Video Microscopy Tutorials

Hilton Americas Houston

November 2-6, 2007

Houston, Texas

 

Video Microscopy Tutorials

1.5 CME Credit per tutorial
($90.00 for members per tutorial,
$180.00 for non-members per tutorial)

 Video Microscopy Tutorials are intimate 90-minute sessions that give participants a chance to interact with experts in the field.  The sessions provide the participants an opportunity to discuss the topics in a smaller less formal group.  Interesting cases on specific topics, similar to cases being reviewed in a hospital on a multi-headed microscope are reviewed using a video microscope.

 

Friday, November 2, 2007

 

Tutorial #1 (1:30 pm to 3:00 pm)

Neuroendocrine Tumors:  A Spectrum in Search of Criteria
     Claire W. Michael, M.D.
     Farnaz Hasteh, M.D.


Educational Objectives:

  1. Review neuroendocrine tumors (NETs) origin and recent WHO classifications for lung and other body sites
  2. Learn the diagnostic cytologic features, differential diagnosis and diagnostic pitfalls
  3. Learn the appropriate application of immunoperoxidase stains to establish the diagnosis and exclude mimickers

Cases of neuroendocrine tumors will be projected from original glass slides.  We will point out the diagnostic features, discuss potential pitfalls and mimickers.  Routine cases of NET’s will be presented with emphasis on pulmonary NET’s and their classification by cytology.  We will also present cases in rare locations and those with unusual presentation such as intra-alveolar growth of neuroendocrine hyperplasia.  The use of immunostains will be discussed when relevant.

 

Tutorial #2 (1:30 pm to 3:00 pm)

Urine Cytology Made Easy
     Eva Wojcik, M.D.


Educational Objectives:

  1. Review cytologic features and discuss potential pitfalls in urine cytology
  2. Understand diagnostic limitations of urine cytology
  3. Recognize clinical implications of various diagnostic categories in urine cytology

Urine cytology is one of the most challenging areas we are dealing with in cytopathology. This interactive workshop will present a simplified, clinically relevant approach to urine specimens. The emphasis will be placed on understanding urine cytology and potential clinical implications of our diagnoses.

 

Tutorial #3 (4:00 pm to 5:30 pm)

Immunocytochemical and Special Stains in Gynecologic and Non-gynecologic Specimens:  Their Contribution to the Final Cytopathologic Interpretation
     Donna K. Russell, M.S., CT(ASCP)HT


Educational Objectives:

  1. Recognize cytopathologic specimens requiring adjunctive testing for an accurate diagnosis. 
  2. Accurately determine the appropriate staining mechanism for diagnosis
  3. Identify positive and negative staining for appropriate immunocytochemical and special stains

This tutorial will allow active participation in the interpretation of both gynecologic and non-gynecologic cytopathologic specimens that require adjunctive testing for an accurate interpretation.  Cell block and liquid based material will be utilized for immunostains and special stains. Differential diagnoses will be discussed. 

 

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

Cervical Cytology: Squamous Lesions and Specimen Adequacy
     Diane Davis Davey, M.D.


Educational Objectives:

  1. Distinguish significant squamous lesions from benign processes
  2. Apply Bethesda adequacy criteria to your cervical cytology specimens
  3. Recommend follow-up management including HPV ancillary testing when appropriate

Squamous lesions are the most common abnormality found in cervical cytology specimens. There are a number of reactive processes that may mimic abnormalities, and laboratories are required to identify, report, and monitor various squamous categories for laboratory accreditation. Follow-up management guidelines for various epithelial abnormalities, including the uses of HPV testing, have changed since the American Society for Colposcopy and Cervical Pathology (ASCCP) held their last consensus conference in 2006. Specimen adequacy criteria are still an area of confusion for many cytologists, especially in special circumstances. This tutorial will illustrate numerous examples of squamous lesions and pitfalls, including reactive processes, in liquid based cytology specimens. Practical tips on how to address specimen adequacy concerns will be discussed, and participants will be updated on changes in management guidelines for major squamous categories.

