4^th International Conference and Exhibition on Pathology July 13-15, 2015 New Orleans, USA

Background: Instructional strategies employed for the teaching of pathology traditionally include lectures, demonstrations,practical classes; problem based learning and clinico-pathological conference. Recently team based learning (TBL) as an instructional strategy has gained acceptance in a variety of undergraduate medical courses. TBL is a student centred instructional strategy providing students with an opportunity to apply their knowledge through a series of activities comprising of individual work, team work and problem solving assignments. Method: In the present study 156 students of year three neuroscience block were divided into seven male and seven female groups comprising of 11-12 students in each group. The TBL was introduced during the six weeks of this block and a total of eight TBL sessions were conducted during this duration. We evaluated the effect of TBL on student learning and correlated it with the student’s performance in summative assessment. Moreover the student’s perception regarding the process of TBL was assessed by online survey. Results: We found that students performed better while working in teams as compared to individual testing. The male students performed better in the TBL and had a more favourable impact on their grades in the summative examination. The students who attended the TBL sessions performed better in the summative examinations as compared to those who did not. There were favourable student responses regarding the content covered in TBL as well as the process of TBL which led to improvement in communication and interpersonal skills. Conclusions: We conclude that implementing TBL strategy increased student’s responsibility for their own learning and helped the students in bridging the gap in their cognitive knowledge which was demonstrated by their improved performance in the summative assessment.

Kwan-Kyu Park has completed his MD and PhD at the age of 35 years from KyungPook National University School of Medicine. He has published more than 38 papers in reputed journals and has been serving as an editorial board member of repute.

The increased proliferation and migration of vascular smooth muscle cells (VSMC) are key process inthe development of atherosclerosis lesions. Platelet-derived growth factor (PDGF) initiates a multitude of biological effects that contribute to VSMC proliferation and migration. Apamin, a component of bee venom, has been known to block the Ca2+-activated K+ channels. However, the potential role of apamin in regulation of VSMC proliferation and migration has not been identified. In this study, we investigate the inhibitory effect of apamin on PDGF-BB-induced VSMC proliferation and migration. Apamin suppressed the PDGF-BB-induced VSMC proliferation and migration with no apparent cytotoxic effect. In accordance with these findings, apamin induced the arrest of cell cycle progression at G0/G1 phase. Apamin also decreased the expressions of G0/G1 specific regulatory proteins including proliferating cell nuclear antigen (PCNA), cyclin D1, cyclin-dependent kinases (CDK) 4, cyclin E and CDK2, as well as increased the expression of p21Cip1 in PDGF-BB-induced VSMC. Moreover, apamin inhibited PDGF-BB-induced phosphorylation of Akt and Erk1/2. These results suggest that apamin plays an important role in prevention of vascular proliferation and migration through the G0/G1 cell cycle arrest by Akt and Erk1/2 signaling pathway. Thus, apamin may be a promising candidate for the therapy of atherosclerosis.

Haytham Helmi has completed his Medical Doctor Degree from a joint international program between the University of Manchester in England and Mansoura University. He then started his acting internship at the University of Alabama at Birmingham working under the direct supervision of pathology pioneers. He then started to work at the Department of Hematopathology at Quest Diagnostics under the direct supervision of the staff hematopathologist. He is planning to persue a career as a pathologist.

Richter syndrome (RS) is defined as the transformation of chronic lymphocytic leukemia (CLL) into an aggressive Large Cell lymphoma. It occurs in about 5% of chronic lymphocytic patients and suggests poor prognosis with 5 to 8 months survival. Newer forms of chemoimmunotherapy are available for this aggressive condition. We present a case of a 66-year-old female patient with history of treated chronic lymphocytic leukemia who developed sudden cervical adenopathy focusing on the clinical, cytogenetic and immunohistochemical features. In this case we investigate the role of epstein barr virus (EBV) in Richter transformation after Acyclovir therapy.

Manabu Yamazaki, DDS, PhD, a board-certified oral pathologist, is assistant professor at the Division of Oral Pathology, Niigata University Graduate School of Medicine and Dentistry, working in research and practice of oral pathology.

