DEPARTMENT OF PATHOLOGY AND
LABORATORY MEDICINE
DÉPARTEMENT DE PATHOLOGIE ET DE
MÉDECINE DE LABORATOIRE
JOURNÉE ANNUELLE
DE LA RECHERCHE
ANNUAL RESEARCH DAY
2017
ANNUAL RESEARCH DAY PROGRAM
DEPARTMENT OF PATHOLOGY AND
LABORATORY MEDICINE
UNIVERSITY OF OTTAWA
Monday May 15th, 2017
ROGER GUINDON HALL
ROOM 1007
HEALTH SCIENCES BUILDING
8:45 - 9:00
COFFEE
9:00 – 9:10
WELCOME
9:10 – 9:25
THE USE OF A TISSUE SAVING MULTIPLEX ANTIBODY
(ADH5) WITH TTF 1 TO SUBTYPE NON-SMALL CELL
LUNG CANCER ON CYTOLOGY SPECIMENS
Jordan Sim, Shahid Islam. Department of Pathology and
Laboratory Medicine, University of Ottawa and The Ottawa
Hospital, Ottawa ON, Canada
9:25 –9:40
IFITM1 OUTPERFORMS CD10 IN DIFFERENTIATING LOW
GRADE ENDOMETRIAL STROMAL SARCOMAS FROM
SMOOTH MUSCLE NEOPLASMS OF THE UTERUS
Aurelia Busca1, Previn Gulavita2, Carlos Parra-Herran3* and
Shahidul Islam1*, 1 Department of Pathology and Laboratory
Medicine, University of Ottawa and The Ottawa Hospital, Ottawa
ON, Canada, 2 Department of Medical Biology, University of
Ottawa and Montfort Hospital, Ottawa ON, Canada, 3 Department
of Laboratory Medicine and Pathobiology, University of Toronto and
Sunnybrook Health Sciences Centre, Toronto ON, Canada
9:40-9:55
NSCLC
LYMPH
NODE
METASTASIS:
DO
CYTOMORPHOLOGICAL FEATURES CORRELATE WITH
STANDARDIZED UPTAKE VALUE OF PET SCAN?
Kianoosh Keyhanian, Harman Sekhon
Department of Pathology and Laboratory Medicine, University of
Ottawa/The Ottawa Hospital, Ottawa, Ontario
9:55-10:10
LIPOMATOUS TUMOURS WITH ATYPIA ARE NOT
ALWAYS LIPOSARCOMA: IMMUNOHISTOCHEMICAL
EVALUATION OF A SERIES OF LIPOMATOUS TUMOURS
WITH ATYPIA, INCLUDING A RETROPERITONEAL
PLEOMORPHIC LIPOMA
Ashley N. Flaman a,b, Denis H. Gravel a,b, Chi K. Lai a,b, Susan J.
Robertson a,b, Bibianna M. Purgina a,b
a
Department of Pathology and Laboratory Medicine, The Ottawa
Hospital, Ottawa, ON; bUniversity of Ottawa, Ottawa, ON
10:10-10:25
VALUE OF EOSINOPHILIC ESOPHAGITIS HISTOLOGY
SCORING SYSTEM
Chernetsova, Elizaveta1, A Agarwal2, D El Demellawy1,2
University of Ottawa, Children’s Hospital of Eastern Ontario,
Canada
10:25 – 10:45
COFFEE BREAK
10:45-11:00
THE HISTOPATHOLOGY AND THE PATHOGENESIS OF
FLOPPY EYELID SYNDROME
Chen, Henry1, 2; Brownstein, Seymour1, 2; Jordan, David R.1;
Belliveau, Michel J.1; Gilberg, Steven1; Blanco, Paula2; Farmer,
James2; Iacob, Codrin3
1. Ophthalmology, University of Ottawa, Ottawa, ON, Canada. 2.
Pathology & Laboratory Medicine, University of Ottawa, Ottawa,
ON, Canada. 3. Pathology, New York Eye and Ear Infirmary, New
York, NY, United States.
11:00-11:15
AN ANALYSIS OF MEDICAL ASSISTANCE IN DYING
CASES IN ONTARIO: UNDERSTANDING THE PATIENT
DEMOGRAPHICS OF CASE UPTAKE IN ONTARIO SINCE
THE ROYAL ASSENT AND AMENDMENTS OF BILL C-14
Rosso, Alexandra E BHSc candidate, School of Health Sciences,
University of Ottawa
Dr Dirk Huyer MD, Chief Coroner for the Province of Ontario, Office
of the Chief Coroner
Dr Alfredo Walker MB.BS, FRCPath, DMJ (Path), MFFLM,
MCSFS.Forensic Pathologist/Coroner – Ontario Forensic
Pathology Service. Eastern Ontario Regional Forensic Pathology
Unit – Ottawa. Department of Pathology and Laboratory Medicine,
University of Ottawa
11:15-11:30
OOCYTE DONATION PREGNANCIES AND THE RISK OF
PREECLAMPSIA OR GESTATIONAL HYPERTENSION: A
SYSTEMATIC REVIEW AND META-ANALYSIS
Masoudian, Pourya, BHSc1 , Ahmed NASR, MD, MSc2, Joseph
De Nannasy, MD1,, Karen FUNG-KEE-FUNG, MD, MHPE3,
Shannon A. BAINBRIDGE, PhD4, Dina EL DEMELLAWY, MD,
PhD1
1Department of Pediatric Pathology, Children's Hospital of Eastern
Ontario, Faculty of Medicine, University of Ottawa, Ottawa, ON
2Department of Pediatric Surgery, Children's Hospital of Eastern
Ontario, Faculty of Medicine, University of Ottawa, Ottawa, ON
3Department of Obstetrics and Gynecology, The Ottawa Hospital,
Faculty of Medicine, University of Ottawa, Ottawa ON
4Faculty of Health Sciences, University of Ottawa, Ottawa, ON.
11:30-11:45
TREATMENT
MODALITIES
OF
TWIN
ANEMIA
POLYCYTHEMIA (TAPS): A SYSTEMATIC REVIEW
Hill, Kevin1, Pourya Masoudian1, Karen Fung-Kee-Fung1,2, Dina El
Demellawy1,3
1
University of Ottawa, Faculty of Medicine, 2Department of
Obstetrics and Gynecology, The Ottawa Hospital, 3Department of
Pediatric Pathology, Children's Hospital of Eastern Ontario, Ottawa,
Ontario
11:45 – 13:45
LUNCH AND POSTER VIEWING
Atrium (University)
13:45 – 14:45
KEYNOTE LECTURE - Dr. Fattaneh Tavassoli
Professor of Pathology - Yale University, USA
Lecture Title: “Correlation between GEP-based Molecular and
Morphologic Classification of Breast Carcinomas”
Objectives: To cover the morphology of multiple variants of triple
negative carcinoma, evolution of molecular classification & some
of the potential problems if one relies completely on molecular
classification.
14:45 – 15:00
POSTER ORAL PRESENTATIONS (OPTIONAL)
14:45-14:50
PEDIATRIC BLASTIC PLASMACYTOID DENDRITIC CELL
NEOPLASM - A SYSTEMATIC LITERATURE REVIEW
Jeong-Min Kim, Marie, Ahmed Nasr, Bilaal Kabir, Joseph de
Nanassy, Ken Tang, Danielle Menzies-Toman, Donna
Johnston, Dina El Demellawy
University of Ottawa, Children’s Hospital of Eastern Ontario,
Canada
14:50-14:55
DIAGNOSTIC VALUE OF MID ESOPHAGEAL BIOPSIES IN
PEDIATRIC
PATIENTS
WITH
EOSINOPHILIC
ESOPHAGITIS
Chernetsova, E,
J Joo, A Agarwal, J Barkey, D El
Demellawy
University of Ottawa, Children’s Hospital; of Eastern Ontario,
Canada
14:55-15:00
A RARE CASE OF PEDIATRIC LIPOMA WITH
T(9;12)(P22;Q14) AND EVIDENCE OF HMGA2 NFIB GENE
FUSION
Lacaria, Melanie1, Dina El Demellawy2,3, Jean McGowanJordan1,4
Genetics Department, Children’s Hospital of Eastern Ontario;
Pediatric Pathology Department, Children’s Hospital of Eastern
Ontario;
3
Department of Surgery, University of Ottawa;
4
Department of Pathology and Laboratory Medicine, University of
Ottawa
1
2
15:00 – 15:15
COFFEE BREAK
15:15 – 15:30
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
POSTERS
1. PEDIATRIC BLASTIC PLASMACYTOID DENDRITIC CELL NEOPLASM
A SYSTEMATIC LITERATURE REVIEW
Jeong-Min Kim, Marie, Ahmed Nasr, Bilaal Kabir, Joseph de Nanassy,
Ken Tang, Danielle Menzies-Toman, Donna Johnston, Dina El Demellawy
University of Ottawa, Children’s Hospital of Eastern Ontario, Canada
2. THE EFFICIENCY OF ACTIVATING THE MasR/Ang1-7 PATHWAY TO
REDUCE MUSCLE ATROPHY AND FUNCTION LOSS FOLLOWING
DENERVATION
Albadrani, H*1 and J.M Renaud*1
Department of the Cellular and Molecular Medicine, Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
3. RNA-SEQ ANALYSIS OF REXINOID RESPONSIVE GENE EXPRESSION
DURING EARLY MYOBLAST DIFFERENTIATION
Khilji, Saadia, Qiao Li
Department of the Cellular and Molecular Medicine, Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
4. Retrospective,
case-controlled
stereological
assessment
of
vascularization in placentas of HIV-exposed, uninfected (HEU)
children.