 

Tutorial #5 (7:00 pm to 8:30 pm)

Lessons Learned from Conventional Pap Smears and Their Applications in the Age of Liquid Base Cytology
     Leigh Ann Cahill, B.S., CT(ASCP)CMIAC


Educational Objective:

  1. The goal of this tutorial is to demonstrate how what we have learned from the conventional Pap smear carries over to the Liquid Base Pap even with the morphological and preparation differences  

The microscopic demonstration will include examples of preparation problems and cases exhibiting the morphologic similarities and differences, as well as challenging cases in both types, to point out the diagnostically challenging areas.  Unknown cases will be shown at the end with participant interaction to determine the most accurate diagnosis.  The Liquid Base Cytology will consist primarily of SurePath® preparations.

 

Tutorial #6 (7:00 pm to 8:30 pm)

We thought it was, but…
     Patricia A. Thomas, M.D., M.A.


Educational Objectives:

  1. Identify some cases and situations that can cause diagnostic dilemmas in the practice of cytology
  2. Learn an approach to recognizing and handling misleading clinical information
  3. Learn an approach to dealing with cytomorphological “mixed messages”

We will review and discuss six cases (non-gynecologic, including FNA) from our daily practice that were a cause of a consternation or outright wrong diagnosis.  The cases vary in that they may have presented or elicited misleading clinical history/information, cytomorphologic “mixed messages” or wishful thinking on the part of myself or others. We will discuss characteristic cytomorphologic features, differential diagnoses, definitive versus less definitive diagnoses,  selection of appropriate ancillary tests, and strategies for “getting it right” (the diagnosis that is)—if that’s possible.

 


Saturday, November 3, 2007

 

Tutorial #7 (8:00 am to 9:30 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 (8:00 am to 9:30 am)

Lymphomania
     Ann T. Moriarty, M.D.

Educational Objectives:

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

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 PowerPoint presentation will be used.

 

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

Cytology and its Role in the Intraoperative Consultation
     Sana O. Tabbara, M.D.
     M. Katayoon Rezaei, M.D.

Educational Objectives:

  1. To highlight the role and advantages of “intraoperative cytology” compared to “frozen section”
  2. To demonstrate the cytologic features of disease processes in sites more frequently evaluated in the intraoperative setting and not always amenable to sampling by FNA
  3. To appreciate the similarities and differences in the cytologic material obtained by fine needle aspiration and direct smears/touch preps

This tutorial offers a case-based approach to “intraoperative cytology” as an accurate, fast, safe and tissue conserving alternative to the traditional “frozen section” during the intraoperative consultation.  During this video microscopic tutorial, cytologic smears of a variety of interesting cases, encountered in the intra-operative consultation, and their surgical follow-up will be presented.  The focus will be on the cytologic features of the disease processes from sites not commonly reached by FNA, such as parathyroid, CNS, lung/mediastinum, and pancreas among others.  An interactive discussion on the differential diagnoses and pitfalls will follow each case presentation.

 

Tutorial #10 (10:30 am to 12:00 pm)

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

Educational Objectives: 

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

Using a series of salivary gland FNA cases, this tutorial will focus on the microscopic evaluation and diagnosis of a range of important salivary gland tumors and their variants.

 

Tutorial #11 (10:30 am to 12:00 pm)

Bone and Soft Tissue, FNA, Core Biopsies, Touch Preparations:  How Far Can We Go?
     William J. Frable, M.D.

Educational Objectives:
Participants will review selected cases to:

  1. Correlate radiologic, clinical features of bone and soft tissue tumors
  2. From the cytology of aspirates and touch preparations of small core biopsies, develop a differential diagnosis
  3. Correlate cytologic findings with morphology of tissue core biopsies
  4. Develop a list of ancillary tests, immunohistochemistry and genetic tests to support their morphologic interpretation

A series of cases will be reviewed at the microscope to analyze cytologic and histologic features from aspirates, touch preparation of core biopsies and core biopsies in conjunction with radiographs, CT scans or MRIs to develop a differential and where possible a final diagnosis.  Participants will be asked to identify the significant features microscopically and correlate them with the radiologic images and clinical information.  Participants will also be asked to identify appropriate ancillary studies to support their interpretation.

 

Tutorial #12 (10:30 am to 12:00 pm)

EUS- and CT-Guided Fine Needle Aspirates of Liver: The Easy and the Challenging
     Ibrahim Ramzy, M.D.