Milk fat globule—epidermal growth factor—factor VIII (MFG-E8) is a secreted glycoprotein that promotes clearance of apoptotic cells by bridging phosphatidylserine on apoptotic cells and integrin alphavbeta3/5 on professional phagocytes. Recently, high expression of MFG-E8 has been reported in various types of cancer in humans. Apoptotic figures are frequently found in the surgical specimens of oral squamous cell carcinoma (SCC), and we have often observed apoptotic carcinoma cells engulfed by macrophages or even by neighboring carcinoma cells. Thus we hypothesized that MFG-E8 might promote engulfment of apoptotic carcinoma cells by living carcinoma cells and that MFG-E8 expressed by carcinoma cells could contribute to tumor progression. The aim of this study was to elucidate the biological role of MFG-E8 in oral SCC. Fifty-three surgical specimens of oral SCC were used for immunohistochemistry for MFG-E8. Also, we examined its function using MFG-E8-overexpressing cultured SCC cells. Most of the cases had MFG-E8-positive SCC cells, and the expression of MFG-E8 was correlated with such clinicopathological features as tumor size, pathological stage, locoregional recurrence, scattering invasion pattern, and SCC cell figures engulfing apoptotic SCC cells. The MFG-E8 staining was enhanced in apoptotic SCC cells, some of which were apparently engulfed by the neighboring SCC cells. Transient MFG-E8 overexpression in SCC cell lines increased invasiveness and engulfment of apoptotic cells. Therefore we have demonstrated that MFG-E8 promotes tumor progression in oral SCC and that it might be involved in the clearance of apoptotic SCC cells by living SCC cells.

He has completed his PhD thesis in Department of Pathology, Faculty of Veterinary Medicine, Ankara University in 2011. PhD Thesis: “Evaluation of The Pathomorphological, Immunohistochemical Findings and In-Situ PCR in Experimental Adenovirus Infections in Chickens”. Main areas have been about neoplasia, genital system and central nervous system disorders and experimental diseases in laboratory animals. He has been many experiences on immunohistochemical methods, in-situ PCR and chromogenic ISH. He has been working as doctor since 2012. He is also responsible for Administrator in Department of Animal Welfare of Labaratory Animal Unit, Faculty of Chemistry and Faculty of Science, Ankara University.

Fibropapilloma are defined as benign proliferative and neoplastic changes of skin in cattle (Jelinek and Tachezy 1995). Fibropapilloma are frequently evaluated together with papilloma at the same topic. In ethiopathogenesis of viral induced papilloma, bovine papillomavirus (BPV) has a role (Goldschmidt and Hendrick 2002). Insulin-like growth factors (IGFs), which have similar molecular structure to proinsulin playing important roles in cellular proliferation, differentiation (Rosenfeld et al. 1990,Sara and Hall 1990, Yu and Rohan 2000). IGF-I makes also transformation in cell to be infected through by some viral proteins. In the study, it was aimed to show combine role of IGFs as possible trigger and BPV-1 in ethiopathogenesis of bovine fibropapilloma. Suspected samples from the fibropapilloma were collected from different parts of body. PCR confirmed to the presence of L genes of BPV-1. Fibropapilloma was diagnosed in histopathologic examination. Feulgen reactions were used to demonstrate for presence of virus in neoplastic epithelial and and fibrocytes. IGF-I and –II expressions were described in tissues with fibropapilloma. Macroscopical and histopathological findings of fibropapillomatouse changes were described in masses collected from skin of ears and palpebra, neck, hindlimbs, mammary region and teats and ventral abdominal region of fifteen cattle which were varied from 14 to 23 month olds. Hyperkeratosis, parakeratosis, acanthosis, degenerative changes and inflammatory cell infiltrations and vascularization were seen to attended to neoplastic cells by several levels. IGF-I positivities were stronger and distributed in epidermis and dermis when compared to IGF-II positivities. Positivities were observed in cytoplasms and membrans of all layer cells in epidermis and in only membrans of fibrocytes and fibroblasts in addition to collagen bundles. It is interpreted that IGF-I and IGF-II have an effect as much as BPV-1 in proliferation cells constituting fibropapillomatouse changes in epidermis and dermis.