Wahba, Mary, Jenifer Bowes (BSc, MSc), Chris G. Ball (M.D.), Jason
Brophy (M.D.), David Grynspan (M.D.)
University of Ottawa, Children’s Hospital of Eastern Ontario, Canada
5. DIAGNOSTIC VALUE OF MID ESOPHAGEAL BIOPSIES IN PEDIATRIC
PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
Chernetsova, E, J Joo, A Agarwal, J Barkey, D El Demellawy
University of Ottawa, Children’s Hospital; of Eastern Ontario, Canada
6. DOUBLE HIT DIFFUSE LARGE B-CELL LYMPHOMA TESTING AT THE
OTTAWA HOSPITAL
Capitano, Mario, M.D., and Philip Berardi, M.D., Ph.D., FRCPC
The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa ON K1H
8L6
7. ADENOCARCINOMA EX-GOBLET CELL CARCINOID TUMOURS,
PATHOLOGIC CLASSIFICATION AND CLINICAL BEHAVIOR: AN
ANALYSIS OF CASE SERIES (FROM 2003-2017 FROM THE OTTAWA
HOSPITAL PATHOLOGY GROUP
Capitano, Mario, M.D., and Zohreh Eslami, M.D., Ph.D., FRCPC
The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa ON K1H
8L6
8. STROMAL TISSUE AS AN ADJUNCT TOOL IN THE DIAGNOSIS OF
FOLLICULAR THYROID LESIONS BY FINE-NEEDLE ASPIRATION
BIOPSY
Hogan, Kevin, Kien T. Mai.
The Ottawa Hospital and University of Ottawa, Pathology and Laboratory
Medicine, Ottawa, ON, Canada
9. CHARACTERISTICS OF LYMPHOPROLIFERATIVE DISORDERS (LPD)
WITH MORE THAN ONE ABERRANT CELL POPULATION AS
DETECTED BY 10 COLOR FLOW CYTOMETRY
Mahdi, Talal (1, 2), Amr Rajab (2,3) ,Ruth Padmore (1), *Anna Porwit (2,4)
(1) Department of Pathology and Laboratory Medicine, The Ottawa
Hospital and Eastern Ontario Regional Laboratory Association and
University of Ottawa, ON, Canada.
(2) Flow Cytometry Laboratory, Department of Laboratory Hematology,
Laboratory Medicine Program, University Health Network, Toronto, ON,
Canada.
(3) Present address: Flow cytometry department, Lifelabs Medical
laboratory services-Toronto.
(4) Present address: Department of Clinical Sciences, Division of Oncology
and Pathology, Faculty of Medicine, Lund University, Lund, Sweden
10. EMERGENCY TRANSFUSION OF ONE UNCROSSMATCHED GROUP O Rh
POSITIVE RED CELL UNIT TO A PATIENT WITH ANTI-D ANTIBODY
IDENTIFY ONCE TYPE AND SCREEN WERE COMPLETED. A CASE REPORT
Mahdi, Talal, MD, Ruth Padmore, MD
The Ottawa Hospital and Eastern Ontario Regional Laboratory Association
and University of Ottawa
11. A RARE CASE OF PEDIATRIC LIPOMA WITH T(9;12)(P22;Q14) AND
EVIDENCE OF HMGA2 NFIB GENE FUSION
Lacaria, Melanie1, Dina El Demellawy2,3, Jean McGowan-Jordan1,4
1Genetics Department, Children’s Hospital of Eastern Ontario;
2Pediatric Pathology Department, Children’s Hospital of Eastern Ontario;
3Department of Surgery, University of Ottawa;
4Department of Pathology and Laboratory Medicine, University of Ottawa
12. DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
HISTOLOGY CORE FACILITY
J.P.Veinot1, C.A. Jodouin2, Z. Ticas3, L. Dong4, E. Labelle5, S. Faulkes6, M.
Khalili7, M. Alazzabi8, O. Agah9
The University of Ottawa, Faculty of Medicine, Department of Pathology
and Laboratory Medicine (PALM), Histology Core Facility
WELCOME
THE USE OF A TISSUE SAVING MULTIPLEX ANTIBODY (ADH5)
WITH TTF 1 TO SUBTYPE NON-SMALL CELL LUNG CANCER ON
CYTOLOGY SPECIMENS
Jordan Sim, Shahid Islam. The Ottawa Hospital, Ottawa, ON, Canada
Background: 70% of lung cancers present at an advanced stage, and
subtyping of non-small cell lung cancers must therefore be done on
cytologic specimens and small biopsies when possible. Many antibodies
have been investigated for the subtyping of non-small cell lung
carcinomas. Although the combination of p40 and TTF-1 is commonly
used, this is not always sufficient and more markers must be used.
Entering the era of personalized medicine, conservation of cell blocks for
molecular studies is vital, and minimizing the number of
immunohistochemical stains is important. The multiplex antibody ADH5 is
frequently used in breast pathology, but to date has not been investigated
for its use in lung cancer. ADH5 includes a panel of antibodies (CK5/14,
CK7/18 and p63) all of which have been proven to aid in the subtyping of
non-small cell lung carcinomas. The aim of this study is to assess the
efficacy of the ADH5 multiplex antibody in combination with TTF-1 in
subtyping
non-small
cell
carcinomas.
Design: A database search from January 2014 onwards was conducted
for cases of cytologically diagnosed non-small cell lung cancer with
subsequent surgical resection specimens. A total of 175 consecutive
cases were retrieved, 83 of which had adequate cell blocks fixed in
formalin. Immunohistochemistry for TTF-1 and ADH5 was performed on
all
83
cases.
Results: Of the 83 cases used in this study, final diagnoses on surgical
resection included squamous cell carcinoma (25.3%), adenocarcinoma
(71.1%) and adenosquamous carcinoma (3.6%). On cytology, 17 (20.5%)
cases could not be subtyped. At the time of original cytologic diagnosis,
immunohistochemistry was used to subclassify NCSLC in 32 (38.6%)
cases. The number of stains performed ranged from 2 to 5 (mean 3.38).
With the use of immunohistochemistry, 9 (11%) remained not subtyped.
Using the combination of TTF-1 and ADH5 multiplex antibody, 80/83
(96%) cases were classified accurately, including 17 cases that were
previously not subtyped and 1 case that was misdiagnosed. 3 (3.6%)
cases of adenosquamous carcinoma could not be accurately subtyped
using
this
panel.
Conclusions: A multiplex antibody for CK5/14, CK7/18 and p63 in
combination with TTF-1 is an effective combination for subtyping NSCLC
on cytology specimens. This combination requires only 2 sections,
therefore saving tissue for further ancillary studies.
IFITM1 OUTPERFORMS CD10 IN DIFFERENTIATING LOW GRADE
ENDOMETRIAL STROMAL SARCOMAS FROM SMOOTH MUSCLE
NEOPLASMS OF THE UTERUS
Aurelia Busca1, Previn Gulavita2, Carlos Parra-Herran3* and Shahidul
Islam1* 1 Department of Pathology and Laboratory Medicine, University of
Ottawa and The Ottawa Hospital, Ottawa ON, Canada
2 Department of Medical Biology, University of Ottawa and Montfort
Hospital, Ottawa ON, Canada
3 Department of Laboratory Medicine and Pathobiology, University of
Toronto and Sunnybrook Health Sciences Centre, Toronto ON, Canada
* CP-H and SI contributed equally as senior authors
Introduction: Distinguishing between uterine neoplasms of smooth
muscle and endometrial stromal origin is a frequent diagnostic challenge.
We investigated the staining pattern of interferon-induced transmembrane
protein-1 (IFITM1), a novel endometrial stromal marker, in endometrial
and smooth muscle uterine neoplasms and compared it to CD10 in its
ability to differentiate between these two groups.
Methods: Immunohistochemistry for IFITM1 and CD10 was performed in
20 cases of smooth muscle neoplasms (10 cases leiomyoma, 10 cases
leiomyosarcoma), 14 cases of endometrial stromal sarcoma (12 cases
low grade and 2 cases high grade) and 12 cases of carcinosarcoma.
Staining was scored in terms of intensity and distribution (0=absent,
1=weak/less than 50%, 2=moderate/50-75%, 3=strong/more than 75%).
A total score was obtained by adding intensity and distribution scores and
classified as positive (score 3-6) or negative (score 0-2).
Results: IFITM1 was positive in 10/12 (83%) low grade endometrial
stromal sarcomas, 6/20 (30%) smooth muscle tumors (leiomyomas and
leiomyosarcomas) and 11/12 carcinosarcomas (91.6%). The two cases of
high grade endometrial stromal sarcoma were IFITM1 negative. While
both IFITM1 (83%) and CD10 (91%) had high sensitivity in differentiating
low grade endometrial stromal sarcomas from smooth muscle
neoplasms, IFITM1 (70%) had higher specificity compared to CD10
(45%).
Conclusions: In this study IFITM1 appears to be a more specific marker
of endometrial stromal differentiation compared to CD10 in differentiating
low grade endometrial stromal sarcomas from smooth muscle
neoplasms. Thus, IFITM1 may be a valuable tool as part of an
immunohistochemical evaluation panel in this diagnostic scenario.