Educational Objectives:  

  1. Identify the cytomorphologic characteristics of hepatic lesions including reactive/regenerative nodules, and the variant patterns of primary hepatic malignancies
  2. Recognize key features of spectrum of liver metastases, and discuss the triaging of samples and selection of ancillary studies that help in identifying the source
  3. Recognize pitfalls in diagnosing liver lesions by fine needle aspiration, and the limitations of various sampling technique

Approximately 15 cases of fine needle aspirates from the liver will be reviewed. The techniques used to procure these samples include transcutaneous CT guided and ultrasound guided endoscopic biopsies. The cases are selected to represent classic as well as atypical and problematic cases that are encountered in the daily practice of cytopathology. The spectrum covers reactive, regenerative and other nonneoplastic conditions, as well as primary hepatic malignancies. A few cases of metastatic malignancies will demonstrate the selection of ancillary techniques in attempting to identify the source of primary neoplasm.

A CD ROM with text, images and references will be available for the participants.

 

Tutorial #13 (3:00 pm to 4:30 pm)

Challenges in Serous Effusion Cytology
     Michael Facik, M.P.A., CT(ASCP)

Educational Objectives:

  1. To appreciate the morphologic characteristics of malignancy in serous effusion
  2. To recognize features that suggest a particular primary site even in the absence of clinical history
  3. Understand basic principals of special staining techniques including expected results
  4. To anticipate the potential of tumor cells in effusion to look different than the same cells observed from a different site

This tutorial will emphasize the cytologic characteristics of difficult serous effusions.  Actual case scenarios will be used to discuss the appropriate use of immunocytochemical stains.  Special attention will be given to the morphologic similarities, or differences, of various primary cancers after they have metastasized to the serous cavities.  The pitfalls encountered in the diagnosis of malignant mesothelioma will also be discussed.

 

Tutorial #14 (3:00 pm to 4:30 pm)

Challenging Cases of Metastatic Tumor of Unknown Primary and Multiple Primaries: Strategies to Arrive at the Correct Diagnosis
     Savitri Krishnamurthy, M.D.

Educational Objectives:

  1. Recognition of the limitations of cytomorphology alone and the overlap in morphological features between different tumors as demonstrated by ten selected challenging cases that will be presented
  2. Familiarity with appropriate panels of immunostains useful in the workup of selected difficult cases of metastatic tumors of unknown primary and multiple primaries

Ten challenging cases that may be encountered not uncommonly in clinical practice including metastatic tumors of unknown primary and multiple primaries will be presented. The cytomorphological features of the cases, and the differential diagnosis of each case will be discussed in detail. The ancillary immunostaining panel in each case will be subsequently presented  highlighting the sensitivity and specificity of pertinent immunomarkers as applicable to each case. At the end of each case, one or two PowerPoint slides will be projected with “take home” information, which will also be provided upfront in the handouts. Overall, 90% of the allotted time will be spent in discussing the cases under the microscope and only 10% will be devoted to PowerPoint slides (one or two per cases) with salient conclusions derived from each presented case.

 

Tutorial #15 (3:00 pm to 4:30 pm)

A Practical Approach to Thyroid FNAs
     Nancy P. Caraway, M.D.

Educational Objectives: 

  1. Recognize architectural patterns and cytomorphologic features to classify thyroid lesions
  2. Review the differential diagnosis of thyroid lesions that have overlapping features
  3. Discuss the role and limitations of ancillary techniques applicable to thyroid FNA

The course will begin with a short didactic presentation on the classification of thyroid lesions based on architectural patterns, cellular features, and background.  The differential diagnosis of papillary, follicular, Hurthle, and cystic lesions will be reviewed.  Then a variety of cases will be discussed using an interactive approach through the use of video microscopy.  Potential pitfalls and the use of ancillary studies will also be discussed.

 

Tutorial #16 (7:00 pm to 8:30 pm)

Endoscopic Ultrasound Guided Fine Needle Aspiration of Mediastinal Lesions: An Algorithmic Approach to Diagnosis
     Nirag Jhala, M.D., MIAC
     Darshana Jhala, B.Mus., M.D.

