Microscopy Tutorials

November 3-8, 2006

Sheraton Centre Toronto

Toronto, Ontario, Canada


$80.00 Member Fee, $155.00 Non-Member Fee


Saturday, November 4, 2006


Tutorial #1 (8:00 am to 9:30 am)

Wait, Wait, Don’t Tell Me:  Challenging Cytopathology Cases from a Comprehensive Cancer Center
Sue Ellen Martin, M.D. Ph.D.

Educational Objective:
During the course of this tutorial, the participants will:

  1. Gain an understanding of the variety of cytopathology cases seen at a tertiary care center
  2. Review the critical role of FNA in the primary diagnosis of cancer as well as in the staging of disease and the diagnosis of recurrence of disease
  3. Evaluate the efficacy of ancillary techniques such as immunocytochemistry in determining whether a malignant neoplasm is primary or metastatic
  4. Gain an appreciation of the critical role of the cytotechnologist in this practice setting

In this microscopy tutorial, the critical role of the cytopathology service in a university based comprehensive cancer center will be presented through microscopic case studies.
Emphasis will be placed on the clinical utilization of the FNA service including the expectations of clinicians, the number and types of FNAs performed and who performs them, and the value of ancillary studies in rendering an accurate and specific diagnosis.  The importance of the cytotechnologist in this clinical setting will be considered.


Tutorial #2 (8:00 am to 9:30 am)

Ann T. Moriarty, M.D.

Educational Objective:

  1. Learn the limitations and advantages of morphologic evaluation of selected non-Hodgkin and Hodgkin Lymphomas.
  2. Identify the ancillary tests required for common lymphomas such as small lymphocytic lymphoma, follicular lymphoma, large B-cell lymphoma and Hodgkin Lymphoma.
  3. Learn the language of modern lymphoma diagnosis based upon the World Health Organization (WHO) classification system.

Cases of lymphoma will be presented projecting the findings from glass slides.  We will use a practical approach based upon size and nuclear features for each case.  Using the morphologic features as a framework, we will discuss the selection of appropriate ancillary tests to confirm the diagnosis.   Each participant will also receive a summary outlining the WHO nomenclature.   Glass slides, handouts and a power point presentation will be used.


Tutorial #3 (2:00 pm to 3:30 pm)

The ThinPrep® for Thyroid FNAs
Edmund S. Cibas, M.D.

Educational Objectives:
Participants will learn to identify diagnostic features of thyroid nodules prepared using the ThinPrep® method including:

  1. Hashimoto’s thyroiditis
  2. Benign (macrofollicular) nodule NOS (predominantly macrofollicular architecture)
  3. Papillary carcinoma
  4. “Suspicious for follicular neoplasm”
  5. “Suspicious for Hurthle cell neoplasm

The moderator will review ThinPrep® slides that demonstrate the diagnostic features of the most commonly encountered thyroid lesions.


Tutorial #4 (2:00 pm to 3:30 pm)

Liquid-based Gynecologic Cytology
Mary Chacho, M.D.

Educational Objectives:

  1. Understand the differences in specimen preparation between ThinPrep® and SurePath®.
  2. Appreciate the differences between these liquid-based preparations as seen microscopically
  3. Understand the nuances of interpreting ThinPrep® and SurePath® slides compared to conventionally-prepared slides

The development and FDA approval of liquid-based Pap tests have had a very significant impact on cytotechnologists and cytopathologists.  This tutorial will provide an overview of the history of the ThinPrep® and SurePath® methods with ample opportunity to review a range of normal and abnormal slides prepared by each of these two modalitics.  The moderators will discuss their years of experience with these techniques and offer helpful hints to those who have or will be adopting either of these new technologies.


Sunday, November 5, 2006

Tutorial #5 (8:00 am to 9:30 am)

Enhancing GYN Microscopic Skills
Barbara D. Benstein, Ph.D., SCT(ASCP)CM

Educational Objective:

  1. Identify potential pitfalls in cytologic preparations
  2. Apply key morphologic criteria to assist in differential interpretation of entities with overlapping cytologic features
  3. Refine interpretive morphologic skills to improve diagnostic accuracy

This tutorial is intended to serve as a review of cytologic criteria in commonly encountered but complex entities in gynecologic cytology.  A series of interesting and challenging cases will be presented for discussion of cytomorphology and differential interpretation. Emphasis will be placed on practical, reproducible cytologic criteria to improve diagnostic skills. Conventional and liquid-based preparations (ThinPrep® and SurePath® ) will be included. 

Tutorial #6 (8:00 am to 9:30 am)

FNA of Lymphoma: A Smorgasbord
Nancy A. Young, M.D.