NSCLC LYMPH NODE METASTASIS: DO CYTOMORPHOLOGICAL
FEATURES CORRELATE WITH STANDARDIZED UPTAKE VALUE OF
PET SCAN?
Kianoosh Keyhanian, Harman Sekhon
Department of Pathology and Laboratory Medicine, University of
Ottawa/The Ottawa Hospital, Ottawa, Ontario
Background/Objective
Positron emission tomography (PET) followed by endobronchial
ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the
suspicious lymph nodes (LNs) is a standard procedure for pre-operative
staging of lung cancer. The objective of this study is to correlate
cytomorphological features of metastatic non-small cell lung carcinoma
(mNSCLC) with maximal standardized uptake value (mSUV) of PET scan
in LNs.
Method(s)
Positive EBUS-TBNA cytology slides were reviewed from patients with
mNSCLC. Fifty-seven LNs were selected from 49 patients who had
undergone PET study. Student t-test was used for statistical
comparisons.
Results
Mean patients’ age was: 68.7, 67% male. LNs locations were as follows:
mediastinum: 48 (24 subcarinal, 24 para-tracheal), lung hilum: 8, axilla: 1.
Final diagnoses were: Adenocarcinoma: 41 LNs, squamous cell
carcinoma: 13 LNs and NSCLC: 3 LNs. Within the Adenocarcinoma
subgroup, we observed that histological patterns correlate with mSUV,
with acinar and papillary (both mean values: 9.3) patterns associating
with significantly lower mSUVs than solid pattern (Mean value: 13.8)
(both P values <0.05). Similar difference exists between low and high
grade Adenocarcinomas (Mean values: 9.4 and 13.2, respectively. P
value <0.01). Interestingly, micropapillary pattern was associated with the
lowest mSUV (Mean value: 4.7). Other features that correlated with
higher mSUV: LN size (correlation coefficient: 0.51, P value: 0.006),
presence of necrosis and moderate/severe nuclear atypia (both P values
< 0.01), LN site (mediastinal vs. hilar Mean value: 11.6 vs. 7,
respectively. P value: 0.01) as well as lower lymphoid tissue yield (Mean
values: 7.7 vs. 11.4, P value: 0.04). Besides, presence of solid pattern
was linked with significantly higher cell-block yield than acinar or papillary
patterns (P values < 0.05).
Conclusions
In LNs with mNSCLC, certain cytomorphological features including
histological pattern, grade, necrosis and moderate/severe nuclear atypia
are associated with higher mSUV. These results are consistent with the
prior studies examining primary lung tumours. Interestingly, more
aggressive metastatic micropapillary carcinomas express lower SUV
values; hence, a lower threshold should raise concerns for metastasis.
LIPOMATOUS
TUMOURS
WITH
ATYPIA
ARE
NOT
ALWAYS
LIPOSARCOMA: IMMUNOHISTOCHEMICAL EVALUATION OF A SERIES
OF
LIPOMATOUS
TUMOURS
WITH
ATYPIA,
INCLUDING
A
RETROPERITONEAL PLEOMORPHIC LIPOMA
Ashley N. Flaman a,b, Denis H. Gravel a,b, Chi K. Lai a,b, Susan J. Robertson a,b,
Bibianna M. Purgina a,b
aDepartment of Pathology and Laboratory Medicine, The Ottawa Hospital,
Ottawa, ON; b, University of Ottawa, Ottawa, ON
Background:
Pleomorphic lipoma/spindle cell lipoma (PL/SCL) is a benign lipomatous tumor
that occurs most commonly in the neck/upper back. They may be diagnostically
challenging because they contain pleomorphic or multinucleated floret-like cells
(PL) and/or spindle cells (SCL) that may mimic well-differentiated liposarcoma
(WDLPS). In contrast, WDLPS is most commonly found in the retroperitoneum
and deep soft tissues of the extremities. While they rarely metastasize, WDLPS
may recur locally or dedifferentiate. As a result, the current assumption is that all
retroperitoneal or deep lipomatous tumors with atypia are considered to be
WDLPS until proven otherwise. Using fluorescence in situ hybridization (FISH)
for MDM2 amplification as the gold standard for diagnosis of WDLPS, we
studied the utility of HMGA2, CD34 and S100, with a focus on the relatively new
marker, HMGA2, in the evaluation of lipomatous tumors with atypia.
Design:
Using MDM2 FISH and IHC for CD34, S100 and HMGA2, we analyzed 10
cases of PL, 6 cases of SCL and 11 cases of WDLPS diagnosed since 2003. 3
PL occurred in unusual locations including the arm, forehead and one in the
retroperitoneum (previously reported only once in an English-language journal
without MDM2 analysis).
Results:
PL/SCL was CD34 positive (100%), and negative for S100 (100%) and HMGA2
(100%), while WDLPS was HMGA2 positive (100%) and negative for S100
(91%) and CD34 (55%); 5 cases of WDLPS showed aberrant staining with
CD34. FISH for MDM2 demonstrated amplification in all tested cases of WDLPS
(7/7) and was not amplified in tested cases of PL/SCL (5/5). The case of
retroperitoneal PL shared the same morphology and IHC pattern as its usual
counterparts, and MDM2 was not amplified via FISH.
Conclusion:
All PL/SCL were negative for HMGA2 and positive for CD34. All WDLPS were
HMGA2 positive with 45% also CD34 positive. CD34 in WDLPS was difficult to
interpret because of increased background staining in many cases. Because of
its tidy nuclear staining and ease of interpretation, as well as its superior
performance at differentiating PL/SCL and WDLPS, the combination of HMGA2
and CD34 may be particularly useful. In addition, while anatomic location may
be suggestive of a particular diagnosis, ultimately, the morphology, IHC and
molecular pathology should be used in concert in the diagnosis of difficult
lipomatous tumors. Finally, retroperitoneal PL/SCL do exist and must be
considered for lipomatous tumors with atypia in this location.
VALUE OF EOSINOPHILIC ESOPHAGITIS HISTOLOGY SCORING
SYSTEM
Chernetsova, Elizaveta1, A Agarwal2, D El Demellawy1,2
University of Ottawa, Children’s Hospital of Eastern Ontario, Canada
Background: EoE is a chronic immune-mediated disorder characterized
by the presence of ≥15 eosinophils/HPF in esophageal biopsies in the
absence of other causes of esophageal eosinophilia. The eosinophilic
infiltrate in EoE tends to be patchy and variable. A new scoring method,
the histology scoring system (HSS), evaluates pediatric patients with EoE
using multiple histologic parameters including their severity (grade) of
pathology and the extent (stage). It was proposed by Collins and her
colleagues in 2016 [1].
Study aim: to assess if there is a difference between the traditional
histologic assessment used by pediatric pathologists at CHEO and the
HSS for EoE diagnosis and monitoring.
Study design: the study was granted CHEO REB approval. We
conducted a retrospective chart review of patients with EoE who
presented at CHEO from 2014 – 2016. We included all patients ≤ 18
years old with a clinical, endoscopic and histological diagnosis of EoE, as
well as available initial and follow-up endoscopies reports and
esophageal biopsy slides for review. We excluded patients with a
diagnosis of eosinophilic gastroenteritis, eosinophilic proctitis,
gastroesophageal reflux disease and parasitic infections. Clinical
symptoms were assessed for nausea, vomiting, heartburn, chest or
abdominal pain, food impaction, dysphagia, and symptom dynamic
(improvement vs no improvement). Treatment was also assessed.
Endoscopic parameters included trachealization, edema, strictures, white
flecks, and mucosal furrowing.
As per the traditional CHEO pathologists’ assessment, the histologic
parameter scoring was conducted solely on the peek eosinophilic count,
in the proximal, middle and distal esophageal biopsies. The same
patients were then scored using the HSS. This assessment included the
following histologic parameters: peak eosinophilic density, eosinophilic
abscess, surface eosinophil layering, basal cell hyperplasia, lamina
propria fibrosis, surface epithelial alterations, spongiosis (dilated
intercellular spaces), and dyskeratotic epithelial cells. For each of the
parameters assessed, a grade and a stage score was assigned, for each
location of the esophageal biopsy (proximal, middle, and distal). Final
grade and stage scores were achieved by the summation of scores
across the parameters for each of the locations. From this, the highest
score across the three locations was used to identify one score per
patient, for both grade and stage. Additionally, an overall combined score
per patient was obtained, by summing their overall grade and stage
score. All scoring was completed for both the initial and follow-up
biopsies, and from this, the change in overall combined score was also
computed.
Statistical Analysis: Demographic, clinical characteristics and the
histological scores of patients with both scoring systems were
summarized using descriptive statistics. Univariate logistic regression
models were created to assess whether the change in overall combined
score predicted endoscopic or symptom improvement in patients with
EOE. All analyses were computed for the HSS, and then for the CHEO
scoring system. All statistics were computed using R Version 1.0.136.
Results: A total of 40 patients were identified and included in the study,
of which 9 (25%) were female and 27 (75%) were male. The main
symptoms at initial presentation included vomiting (2.5%), heartburn
(5%), chest or abdominal pain (5%), food impaction/sensation of the food
sticking (22.5%), and dysphagia (25%). 35 (87.5%) of patients
demonstrated symptom improvement at the time of the follow up
assessment.