Educational Objectives:

  1. Generate a sound algorithm based diagnosis and differential diagnosis of mediastinal lesions aspirated under Endoscopic Ultrasound (EUS) Guidance
  2. Identify areas of potential pitfalls in evaluating samples obtained using EUS-FNA
  3. Identify need for appropriate ancillary studies to arrive at accurate diagnosis

This tutorial will demonstrate various mediastinal lesions including those from the intra thoracic lymph nodes, posterior mediastinum and lungs. The course will use an index case aspirated under EUS guidance. This will serve as a jump board to demonstrate an algorithmic approach to arrive at morphology based diagnosis and differential diagnosis.  Furthermore, it will also document morphologic changes on slides that should be recognized to avoid potential pitfalls. In addition, this course will highlight the value appropriate ancillary studies needed to arrive at accurate diagnosis and thereby could potentially impact management decisions.

 

Tutorial #17 (7:00 pm to 8:30 pm)

Non-Gynecologic Cytology on Liquid-Based Preparations
     Rana S. Hoda, M.D., FIAC

Educational Objectives:

  1. Facilitate diagnostic interpretation of non-gynecologic cytology on liquid-based preparations (via SurePath® and ThinPrep® )
  2. Recognize the diagnostic pitfalls induced by the liquid-based preparatory techniques
  3. Demonstrate practical applications of ancillary (including immunocytochemical and molecular) tests on these specimens
  4. Learn about the basic morphological differences between LBP and conventional smears

Liquid-based preparations (LBP) (via SurePath® and ThinPrep®) are rapidly replacing conventional preparatory methods for non-gynecologic cytology including exfoliative and fine needle aspiration (FNA) cytology.  The LBP invariably induce alterations in cytomorphology of the exfoliated and aspirated cells from various sites and produce diagnostic pitfalls in interpretation not seen on conventional preparations.  There is a need to educate practitioners of non-gynecologic cytology on various practical aspects of interpretation of LBP.  It is also necessary to achieve greater understanding of the applications of ancillary (including immunocytochemical and molecular) tests on LBP, particularly, human papillomavirus (HPV) test and fluorescence in situ hybridization (FISH).

This session will cover differences in cellular morphology in LBP vis a vis conventionally prepared specimens.  Ten illustrative LBP cases, each depicting a different set of clinical and pathological findings, will be discussed including selected lesions of thyroid, salivary gland, lymph node, breast, lung, pancreas, cutaneou, effusion, and genitor-urinary cytology.  Pertinent differential diagnoses and diagnostic pitfalls associated with LBP will also be presented.  The use of immunocytochemical and molecular testing will be incorporated wherever applicable.  Glass slides and PowerPoint presentation will be utilized.  Participants will also receive a handout.

 

Tutorial #18 (7:00 pm to 8:30 pm)

Fluid Cytology
     Kristen A. Atkins, M.D.

Educational Objectives:

  1. To assess common fluid sites (effusions, ascites) for pitfalls in diagnosis (benign and malignant mesothelial mimics)
  2. Discuss new antibodies available for aiding in differentiating mesothelial cells from malignant mimics
  3. To review ovarian cyst cytology, and discuss the usual managerial implications.
  4. To evaluate vitreous fluid and view primary and metastatic malignancies, as well as normal components

Fluid cytology accounts for a large proportion of medical cytology specimens.  Additionally, we are seeing more frequent sampling from sites such as ovarian cysts and vitreous fluid.  Despite the large volume in many laboratories, fluid cytology remains extremely challenging.  This tutorial will review the mimics of mesothelial cells and clues to spotting them, uncommon fluids and the frequent normal constituents as well as neoplasms.  We will review ancillary testing such as flow cytometry and immunocytochemistry (with a comprehensive handout). This microscopy tutorial assumes a basic understanding of fluid cytology.

 


Sunday, November 4, 2007

 

Tutorial #19 (8:00 am to 9:30 am)

FNA of Lymph Nodes: From Non-neoplastic to Neoplastic
     Ibrahim Ramzy, M.D.