Educational Objectives:

  1. Identify the most commonly encountered lymphomas by FNA and compare and contrast their cytomorphologic features
  2. Choose appropriate ancillary tests for diagnosis based on clinical history and cytomorphology
  3. Integrate morphologic, immunophenic, and molecular studies in the cytologic diagnosis of lymphoma
  4. Identify and address potential pitfalls associated with the use of FNA to diagnose lymphoma

This tutorial is designed for those who already have a basic understanding of the WHO classification of NHL but want to review their knowledge and have fun seeing a “smorgasbord” of aspirates of lymphoproliferative disorders, all in one sitting. Entities will be presented through a case history format. Accompanying panels of flow cytometry will be projected with discussion of their interpretation. Additional confirmatory tests performed will be discussed as appropriate. Potential pitfalls in the diagnosis of lymphoma by FNA as they relate to the cases will be discussed.

Tutorial #7 (10:00 am to 11:30 am)

Pitfalls in Pulmonary Cytology: Avoiding a False Positive Diagnosis
Hormoz Ehya, M.D.

Educational Objectives:

  1. To recognize cytologic features of degeneration, repair, metaplasia, hyperplasia and treatment effect in the lung
  2. To become familiar with benign conditions that mimic specific types of lung cancer
  3. To recognize cytologic criteria helpful in avoiding a false positive diagnosis

This tutorial is designed to familiarize the participants with benign entities that could be mistaken for cancer in pulmonary cytology. A number of cases showing epithelial atypia secondary to infection, chemotherapy, irradiation and other benign etiologies that mimic specific types of lung cancer will be reviewed at the microscope. The specimens will include bronchial washings, bronchial brushings, bronchoalveolar lavages and fine needle aspirates. The criteria to distinguish such abnormalities from malignant neoplasms will be discussed and examples of malignant tumors will be shown for comparison. The course registrants will be given ample opportunity to participate in the discussions.

Tutorial #8 (10:00 am to11:30 am)

A Potpourri of Challenging Cytology Cases
Ritu Nayar, M.D., MIAC

Educational Objectives: 

  1. Present an admixture of FNA, non-gynecologic and gynecologic cases which represent challenges in interpretation and differential diagnosis
  2. Discuss cytomorphology, pitfalls and differential diagnosis
  3. Discuss relevant clinical considerations

The tutorial will take a clinically oriented approach to review cytomorphology, differential diagnosis, and application of ancillary studies to reach a final diagnosis. Cases presented will include FNA, non-gynecologic non-FNA and gynecologic cytology cases. A variety of specimen preparations, smears, core biopsies, cell blocks, cytospins, and liquid based, will be utilized. Papanicolaou, Diff Quik, H&E and applicable immunohistochemical stains will be shown. The tutorial will cover a variety of diagnostic dilemmas and provide the attendes an opportunity to share a variety of cases ranging from “nice case- there is a good chance I’ll see this” to “rarely seen cases or fascinomas”.  A detailed handout with references will be provided.

Tutorial #9 (2:00 pm to 3:30 pm)

Interpretation of Breast Cytology Specimens Obtained by Random Periareolar Fine Needle Aspiration in High Risk Women
Carola Zalles, M.D.

Educational Objectives :

  1. Familiarize cytopathologists with the RPFNA technique, its clinical use, limitations and possible future clinical applications
  2. Review the morphologic spectrum of cytology specimens obtained by RPFNA
  3. Describe the different biomarker studies underway using material from RPFNA in high risk women


A brief initial description of high risk assessment including selection criteria for random periareolar fine needle aspiration (RPFNA) will be followed by review of select cytology material obtained from multiple institutions.  The classification criteria for each risk category will be reviewed including the use of the semi-quantitative Masood Index.  Review of immunocytochemical stains used in identifying biomarkers.  Overview of spectral –spatial analysis and ongoing molecular studies of RPFNA specimens currently underway.

Tutorial #10 (2:00 pm to 3:30 pm)

Aspiration Cytopathology of Diagnostically Challenging Pancreatic Lesions
Syed Ali, M.D.

Educational Objectives:

  1. Identify the value and limitations of pancreatic fine needle aspiration (FNA)
  2. Identify the various diagnostic pitfalls and mimics of cancer
  3. Formulate a differential diagnosis based on key morphologic characteristics
  4. Analyze the immunoperoxidase staining profile of various neoplastic lesions

Cytopathologic diagnosis of pancreatic tumors and pseudo-tumors is often difficult, even for the cytopathologist who is experienced in this area.  Selected pancreatic lesions that can lead to erroneous cytopathologic interpretation will be illustrated at the microscope.  Emphasis will be placed on the formulation of a differential diagnosis based on key morphologic characteristics, discussion of immunoperoxidase staining profiles and clinical implications of an FNA diagnosis.

Tutorial #11 (4:00 pm to 5:30 pm)

Cytology of Serous Effusions
Michael S. Facik, M.P.A., CT(ASCP)CFIAC

Educational Objectives: 

  1. To appreciate the morphologic characteristics of common and not so common malignancies in serous effusion
  2. To recognize features which suggest a particular primary site even in the absence of clinical history
  3. Understand the basic principles of special staining techniques
  4. To anticipate the potential of tumor cells in effusion cytology to look different than the same cells observed from a different site

Actual case scenarios will be used to address the cytologic challenges in serous effusions. Very brief discussion will include benign effusion cytology. Most case examples will include malignant processes and many will include the use of special stains. Interesting examples of common malignant entities as well as those rarely seen in serous effusion will be included in this tutorial.