Of the 40 patients, 39 (97.5%) had a diagnostic abnormality on the initial
endoscopy; and 33 (82.5%) patients had an abnormality that persisted on
the follow-up endoscopy. All patients received treatment with PPI and 23
(57.5%) of patients received treatment with oral steroids as well. 39
(97.5%) of patients were on milk-free diet.
HSS:
The mean overall grade score on the initial biopsy was 12.5 (±5.1), while
on the follow-up biopsy it was 7.4 (±5.6). The mean overall stage score at
the time of the initial biopsy was 11.7 (±4.5), while on the follow-up biopsy
it was 7.3 (±5.4). The mean overall combined score at the time of the
initial biopsy was 24.2 (±9.1), while on the follow-up biopsy it was 14.8
(±10.9).
The change in the overall combined histological score from the initial to
follow-up biopsy, as determined by the HSS, significantly predicted
endoscopic improvement (OR=0.93, p=0.05) and symptom improvement
(OR=0.87, p=0.01) in the follow-up assessment.
CHEO pathologists’ semi quantitative system:
The mean eosinophil count on the initial biopsy was 86.2 (±53.6), while
on the follow-up biopsy it was 43.2 (±52.4).
In contrast to the HSS, the eosinophil count by itself did not significantly
predict endoscopic improvement (OR=0.99, p=0.34) or symptom
improvement (OR=0.99, p=0.45).
Conclusion: our study shows that in contrast to maximum intraepithelial
eosinophilic count that is traditionally used to evaluate EOE histologically,
HSS is of value in predicting endoscopic and symptom improvement in
pediatric patients with EOE.
Reference list.
1. Collins
MH, Martin
LJ, Alexander
ES.
Et
al.
Newly developed and validated eosinophilic esophagitis histology scoring
system and evidence that it outperforms peak eosinophil count for
disease diagnosis and monitoring. Dis Esophagus. 2017 Feb 1;30(3):1-8.
doi: 10.1111/dote.12470.
BREAK
THE HISTOPATHOLOGY AND THE PATHOGENESIS OF FLOPPY
EYELID SYNDROME
Chen, Henry1, 2; Brownstein, Seymour1, 2; Jordan, David R.1; Belliveau,
Michel J.1; Gilberg, Steven1; Blanco, Paula2; Farmer, James2; Iacob,
Codrin3
1. Ophthalmology, University of Ottawa, Ottawa, ON, Canada.
2. Pathology & Laboratory Medicine, University of Ottawa, Ottawa, ON,
Canada.
3. Pathology, New York Eye and Ear Infirmary, New York, NY, United
States.
Purpose: Floppy eyelid syndrome (FES) is an uncommon, but
distressing condition, characterized by a constellation of symptoms and
signs that include an easily everted upper eyelid, papillary conjunctivitis,
nonspecific ocular irritation, and a rubbery, malleable eyelid. The
pathogenesis of FES has not been fully elucidated. We performed an
observational case series to further explore the pathogenesis of FES by
studying the degree of association of elastic tissue loss, adipose tissue
accumulation, and scarring in the tarsus.
Methods: Twenty specimens of FES were obtained from the Ocular
Pathology Registry of the University of Ottawa. Sections from each
formalin-fixed paraffin-embedded specimen were stained with
hematoxylin and eosin, periodic acid-Schiff, Masson’s trichrome,
Verhoeff-Van Gieson elastica, and S100. Each slide was analyzed by
light microscopy. Scores of 1 to 4+ were assigned for the amount of
elastic tissue, number of adipocytes, and degree of fibrovascular scarring
in the tarsus. In each specimen, the number of adipocytes can readily be
counted, while the degree of changes in the elastic tissue and amount of
fibrovascular scarring were compared to selected test slides. Specimens
of eyelids with a normal tarsus served as controls.
Results: The amount of elastic tissue, number of adipocytes, and
fibrovascular scarring will be evaluated pending controls (p<0.05).
Conclusions: Our study documents the possibility of decreased elastic
tissue, the presence of increased adipocytes, and the presence of
fibrovascular scarring and their potential role in the pathogenesis of FES.
Our results further characterize the pathological processes involved in
FES.
AN ANALYSIS OF MEDICAL ASSISTANCE IN DYING CASES IN
ONTARIO: UNDERSTANDING THE PATIENT DEMOGRAPHICS OF
CASE UPTAKE IN ONTARIO SINCE THE ROYAL ASSENT AND
AMENDMENTS OF BILL C-14
Rosso, Alexandra E BHSc candidate, School of Health Sciences,
University of Ottawa
Dr Dirk Huyer MD, Chief Coroner for the Province of Ontario, Office of the
Chief Coroner
Dr Alfredo Walker MB.BS, FRCPath, DMJ (Path), MFFLM, MCSFS.
Forensic Pathologist/Coroner – Ontario Forensic Pathology Service
Eastern Ontario Regional Forensic Pathology Unit – Ottawa
Department of Pathology and Laboratory Medicine, University of Ottawa
On June 17, 2016, the Canadian government legalized medical
assistance in dying (MAID) across the country by giving Royal Assent to
Bill C-14. This Act made amendments to the Criminal Code and other
Acts relating to MAID, allowing physicians and nurse practitioners to offer
clinician-administered and self-administered MAID in conjunction with
pharmacists being able to dispense the necessary medications. The
eligibility criteria for MAID indicates that the individual (i) must be a
recipient of publicly funded health services in Canada, (ii) be at least 18
years of age, (iii) be capable of health-related decision-making, and (iv)
has a grievous and irremediable medical condition
Because this is a new practice in Canadian health care, there are no
published Canadian statistics on MAID cases to date and this paper
constitutes the first analysis of MAID cases in both the province of
Ontario and Canada. Internationally, there are only a few jurisdictions
with similar legislation already in place (USA, the Netherlands, Belgium,
Luxembourg, Switzerland, Columbia, Japan and the United Kingdom).
The published statistics on MAID cases from these jurisdictions were
reviewed and used to establish the current global practices and
demographics of MAID and will provide useful comparisons for Canada.
This analysis will (i) outline the Canadian legislative approach to MAID,
(ii) provide an understanding of which patient populations in Ontario are
using MAID and under what circumstances and (iii) determine if patterns
exist between the internationally published MAID patient demographics
and the Canadian MAID data.
Selected patient demographics of the first 100 MAID cases in Ontario
were reviewed and analyzed using anonymized data obtained from the
Office of the Chief Coroner for Ontario so that an insight into the provision
of MAID in Ontario was obtained. Demographic factors such as age, sex,
the primary medical diagnosis that prompted the request for MAID and
patient rationale for making a MAID request, the place where MAID was
administered, the nature of MAID drug regimen used and the
status/specialty of medical personnel who administered the MAID drug
regimen were analyzed.
The analysis revealed that the majority of the first 100 MAID recipients
were older adults (only 5.2% of patients were aged 35 - 54 years with no
younger adults between ages 18-34 years) who were afflicted with cancer
(64%) and had opted for clinician-administered MAID (99%) which had
been delivered in either a hospital (38.8%) or private residence (44.9%).
Although the cohort was small, these Ontario MAID demographics reflect
similar observations as those published internationally but further analysis
of both larger and annual case uptake in both Ontario and Canada will be
conducted as the number of cases increase.
OOCYTE DONATION PREGNANCIES AND THE RISK
PREECLAMPSIA
OR
GESTATIONAL
HYPERTENSION:
SYSTEMATIC REVIEW AND META-ANALYSIS
OF
A
Masoudian, Pourya, BHSc1 , Ahmed NASR, MD, MSc2, Joseph de
Nanassy, MD1,, Karen Fung-Kee-Fung, MD, MHPE3, Shannon A.
Bainbridge, PhD4, Dina El Demellawy, MD, PhD1
1Department
of Pediatric Pathology, Children's Hospital of Eastern
Ontario, Faculty of Medicine, University of Ottawa, Ottawa, ON
2Department of Pediatric Surgery, Children's Hospital of Eastern Ontario,
Faculty of Medicine, University of Ottawa, Ottawa, ON
3Department of Obstetrics and Gynecology, The Ottawa Hospital, Faculty
of Medicine, University of Ottawa, Ottawa ON
4Faculty of Health Sciences, University of Ottawa, Ottawa, ON
OBJECTIVE: To determine whether pregnancies achieved via oocyte
donation, compared to pregnancies achieved via other assisted
reproductive technology methods or natural conception demonstrate
increased risk of preeclampsia or gestational hypertension.
DATA SOURCES: PubMed, MEDLINE, Embase and CENTRAL (from
1989 to 2015); bibliographies, Google Scholar.
STUDY ELIGIBILITY CRITERIA: Comparative studies of pregnancies
achieved with oocyte donation versus other methods of assisted
reproductive technology or natural conception, with preeclampsia or
gestational hypertension included as one of the measured outcomes.
Abstracts and unpublished studies were excluded.
STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers
independently selected studies, assessed for quality using
Methodological Index for Non-Randomized Studies, and extracted the
data. Statistical analysis was conducted using Review Manager 5.3.
RESULTS: Of 523 studies initially reviewed, 19 comparative studies met
the pre-defined inclusion and exclusion criteria and were included in the
meta-analysis, allowing for analysis of a total of 86,515 pregnancies. Our
pooled data demonstrated that the risk of preeclampsia is higher in
oocyte donation pregnancies compared to other methods of assisted
reproductive technology (OR: 2.54 [1.98, 3.24], p<0.0001) or natural
conception (OR: 4.34 [3.10, 6.06], p<0.0001). The risk of gestational
hypertension was also significantly increased in oocyte donation
pregnancies in comparison with other methods of assisted reproductive
technology (OR: 3.00 [2.44, 3.70], p<0.0001) or natural conception (OR:
7.94 [1.73, 36.36], p=0.008). Subgroup analysis conducted for singleton
and multiple gestations demonstrated similar risk for preeclampsia and
gestational hypertension in both singleton and multiple gestations.