Educational Objectives:

  1. Recognize the morphologic features of needle aspirates from inflammatory and other reactive lesions of lymph nodes
  2. Identify the cytomorphologic characteristics of Hodgkin and non-Hodgkin lymphomas
  3. Discuss the triaging of samples and selection of ancillary studies to identify sources of metastases in lymph node aspirates
  4. Recognize some of the common pitfalls in diagnosing lymphadenopathies by fine needle aspiration, and the limitations of the technique

Approximately 15 cases of fine needle aspirates from lymph nodes will be reviewed. The cases are selected to represent classic as well as atypical and problematic cases that are encountered in the daily practice of cytopathology. The spectrum covers reactive, granulomatous, granulosuppurative and other nonneoplastic conditions, as well as Hodgkin and non-Hodgkin lymphomas. A few cases of metastatic malignancies are used to demonstrate the selection of ancillary techniques in attempting to identify the source of primary neoplasm. The role and limitations of FNA and ancillary technique will be discussed using the cases presented.

 

Tutorial #20 (8:00 am to 9:30 am)

Cyto-Olympics – Fine Needle Aspiration of Superficial Palpable Lumps and Bumps
     Edward Bernacki, M.D.

Educational Objectives:

  1. To review and discuss the cytologic features of fine needle aspiration biopsy specimens retrieved from superficial palpable lesions
  2. To discuss the differential diagnostic possibilities of the individual cases

Cyto-Olympics is a friendly diagnostic competition of microscopic skills of superficial palpable fine needle aspiration specimens presented in an interactive unknown slide conference format.

 

Tutorial #21 (8:00 am to 9:30 am)

Cytopathology of Infectious Disease
     Celeste N. Powers, M.D., Ph.D.

Educational Objectives:

  1. The importance of cytopathology in the diagnosis of infectious disease
  2. The important cytologic criteria for the diagnosis of several microorganisms
  3. The utility of Papanicolaou, DiffQuik® and special stains in the identification of infectious agents

The availability of a variety of rapid, safe and cost-effective techniques and stains often place cytopathology in the forefront of diagnostic evaluations, including the diagnosis of infectious disease. This tutorial will explore the utility of cytopathology in the diagnosis of infectious disease with emphasis on the detection and identification of common microorganisms in various cytologic specimens.  Examples from the four major categories of microorganisms (bacteria, fungus, parasite and virus) will be shown.  The role of DiffQuik®, Papanicolaou and special stains for cytodiagnosis of various infectious agents will also be discussed.

 

Tutorial #22 (2:00 pm to 3:30 pm)

The Problem Pap Test – Interesting and Unusable Cases in GYN Cytopathology
     Jamie L. Covell, B.S., CT(ASCP)

Educational Objectives:

  1. Be able to recognize and discuss differential diagnosis for difficult cases
  2. Describe criteria for making morphologic evaluations in unusual cases
  3. Discuss the importance of clinical history in the evaluation of Pap tests

The participants will have the opportunity to review liquid – based and conventional slides from interesting and unusual cases in GYN Cytopathology.  Slide examples of entities in the differential diagnosis will be reviewed and compared for each case.  A cytologic criteria and clinical history will be discussed.

 

Tutorial #23 (2:00 pm to 3:30 pm)

Challenging Gynecologic Cases on ThinPrep® Cytology
      Suzanne Selvaggi, M.D.

Educational Objectives:

  1. Review difficult diagnostic cases including ASC-H, HSIL involving endocervical glands versus endocervical AIS, and background changes in radiation change, atrophy/atrophic vaginitis and invasive squamous cell carcinoma on the ThinPrep® Pap TestTM  as compared to the conventional smear
  2. Compare and contrast benign/inflammatory background changes with tumor diathesis on ThinPrep® slides

In 1996, the ThinPrep® Pap TestTM was FDA approved as an alternative to the conventional Papanicolaou smear in the diagnosis of cervivovaginal lesions.  Since that time, articles and monographs have been published on the cytomorphologic features of the more classic gynecologic lesions.  This microscopic tutorial will present potpourri of gynecologic diagnostic dilemmas on ThinPrep® cytology, including the cytologic features of ASC-H, the cytologic features of HSIL involving endocervical glands versus endocervical adenocarcinoma in situ, background changes in radiation, atrophy/atrophic vaginitis and invasive squamous cell carcinoma – can they be reliably distinguished on ThinPrep® cytology.  Benign/inflammatory background changes on ThinPrep® slides will be compared and contrasted with tumor diathesis.

 

Tutorial #24 (2:00 pm to 3:30 pm)

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

Educational Objectives:

  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. 

 


Monday, November 5, 2007

 

Tutorial #25 (8:00 am to 9:30 am)

Aspiration Cytopathology of Diag