Monday, November 6, 2006


Tutorial #12 (8:00 am to 9:30 am)

Low-Grade Urothelial Lesions:  Keeping Your Head Above Water!
Dorothy L. Rosenthal, M.D., FIAC

Educational Objectives:

  1. Understand the capabilities and limitations of urinary cytology to diagnose low-grade urothelial lesions
  2. Frame diagnoses in a manner that is clinically relevant.
  3. Refine criteria to enhance diagnostic accuracy for low-grade lesions

Using a series of cases as examples, the instructor will illustrate subtle yet reliable distinctions between reactive and low-grade neoplastic urothelial lesions of the urinary tract.  Microscope slides will be projected, allowing for simultaneous discussion of the entities.  Each registrant will receive a CD Rom with images and criteria.


Tutorial #13 (8:00 am to 9:30 am)

Fine Needle Aspiration of the Salivary Gland
William C. Faquin, M.D., Ph.D.

Educational Objectives:

  1. Review the cytomorphologic criteria of key salivary gland tumors
  2. Formulate a differential diagnosis based upon cytomorphologic features
  3. Recognize diagnostic pitfalls in salivary gland cytology

This tutorial will use a series of salivary gland FNA cases to discuss the evaluation and diagnosis of several commonly encountered, yet sometimes diagnostically challenging, salivary gland tumors.


Tutorial #14 (10:00 am to 11:30 am)

Lessons From Litigations
R. Marshall Austin, M.D., Ph.D.

Educational Objectives:

  1. Become familiar with recurring clinically significant areas of Pap interpretation
  2. Become familiar with adjudication of disputed cases by Multiple Slide blinded Rescreening

Pap litigation cases are reviewed to illustrate clinically significant problem areas in Pap interpretation and discuss adjudication of disputed cases as well as risk management techniques


Tutorial #15 (10:00 am to 11:30)

Glandular Lesions in Cervicovaginal Cytology: Conventional, ThinPrep® and SurePath®
Dina R. Mody, M.D.

Educational Objectives: 

  1. List the diagnostic criteria for endocervical adenocarcinoma in situ and invasive adenocarcinoma on all preparation types
  2. Describe the morphologic differences between a high-grade squamous intraepithelial lesion and endocervical adenocarcinoma in situ
  3. Identify the benign mimics of glandular neoplastic lesions in cervicovaginal cytology
  4. Recognize patterns of endometrial and extrauterine carcinomas in all preparation types

This 1.5 hour microscopic tutorial will review examples of significant glandular lesions in cervicovaginal cytology using both conventional and liquid-based preparations (ThinPrep® and SurePath®).  The lesions include adenocarcinoma in situ of the cervix, endocervical adenocarcinoma, endometrial and extrauterine carcinomas.  The findings of these significant lesions will be contrasted with other benign mimics like tubal metaplasia, microglandular hyperplasia, lower uterine segment endometrium and post-conization diathermy artifact.  Criteria to separate high-grade squamous intraepithelial lesions from adenocarcinoma in situ will also be presented. Time permitting, selected consultations will be reviewed.

Tutorial #16 (2:00 pm to 3:30 pm)

Thyroid FNA, Morphology and Beyond
David L. Rimm, M.D., Ph.D.

Educational Objectives: 

  1. To review thyroid FNA
  2. To learn about the sensitivity and specificity data associated with this procedures
  3. To learn about new technologies that may impact thyroid FNA in the future

Dr. Rimm will review 10-12 cases from thyroid FNAs with the group and discuss differential diagnoses.  He will discuss the correlation between the cytologic diagnosis and the final surgical pathology specimens.  Finally he will present a short discussion on future technologies that may someday impact thyroid FNA.

Tutorial #17 (4:00 pm to 5:30 pm)

Fine Needle Aspiration of the Thyroid
George G. Birdsong, M.D.

Educational Objectives: 

  1. Review various techniques of fine needle aspiration of the thyroid
  2. Learn cytologic features of pathologic entities commonly seen in thyroid aspirates
  3. Learn differential diagnostic features of pathologic entities, which may have similar morphology

In this tutorial, examples of thyroid lesions which are likely to be encountered in fine needle aspiration specimens will be shown and discussed. Morphologic features which may be helpful in distinguishing between entities with similar morphology will be emphasized. Published data regarding the accuracy of fine needle aspiration of the thyroid will be briefly discussed. Participants will gain increased confidence in their ability to interpret thyroid fine needle aspirations


Tutorial #18 (4:00 pm to 5:30 pm)

Cytopathology of Gastrointestinal System
Yener S. Erozan, M.D.

Educational Objectives: 

  1. To discuss the cytopathological diagnosis of selected neoplasms of the gastrointestinal tract, biliary tract and liver on brush and fine needle aspiration specimens

Cytopathological diagnosis of selected lesions of the gastrointestinal system, including biliary tract and liver will be discussed by reviewing representative slides. Emphasis will be given to differential diagnostic problems on brush, percutaneous and EUS-guided fine needle aspirations.