CONCLUSIONS: This meta-analysis provides further evidence
supporting that egg donation increases the risk of preeclampsia and
gestational hypertension compared to other assisted reproductive
technology methods or natural conception.
TREATMENT MODALITIES OF TWIN ANEMIA POLYCYTHEMIA
(TAPS): A SYSTEMATIC REVIEW
Hill, Kevin1, Pourya Masoudian1, Karen Fung-Kee-Fung1,2, Dina El
Demellawy1,3
1University of Ottawa, Faculty of Medicine, 2Department of Obstetrics and
Gynecology, The Ottawa Hospital, 3Department of Pediatric Pathology,
Children's Hospital of Eastern Ontario, Ottawa, Ontario
Objective: Twin anemia-polycythemia sequence (TAPS) is a
complication of monochorionic twin or multiple gestation pregnancies with
a variety of management options. Our objective was to evaluate the
effects of various interventions on perinatal outcomes associated with
pregnancies complicated with TAPS.
Methods: A literature search in PubMed, MEDLINE, EMBASE and
CENTRAL (until 2016) was performed to identify cases of TAPS which
were diagnosed antenatally and for which the perinatal outcomes were
reported. We included both comparative and non-comparative studies
(including case reports and case series). Abstracts and unpublished
studies were excluded. Articles were screened and the data was
extracted by two reviewers independently.
Results: Of 936 articles initially screened, 22 studies met our pre-defined
inclusion criteria. We identified 54 cases of TAPS from case studies and
61 pregnancies with TAPS from two comparative studies. In the 7
included cases managed with laser ablation therapy there was a mortality
of 20%, a live-birth morbidity of 0% and a 12.4% rate of adverse perinatal
outcomes. Of the 21 studies which used any combination of intrauterine
transfusion (IUT) and partial exchange transfusion (PET), a mortality of
16.7%, morbidity of 25.6% and rate of adverse perinatal outcomes of
43.6% were reported. Finally, the 18 cases managed expectantly
demonstrated an 11% mortality, 23.5% morbidity and a rate of adverse
perinatal outcomes of 73.5%. In addition, the percent of cases requiring
emergent caesarean section for laser ablation, IUT/PET and expectant
management were 28.6%, 65% and 71.4%, respectively.
Conclusion: Laser ablation therapy appears to have the lowest rates of
morbidity, occurrence of adverse perinatal outcomes and emergent
caesarean sections compared to IUT and expectant management.
However, due to presence of bias associated with using non-comparative
studies, it is difficult to draw conclusions and more prospective
comparative studies are needed in the future.
LUNCH
AND
POSTER
VIEWING
(ATRIUM)
GUEST SPEAKER
DR. fattaneh tavassoli
Professor OF PATHOLOGY
YALE UNIVERSITY
USA
TITLE: “Correlation between GEP-based
Molecular and Morphologic Classification
of Breast Carcinomas”
POSTERS
(ORAL
PRESENTATIONS)
PEDIATRIC
BLASTIC
PLASMACYTOID
DENDRITIC
NEOPLASM - A SYSTEMATIC LITERATURE REVIEW
CELL
Jeong-Min Kim, Marie, Ahmed Nasr, Bilaal Kabir, Joseph de Nanassy,
Ken Tang, Danielle Menzies-Toman, Donna Johnston, Dina El
Demellawy
University of Ottawa, Children’s Hospital of Eastern Ontario, Canada
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare
aggressive hematologic malignancy characterized by frequent skin
involvement that most commonly affects older patients. BPDCN is known
to have a poor prognosis. Our objective was to assess if outcome and
disease
prognosis were independently influenced
by
age when
evaluated with clinical presentation, sex, and treatment regimens.
We conducted a systematic review to identify BPDCN cases, in order to
compare pediatric BPDCN cases with adult cases. A total
of 125 publications were
identified
detailing 356 cases. Including
one pediatric case from our institution, 74 were children, and 283 were
adults aged 19 or over.
Age was shown to be an independent prognostic factor predictive of more
favorable outcomes across measures including initial response to
therapy, likelihood of relapse, and overall survival at follow-up. The
distribution of affected organs at diagnosis was similar across children
and adults and type of clinical presentation did not disproportionately
influence one age group’s prognosis over the other. Acute Lymphoblastic
Leukemia (ALL)-type chemotherapy regimens were shown to be superior
to other chemotherapy regimens (Acute Myeloid Leukemia, Lymphoma,
ALL/Lymphoma, other, or none) in inducing complete remission.
Allogeneic stem cell transplantation was shown to increase mean
survival time. Future research may be directed towards elucidating the
further morphologic, cytogenetic, and cytochemical differences between
younger and older BPDCN patients.
DIAGNOSTIC VALUE OF MID ESOPHAGEAL BIOPSIES
PEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
IN
Chernetsova, E, J Joo, A Agarwal, J Barkey, D El Demellawy
University of Ottawa, Children’s Hospital; of Eastern Ontario, Canada
Background:
Eosinophilic esophagitis (EOE) is a chronic immune-mediated disorder
characterized by the presence of ≥15 eosinophils/HPF in esophageal
biopsies in the absence of other causes of esophageal eosinophilia.
The esophageal eosinophilic infiltrate is patchy and levels of eosinophilia
can vary between the distal, middle and proximal esophagus. Studies
have shown that increasing numbers of biopsies (6–9 biopsies) improve
the diagnostic sensitivity. However, studies comparing different biopsy
protocols for diagnosis of EOE, particularly in pediatric patients, have not
been conducted.
Design:
We performed a retrospective study of pediatric patients with EOE
presenting at our institute from 2007 – 2015. Our inclusion criteria
included patients’ ≤ 18 years old with clinical, endoscopic and histological
diagnosis of EoE and available initial and follow-up upper GI endoscopies
and esophageal biopsies. Our exclusion criteria included syndromic
conditions, parasitic infections, diagnosis of reflux esophagitis on biopsy
and history of medication at the time of initial presentation. Endoscopic
parameters evaluated were linear furrows, edema/decreased
vascularity/mucosal
stiffness,
white
papules/exudate,
trachealization/rings, stricture and crêpe-paper mucosa. Histologic
parameters evaluated were eosinophils number, basal cell hyperplasia,
lamina propria fibrosis, eosinophilic abscess and spongiosis. The
McNemar chi-square test was used to identify a statistically significant
difference in signal detection of various parameters across the proximal
or distal versus the mid esophageal biopsies. SPSS version 24 was used
for the statistical analysis.
Results:
A total of 100 patients were identified. At the initial diagnostic visit, for the
proximal/distal versus mid esophageal biopsies, there was a statistically
significant difference in identifying intraepithelial eosinophils (p<0.001),
lamina propria fibrosis (p=0.008), crust and erosion (p<0.001),
esophageal thickening/nodularity (p=0.004), furrowing/striation (p=0.01)
and white flecks/exudates (p=0.031) In all significant cases, the proximal
or distal biopsy detected more signals as compared to the mid
esophageal biopsies. There was no statistically significant difference
between the proximal/distal versus mid esophageal biopsies in identifying
basal cell hyperplasia (p=0.063), eosinophilic abscess (p=0.824), erosive
changes/ulceration (p=0.250), spongiosis (p=0.481), trachealization
(p=0.375), edema/loss of vascular pattern/stiffening (p=0.219), strictures
(p=0.625), impacted food content (p=1.000), and friability (p=0.250).
For any follow-up biopsies, for the proximal/distal versus mid esophageal
biopsies, there was a statistically significant difference in identifying
eosinophilic abscess (p=0.027), spongiosis (p<0.001), crust and erosion
(p=0.024), furrowing/striations (p=0.001), edema/loss of vascular pattern
(p=0.001), white flecks, exudates (p=0.008), and impacted food content
(p=1.000). In all significant cases, the proximal or distal biopsy detected
more signals as compared to the mid esophageal biopsies. There was no
statistically significant difference between the proximal/distal versus mid
esophageal biopsies in identifying intraepithelial eosinophils (p=0.238),
basal cell hyperplasia (p=0.581), lamina propria fibrosis (p=0.092),
esophageal thickening/nodularity (p=0.180), erosive changes/ulcerations
(p=1.000), trachealization (p=1.000), erythema (p=0.125), strictures
(p=0.250) and friability of tissue (p=0.250)
Conclusion:
Our study demonstrated that biopsies of the proximal/distal esophagus
show superior diagnostic value compared to the mid esophageal biopsy
at the initial presentation of EOE in children with identifying intraepithelial
eosinophils (≥15 eosinophils/HPF). Similarly the proximal/distal
esophagus show additional information compared to the mid follow up
esophageal biopsies with significantly identifying eosinophilic abscesses,
crust/erosions and spongiosis. The mid esophagus did not show
additional gross or microscopic pathology on the initial or follow up
presentations in pediatric patients with EOE. However, severity of
pathological findings was not assessed in the current study.
