris Morash, Trevor A Flood. The Ottawa Hospital, Ottawa, ON, Canada; The University of Ottawa, Ottawa, ON, Canada

Introduction: Selected patients with Gleason score (GS) 3+4=7 prostate cancer (PCa) detected on TRUS-guided biopsies may be considered for active surveillance (AS); however, a proportion of these will harbor more aggressive disease. The purpose of this study was to determine if morphologies of Gleason Pattern 4 PCa may predict upgrading and/or upstaging after radical prostatectomy (RP).

Materials and Methods: A database search for men with GS 3+4=7 PCa diagnosed on TRUS-guided biopsy that underwent RP between January 2010 and October 2015 identified 152 patients. Two blinded genitourinary pathologists independently reviewed the biopsies and assessed for the presence or absence of: ill-defined glands (IDG), fused glands, small or large cribriform patterns, and glomerulations. Patient age and serum prostate-specific antigen (PSA) were also recorded. Gleason score and stage (presence or absence of extraprostatic extension [EPE]) were retrieved from RP reports. Data were compared using independent t-tests and the chi-square statistic. Inter-observer agreement was calculated using the Kappa statistic.

Results: 28.9% (44/152) of patients were upgraded to Gleason score >3+4=7 at RP (Gleason score 4+3=7 [N=18], Gleason score 4+3=7 with tertiary pattern 5 [N=25], and Gleason score 4+5=9 [N=1]) and 44.1% (67/152) showed EPE after RP. PSA was associated with both upgrading (8.5 ± 5.4 vs. 6.9 ± 3.2 ng/mL, [p=0.04]) and EPE (8.2 ± 4.6 vs. 6.7 ± 3.2 ng/mL, [p=0.03]). IDG, fused glands, and glomerulations were not associated with upgrading or EPE (p>0.05) with moderate to strong inter-observer agreement (K=0.76-0.88). There was strong inter-observer agreement for small and large cribriform formations (K = 0.93 and 0.94, respectively) and both were stongly associated with upgrading and EPE on RP (p ................
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