A RARE CASE OF PEDIATRIC LIPOMA WITH T(9;12)(P22;Q14) AND
EVIDENCE OF HMGA2 NFIB GENE FUSION
Lacaria, Melanie1, Dina El Demellawy2,3, Jean McGowan-Jordan1,4
1Genetics Department, Children’s Hospital of Eastern Ontario;
2Pediatric Pathology Department, Children’s Hospital of Eastern Ontario;
3Department of Surgery, University of Ottawa;
4Department of Pathology and Laboratory Medicine, University of Ottawa
Abstract
Lipoma is a benign tumor, typically of adulthood, with characteristic
cytogenetic findings including rearrangement of 12q13-15; these
rearrangements often lead to the fusion of the HMGA2 gene at this locus
to the transcriptional regulatory domain of its fusion partner, resulting in
neomorphic activity that presumably facilitates the neoplastic process.
Herein, we report a rare case of pediatric lipoma with t(9;12)(p22;q14)
and evidence of HMGA2-NFIB gene fusion in a 9 year-old boy. This case
provides further evidence of the link between NFIB rearrangement and
early-onset, deep-seated lipomatous tumors.
Key Words: HMGA2, NFIB, FISH, lipoma
COFFEE
BREAK
ANNOUNCEMENT OF
PRIZE WINNERS AND
CONCLUSION
POSTERS
PEDIATRIC
BLASTIC
PLASMACYTOID
DENDRITIC
NEOPLASM - A SYSTEMATIC LITERATURE REVIEW
CELL
Jeong-Min Kim, Marie, Ahmed Nasr, Bilaal Kabir, Joseph de Nanassy,
Ken Tang, Danielle Menzies-Toman, Donna Johnston, Dina El
Demellawy
University of Ottawa, Children’s Hospital of Eastern Ontario, Canada
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare
aggressive hematologic malignancy characterized by frequent skin
involvement that most commonly affects older patients. BPDCN is known
to have a poor prognosis. Our objective was to assess if outcome and
disease
prognosis were independently influenced
by
age when
evaluated with clinical presentation, sex, and treatment regimens.
We conducted a systematic review to identify BPDCN cases, in order to
compare pediatric BPDCN cases with adult cases. A total
of 125 publications were
identified
detailing 356 cases. Including
one pediatric case from our institution, 74 were children, and 283 were
adults aged 19 or over.
Age was shown to be an independent prognostic factor predictive of more
favorable outcomes across measures including initial response to
therapy, likelihood of relapse, and overall survival at follow-up. The
distribution of affected organs at diagnosis was similar across children
and adults and type of clinical presentation did not disproportionately
influence one age group’s prognosis over the other. Acute Lymphoblastic
Leukemia (ALL)-type chemotherapy regimens were shown to be superior
to other chemotherapy regimens (Acute Myeloid Leukemia, Lymphoma,
ALL/Lymphoma, other, or none) in inducing complete remission.
Allogeneic stem cell transplantation was shown to increase mean
survival time. Future research may be directed towards elucidating the
further morphologic, cytogenetic, and cytochemical differences between
younger and older BPDCN patients.
THE EFFICIENCY OF ACTIVATING THE MasR/Ang1-7 PATHWAY TO
REDUCE MUSCLE ATROPHY AND FUNCTION LOSS FOLLOWING
DENERVATION
Albadrani, Hind*1 and Renaud, JM1
Department of the Cellular and Molecular Medicine, Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
Muscle atrophy involved a sequence of events including loss of muscle
mass, reduction in fiber diameter, disorganization of intracellular
structures and decrease in force generation. Muscle atrophy occurs with
spinal cord injury (SCI), neural denervation and space travel as well as
chronic diseases such as heart and renal failure. Recent studies reported
that activation of MasR/Ang1-7 pathway reversed muscle atrophy in
skeletal muscle wasting disease. It remains to be determined, however,
whether Ang 1-7 can also reduce the atrophy process and force loss
following muscle denervation. So, the objective was to test the hypothesis
that “an activation the MasR/Ang1-7 pathway reduces the atrophy and
function loss following denervation in skeletal muscle”. Mouse extensor
Digitorum Longus (EDL) and soleus were denervated by removing 3-4
mm of the sciatic nerve at the thigh level. Denervated mice were divided
into 4 groups: i) denervated; ii) denervated and treated with Ang 1-7 at a
rate of 100 ng/kg body weight/ min; and iii) denervated and treated with
diminazene aceturate (DIZE), a ACE2 activator to locally increase Ang 17 levels, administrated by oral gavage at 15 mg/kg body weigh/day, iv)
denervated group receiving 1 g/kg/day of sucrose by oral gavage. A 5 th
group was used as control; i.e., normal innervated mice. Angiotensin 1-7
and DIZE fully prevented the decrease in isometric force in EDL and
soleus muscle that occurred after 2 and 4 week denervation period. It
also partially reduced the decrease in muscle fiber cross sectional area.
This study is thus providing strong evidence that Ang 1, 7 has therapeutic
potential to prevent function loss following a denervation.
RNA-SEQ
ANALYSIS OF REXINOID RESPONSIVE GENE
EXPRESSION DURING EARLY MYOBLAST DIFFERENTIATION
Khilji, Saadia, Qiao Li
Department of the Cellular and Molecular Medicine, Faculty of Medicine,
University of Ottawa, Ottawa, ON, Canada
The development of skeletal muscle is regulated by complex coordinated
signaling pathways. We have previously established that bexarotene, a
clinically approved agonist of retinoid X receptor, promotes the
specification and differentiation of the muscle lineage. Here, we examine
the genome-wide impact of rexinoid action on myogenic expression
through RNA-seq transcriptome profiling. We found that bexarotene
promotes myogenic differentiation in a time specific manner. In addition,
we show that bexarotene promotes myoblast differentiation via the
simultaneous coordination of exit from the cell cycle to the activation of
muscle-related genes. Our future work will focus on characterizing the
mechanism of bexarotene action, in addition to, using a combination of
RNA-seq and ChIP-seq datasets to discern functionally novel myogenic
targets. These studies will allow for further dissection of signaling
pathways in myogenesis, in search for developing cell-based therapies
for skeletal muscle-related diseases.
Retrospective, case-controlled stereological assessment of
vascularization in placentas of HIV-exposed, uninfected (HEU)
children.
Wahba, Mary, Jenifer Bowes (BSc, MSc), Chris G. Ball (M.D.), Jason
Brophy (M.D.), David Grynspan (M.D.)
University of Ottawa, Children’s Hospital of Eastern Ontario, Canada
Background: To prevent vertical human immunodeficiency virus (HIV)
transmission, HIV+ pregnant women are treated with combination
antiretroviral therapy (cART). Increased rates of preterm delivery have
been found in HIV+ women, in some studies linked to protease inhibitor
(PI) based cART treatment, although the underlying mechanism is not
clear.
Hypothesis: cART increases placental vessel formation, leading to
adverse pregnancy outcomes.
Materials and methods: Placentas were available for 40 HIV+
women from July 2014 – December 2016; with pathology slides
available for 27. Slides were retrieved for 21 term HIV+ cases and 22
HIV-negative controls; preterm cases were excluded (5/27, 18.5%). 7/21
cases had received a PI. Vessel volume fractions (VVFs) and length
densities (LDs) were calculated (Stereology Analyzer, ADCIS).
Results: Mean VVFs for cases and controls were both 0.21. Mean
LD was 335/mm2 (cases) versus 359/mm2 (controls). For PI-treated
cases, mean VVF was 0.23 and mean LD was 324/mm2. Stereology
measurements were not significantly different between groups. Mean
placental weight was 471.2g (cases) versus 675g (controls) (p<.0001).
Conclusion: Vessel measurements were not significantly different
between term cases and controls. The difference in placental weight
between cases and controls raises the possibility of confounding factors
which will be addressed with a larger cohort. Future work will include
examination of preterm placentas.
DIAGNOSTIC VALUE OF MID ESOPHAGEAL BIOPSIES
PEDIATRIC PATIENTS WITH EOSINOPHILIC ESOPHAGITIS
IN
Chernetsova, E, J Joo, A Agarwal, J Barkey, D El Demellawy
University of Ottawa, Children’s Hospital; of Eastern Ontario, Canada
Background:
Eosinophilic esophagitis (EOE) is a chronic immune-mediated disorder
characterized by the presence of ≥15 eosinophils/HPF in esophageal
biopsies in the absence of other causes of esophageal eosinophilia.
The esophageal eosinophilic infiltrate is patchy and levels of eosinophilia
can vary between the distal, middle and proximal esophagus. Studies
have shown that increasing numbers of biopsies (6–9 biopsies) improve
the diagnostic sensitivity. However, studies comparing different biopsy
protocols for diagnosis of EOE, particularly in pediatric patients, have not
been conducted.
Design:
We performed a retrospective study of pediatric patients with EOE
presenting at our institute from 2007 – 2015. Our inclusion criteria
included patients’ ≤ 18 years old with clinical, endoscopic and histological
diagnosis of EoE and available initial and follow-up upper GI endoscopies
and esophageal biopsies. Our exclusion criteria included syndromic
conditions, parasitic infections, diagnosis of reflux esophagitis on biopsy
and history of medication at the time of initial presentation. Endoscopic
parameters evaluated were linear furrows, edema/decreased
vascularity/mucosal
stiffness,
white
papules/exudate,
trachealization/rings, stricture and crêpe-paper mucosa. Histologic
parameters evaluated were eosinophils number, basal cell hyperplasia,
lamina propria fibrosis, eosinophilic abscess and spongiosis. The
McNemar chi-square test was used to identify a statistically significant
difference in signal detection of various parameters across the proximal
or distal versus the mid esophageal biopsies. SPSS version 24 was used
for the statistical analysis.
Results:
A total of 100 patients were identified. At the initial diagnostic visit, for the
proximal/distal versus mid esophageal biopsies, there was a statistically
significant difference in identifying intraepithelial eosinophils (p<0.001),
lamina propria fibrosis (p=0.008), crust and erosion (p<0.001),
esophageal thickening/nodularity (p=0.004), furrowing/striation (p=0.01)
and white flecks/exudates (p=0.031) In all significant cases, the proximal
or distal biopsy detected more signals as compared to the mid
esophageal biopsies. There was no statistically significant difference
between the proximal/distal versus mid esophageal biopsies in identifying
basal cell hyperplasia (p=0.063), eosinophilic abscess (p=0.824), erosive
changes/ulceration (p=0.250), spongiosis (p=0.481), trachealization
(p=0.375), edema/loss of vascular pattern/stiffening (p=0.219), strictures
(p=0.625), impacted food content (p=1.000), and friability (p=0.250).
For any follow-up biopsies, for the proximal/distal versus mid esophageal
biopsies, there was a statistically significant difference in identifying
eosinophilic abscess (p=0.027), spongiosis (p<0.001), crust and erosion
(p=0.024), furrowing/striations (p=0.001), edema/loss of vascular pattern
(p=0.001), white flecks, exudates (p=0.008), and impacted food content
(p=1.000). In all significant cases, the proximal or distal biopsy detected
more signals as compared to the mid esophageal biopsies. There was no
statistically significant difference between the proximal/distal versus mid
esophageal biopsies in identifying intraepithelial eosinophils (p=0.238),
basal cell hyperplasia (p=0.581), lamina propria fibrosis (p=0.092),
esophageal thickening/nodularity (p=0.180), erosive changes/ulcerations
(p=1.000), trachealization (p=1.000), erythema (p=0.125), strictures
(p=0.250) and friability of tissue (p=0.250)
Conclusion:
Our study demonstrated that biopsies of the proximal/distal esophagus
show superior diagnostic value compared to the mid esophageal biopsy
at the initial presentation of EOE in children with identifying intraepithelial
eosinophils (≥15 eosinophils/HPF). Similarly the proximal/distal
esophagus show additional information compared to the mid follow up
esophageal biopsies with significantly identifying eosinophilic abscesses,
crust/erosions and spongiosis. The mid esophagus did not show
additional gross or microscopic pathology on the initial or follow up
presentations in pediatric patients with EOE. However, severity of
pathological findings was not assessed in the current study.
DOUBLE HIT DIFFUSE LARGE B-CELL LYMPHOMA TESTING AT
THE OTTAWA HOSPITAL
Capitano, Mario, M.D., and Philip Berardi, M.D., Ph.D., FRCPC
The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa ON K1H
8L6
Introduction:
Double-hit diffuse large B-cell lymphomas (DH-DLBCL) are more
aggressive variants of DLBCL characterized by MYC translocation plus
translocations in BCL2 and/or BCL6. This diagnosis is made by
expensive fluorescent in-situ hybridization (FISH) testing. Current
screening practices suggest only testing cases of germinal center B-celllike (GCB) DLBCL that overexpress MYC and BCL2 and/or BCL6 (dual
expressors) as opposed to non-GCB DLBCL cases, since GCB DLBCL
are more likely to be double-hit cases when they are dual expressors.
However, non-GCB DLBCL are more likely to be dual expressors
compared to GCB cases.
Design and Results:
Cases of de novo diffuse large B-cell lymphomas that were tested for
MYC and BCL2 and/or BCL6 translocations by FISH were searched in
PowerPath from 2010-2016 (inclusive) using variations of “diffuse large
B-cell lymphoma”, “lymphoma”, and “MYC”. Cases were excluded if they
were transformed from a lower grade lymphoma, were a primary central
nervous system lymphoma, or had not had FISH testing for MYC and
BCL2 and/or BCL6 translocations. This resulted in 39 cases of at least
dual expressor DLBCL that had FISH testing. Fourteen cases (35.9%)
were GCB DLBCL and 25 cases (64.1%) were non-GCB DLBCL. There
were 11 cases of DH-DLBCLs. 7/14 (50%) of GCB DLBCL cases were
DH-DLBCLs and 4/25 (16%) of the non-GCB DLBCL cases were DHDLBCLs. Overall, 7/11 (63.6%) of DH-DBLCL cases were GCB DLBCLs
and 4/11 (36.4%) cases were non-GCB DLBCLs.
CONCLUSION:
This retrospective study of DH-DLBCLs cases at The Ottawa Hospital
corroborates previous evidence showing that non-GCB DLBCLs are more
likely to be dual expressors while GCB DLBCLs are more likely to actually
harbour double-hit translocations. However, given that a substantial
number of DH-DLBCLs cases may be missed if only GCB dual expressor
cases undergo FISH testing, further research with a large retrospective
study or a prospective study with strict criteria for FISH testing for MYC
and BCL2 and/or BCL6 translocations should be done to better determine
an effective screening algorithm for DH-DLBCL cases .
ADENOCARCINOMA
EX-GOBLET
CELL
CARCINOID
TUMOURS,
PATHOLOGIC CLASSIFICATION AND CLINICAL BEHAVIOR: AN
ANALYSIS OF CASE SERIES (FROM 2003-2017 FROM THE OTTAWA
HOSPITAL PATHOLOGY GROUP
Capitano, Mario, M.D., and Zohreh Eslami, M.D., Ph.D., FRCPC
The Ottawa Hospital, General Campus, 501 Smyth Rd, Ottawa ON K1H
8L6
Introduction:
Adenocarcinoma ex-goblet cell carcinoids are poorly characterized, rare
appendiceal tumours that histologically appear as a mix of goblet cell
carcinoid tumour with a high grade adenocarcinoma. These tumours tend
to occur more often in females who present with advanced clinical stage
with gynecologic tract metastases, making it an important entity for
gynecologic pathologists to be aware of.
Design and Results:
Here we report nine cases of adenocarcinoma ex-goblet cell carcinoid
from 2003-2017. Tumours occurred predominantly in females (7/9),
median age of 57 years, and advanced stage disease (7/9). Patients
presented as acute appendicitis (3/9), bowel obstruction (4/9), or pelvic
masses (2/9). Morphologically these tumours had a component of
mucinous/signet ring cells admixed with well-formed glands. Limited IHC
shows positivity for CK20, CDX-2, focal positivity for synaptophysin and
chromogranin, and negative for CK7, PAX8, TTF-1. Most patients were
treated surgically with right hemicolectomy or subtotal colectomy (6/9)
and variations of bilateral salping-oophoerectomy and omentectomy. Five
of nine cases had follow-up greater than three years. Four underwent
standard chemotherapy for colonic adenocarcinoma. Four had disease
progression to peritoneal carcinomatosis and one had no recurrence after
5 years.
CONCLUSION:
This study reveals that the high-grade entity of goblet cell carcinoid is a
unique tumor with fairly specific morphologic and immunohistochemical
features of gastrointestinal origin unique to the appendix, and has a
variety of distinguishing clinicopathologic characteristics. Our results
corroborate previous studies that show that these high grade tumors are
seen predominantly in females in their early to mid-fifties, and have a
predilection for transcoelomic dissemination with frequent gynecologic
tract involvement.
STROMAL TISSUE AS AN ADJUNCT TOOL IN THE DIAGNOSIS OF
FOLLICULAR THYROID LESIONS BY FINE-NEEDLE ASPIRATION
BIOPSY
Hogan, Kevin, Kien T. Mai.
The Ottawa Hospital and University of Ottawa, Pathology and Laboratory
Medicine, Ottawa, ON, Canada
Background: The stroma in fine-needle aspiration biopsy (FNAB) of
thyroid lesions has not been well investigated.
Design : We studied 256 consecutive cases of thyroid FNAB prepared
with traditional smear technique. The stroma was categorized: Type 1a
consisted of long (more than 3 mm), broad bands composed of mesh
containing collagen fibrils thickened by entrapped blood components and
follicular cells. Type 1b consisted of dense strands/bands. Type 2 was
similar to Type 1a but with shorter (<2 mm) and looser stromal strands.
Results : Types 1a and b showed straight/curved/circular branching
patterns suggestive of incomplete frameworks of nodular/papillary
architectures or fragments of capsule. Type 1b stroma likely represented
thick/collagenized fibrous septae. Incomplete or complete rings of small
encapsulated tumor were occasionally identified. These frameworks of
stroma were frequently associated with multinodular goiters (MNGs)
which are often hypocellular and follicular neoplasms/papillary thyroid
carcinoma with increased cellularity. Type 2 was associated with
microfollicles in encapsulated neoplasms or with macrofollicles in MNG.
Follicular lesions of unknown significance (n = 41) either negative (n = 26)
or positive (n = 15) for carcinoma in subsequent follow-up were frequently
associated with stroma characteristic of MNG and carcinoma,
respectively. Conclusion : The preservation of the in vivo architecture of
Type 1 is likely due to its elasticity. Recognition of the stromal
architecture will likely facilitate the diagnosis.
CHARACTERISTICS OF LYMPHOPROLIFERATIVE DISORDERS
(LPD) WITH MORE THAN ONE ABERRANT CELL POPULATION AS
DETECTED BY 10 COLOR FLOW CYTOMETRY
Mahdi, Talal (1, 2), Amr Rajab (2,3) ,Ruth Padmore (1), *Anna Porwit (2,4)
(1) Department of Pathology and Laboratory Medicine, The Ottawa
Hospital and Eastern Ontario Regional Laboratory Association and
University of Ottawa, ON, Canada.
(2) Flow Cytometry Laboratory, Department of Laboratory Hematology,
Laboratory Medicine Program, University Health Network, Toronto, ON,
Canada.
(3) Present address: Flow cytometry department, Lifelabs Medical
laboratory services-Toronto.
(4) Present address: Department of Clinical Sciences, Division of
Oncology and Pathology, Faculty of Medicine, Lund University, Lund,
Sweden
Background: We have evaluated the frequency of lymphoproliferative
disorders with more than one aberrant population of monotypic B-cells
detected during routine hematopathological diagnostics.
Materials and Methods: 2600 samples peripheral (blood, bone marrow,
fine needle aspirate, lymph node and pleural fluid cell suspensions) were
analyzed with flow cytometry using a ten-color B-cell panel and a tencolor T-cell panel. A ten-color plasma cell/lymphoplasmacytic panel was
performed when appropriate.
Results: 790/2600 samples (30%) showed at least one aberrant B-cell
population and 27(1%) showed an aberrant T-cell population. 41/790
samples (5.1%) showed two aberrant B-cell populations. Thirteen
patients had two B-cell populations with different surface immunoglobulin
restriction (one kappa+ and one lambda+), most with B-cell chronic
lymphocytic leukemia-like phenotype. Five cases showed two B-cell
populations with the same light chain restriction but distinctly different
immunophenotypes. In 23 cases, two populations had the same light
chain restriction and differed by expression of one or 2 markers, thus, a
possibility of intraclonal variation could not be excluded. Cases with
possible intraclonal variation had a significantly higher proportion of
aberrant B-cells than those with two coexisting aberrant B-cell
populations (49.9% vs. 27.7%, p = 0.008). In only one sample one
population of clonal B-cell and one clonal T-cell population with large
granular lymphocyte related phenotype were found.
Conclusion: Using our panels 5.1% of cases with LPD-associated
aberrant findings show two aberrant lymphoid and/or plasma cell
populations.
EMERGENCY TRANSFUSION OF ONE UNCROSSMATCHED GROUP O Rh
POSITIVE RED CELL UNIT TO A PATIENT WITH ANTI-D ANTIBODY
IDENTIFY ONCE TYPE AND SCREEN WERE COMPLETED. A CASE
REPORT
Mahdi, Talal, MD, Ruth Padmore, MD
The Ottawa Hospital and Eastern Ontario Regional Laboratory Association and
University of Ottawa
Introduction: Patient blood management programs aim to transfuse
group O Rh negative red cells (RCs) only to Rh negative recipients. At
the Ottawa Hospital, the CODE BLEED policy for trauma patients
specifies that if uncross matched RC units are required for patients with
unknown blood group, only female patients less than 45 years of age
receive group O Rh negative RC units. All other patients receive group O
Rh positive RC units. We report a patient who was transfused one unit of
uncross matched group O Rh positive RC and in whom anti-D antibody
was identified once the type and screen were completed.
Case Report: The patient was an 87-year-old female trauma patient with
pelvic fracture. The patient was initially transported to a community
hospital; 2 hours later she was transferred to the Ottawa Hospital (TOH)
Civic Campus Trauma Centre (day 0). On arrival the patient was
unstable and a CODE BLEED was initiated. One unit of uncross
matched group O Rh positive RC was transfused. Half an hour after
transfusion the patient complained of nausea and back pain. One hour
after transfusion, the transfusion medicine (TM) laboratory reported the
patient was group B Rh negative with positive antibody screen;
subsequently anti-D and anti-E alloantibodies were identified. The clinical
team was notified, and no further group O Rh positive RCs were
transfused. Following transfusion of the incompatible RC unit the
hemoglobin stayed the same, 90 g/L pre and post transfusion and the
post transfusion DAT anti-IgG was only weakly positive. Surgical open
reduction and internal fixation were performed on day +6. The patient
was discharged to rehabilitation on day +32. In retrospect, the
community hospital TM lab results of group B negative with a positive
antibody screen were available approximately at time of transfer to TOH,
but there was no forward feeding of this information.
Conclusion: Transfusion of uncross matched RCs has a low but definite
risk for incompatible transfusion. Elderly Rh negative females whose
childbearing years pre-date the universal introduction of RhIg might have
increased incidence of anti-D antibody. Forward feeding of TM
laboratory results is important for trauma transfusion protocols.
A RARE CASE OF PEDIATRIC LIPOMA WITH T(9;12)(P22;Q14) AND
EVIDENCE OF HMGA2 NFIB GENE FUSION
Lacaria, Melanie1, Dina El Demellawy2,3, Jean McGowan-Jordan1,4
1Genetics Department, Children’s Hospital of Eastern Ontario;
2Pediatric Pathology Department, Children’s Hospital of Eastern Ontario;
3Department of Surgery, University of Ottawa;
4Department of Pathology and Laboratory Medicine, University of Ottawa
Abstract
Lipoma is a benign tumor, typically of adulthood, with characteristic
cytogenetic findings including rearrangement of 12q13-15; these
rearrangements often lead to the fusion of the HMGA2 gene at this locus
to the transcriptional regulatory domain of its fusion partner, resulting in
neomorphic activity that presumably facilitates the neoplastic process.
Herein, we report a rare case of pediatric lipoma with t(9;12)(p22;q14)
and evidence of HMGA2-NFIB gene fusion in a 9 year-old boy. This case
provides further evidence of the link between NFIB rearrangement and
early-onset, deep-seated lipomatous tumors.
Key Words: HMGA2, NFIB, FISH, lipoma
DEPARTMENT OF PATHOLOGY AND LABORATORY MEDICINE
HISTOLOGY CORE FACILITY
J.P.Veinot1, C.A. Jodouin2, Z. Ticas3, L. Dong4, E. Labelle5, S. Faulkes6,
M. Khalili7, M. Alazzabi8, O. Agah9
The University of Ottawa, Faculty of Medicine, Department of Pathology
and Laboratory Medicine (PALM), Histology Core Facility
The Histology Core Facility (HCF) is a full-service research histology
laboratory, located in the Department of Pathology and Laboratory
Medicine of the University of Ottawa. The HCF has served the University
and the Ottawa Region by providing histology services to faculty,
researchers, clinicians, and students. Currently the HCF provides
histology service to over 70 researchers from the University of Ottawa
(Neuroscience, CMM, and BMI) and its partners at the Ottawa Hospital
Research Institute (OHRI), University of Ottawa Heart Institute (UOHI),
The Ottawa Hospital Cancer Centre (TOHCC), Children's Hospital of
Eastern Ontario (CHEO), and the Eastern Ontario Regional Laboratory
Association (EORLA). The HCF also provides service to special projects
of the Public Health Agency of Canada (PHAC), Health Canada, the
National Research Council (NRC), and Canadian Nuclear Labs in Deep
River Ontario which contribute to the University of Ottawa's goal of
excellence in research.
The Histology Core Facility services offered include: Paraffin processing
and embedding; Paraffin, frozen, and RNAse free sectioning; Histological
stains for general morphology, carbohydrates, connective tissue, lipids,
microorganisms, and intracellular granules.
Immunohistochemistry
services include: optimization of new antibodies, staining of routine and
new antibodies, chromogenic and single or dual colour
immunofluorescence. Digital whole slide scanning on the Zeiss Mirax
Midi Slide scanner can scan all brightfield slides containing one or
multiple tissue sections at resolution magnification of 40X. The Histology
Core Facility provides training, education and assistance with course
content and set-up for first and second year medical students and
graduate students. We participate in the Faculty of Medicine program
that provides high school student tours throughout the year.
In 2016 the Histology Core Facility implemented an online system to
streamline the processing of client service requests, invoicing, tracking of
equipment training requests and usage of common area equipment as
part of our services. The iLAB system optimizes the processing of service
requests and improves turnaround times for our Internal, External, and
Commercial clients. Monthly microtome and cryostat training is also
offered with registration via the iLab system.
Consultation services are available to direct and coordinate research,
develop protocols, provide teaching or carry out clinical work. Project
service requests are offered on an individual basis to accommodate the
specific needs of our research clients to include protocol development,
preliminary costing services, and protocol technical information.
The HCF is equipped with two automatic LOGOS tissue processors for
paraffin processing, and microtomes to section paraffin blocks. Cryostats
are available for sectioning frozen tissues for lipid and enzyme
demonstration, and for immunohistochemical or immunofluorescence
service requests. In 2016, the HCF acquired a Thermo-VWR NX-70
Cryostar Cryostat and a Thermo-Fisher Slide-Mate Slide Printer. A fully
automated Leica Bond III automated immunostainer will be operational in
the very near future. The Leica Bond III is able to perform automated
immunohistochemistry (IHC),
in-situ hybridization (ISH), and
Immunofluorescence (IF). This together with other existing instruments,
services, and staff expertise is will allow the HCF to expand its menu of
available services and provide reproducible, consistent, high-quality
staining and increased throughput.