She completed her PhD thesis (Comparison of Histopathologic, Immunperoxidase and Immunfloresan Methods in Diagnosis of Rabies Virus Infection in Dogs) in 1997. She was assigned as Prof. in 2008. Main research areas genital system and nervous system disorders, immunohistochemical and molecular diagnosis including IS-PCR and ISH of tumours, apoptotical mechanism in different natural and experimental animal models. She has conducted and worked over than 12 scientific projects. Her articles over than 65 have been published in well known international journals. Also, she has presented over than 60 posters and oral presentations in national and international congress.

Mammary tumours in dogs are the most common tumours following skin tumours. The aim of this study was to investigate the accumulation of p53 protein and MT in malignant and benign mammary tumours in dog and to correlate them with the tumour type and grade. In the study, p53 protein and metallothioneins (MT) were investigated by immunohistochemistry in canine mammary tumours (n = 50). These tumours [5 benign mixed tumours (BMT) and 45 malignant tumours whose 36 malignant mixed tumours (MMT) and 9 adenocarcinomas (AC)] mainly involved inguinal (n = 18), caudal thoracic (n = 11) and caudal abdominal (n = 10) glands. Positive p53 protein immunolabelling of nucleus and/or cytoplasm of glandular epithelial cells and more rarely of ductal epithelial cells were observed in all malignant tumours. Furthermore, a moderate to marked p53 staining was evidenced in 75% of MMT and in 44% of AC. Forty-four (98%) malignant tumours also exhibited metallothionein (MT) positive immunostaining of nucleus, cytoplasm or both. The MT positivity was moderate to intense in 82% of positive tumours (30 MMT and 6 AC). The p53 protein and MT expressions with a low to a moderate intensity were detected in 2 and 3 benign mixed tumours respectively and 2 of them simultaneously expressed the 2 markers. These results suggest that the subcellular accumulation of p53 protein and MT is associated with tumour malignancy and that positive MT and p53 protein benign tumours would evolve into malignant tumours.

Kei Tomihara received his PhD degree in 2006 from Sapporo Medical University, working on immunegene therapy by adenovirus vector. He then moved to Cancer Therapy and Research Center (CTRC) at The University of Texas Health Science Center at San Antonio(UTHSCSA) to work with Dr. Shin as a post-doctoral fellow. He obtained an assistant professor position in 2013 in the Department of Oral and Maxillofacial Surgery Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, where he started independent research on cancer immunology.

Cancer is often associated with destruction in both the humoral and cellular immune responses, and this phenomenon has been suggested to be attributed by the alteration of several cell populations. A population of CD11b+Gr-1+ cells, one of the myeloid lineage cells, has been shown to be accumulated within either the tumor microenvironment or peripheral blood which collates with the impairment of immune response and the promotion of tumor growth. However, this cell type is a heterogeneous cell population that can be altered by type of the tumor and its anatomical location, and the characterization of their function during cancer has not been still fully elucidated. Here, we show that CD11b+Gr-1+ cells are increased in the spleen, bone marrow, peripheral blood and the tumor site in the murine oral squamous cell carcinoma-bearing mice, however, the phenotype and function of the cells from each origins are not consistent. CD11b+Gr-1+ cells in the tumor site, but not in the spleen, bone marrow, and peripheral blood exhibit increased expression of PD-L1 on their cell surface and strong immune suppression against in vitro co-cultured T cells through the expression of PD-L1, indicating that CD11b+Gr-1+ cells accumulated in tumor bearing host may not be originally immune suppressive, however, they could be phenotypically and functionally altered by the influence of tumor-derived factors and converted into immune suppressive cells. Our results suggest that targeting CD11b+Gr-1+ cells would be more efficient strategy for cancer treatment in combination with PD-L1 blocking.

He has worked for Ministry of Food, Agriculture and Livestock between 2007-2011. He has assigned as research assistant to Department of Pathology, Faculty of Veterinary Medicine, Ankara University in 2012. He has been still working at same place since 2012. His PhD Thesis: “Comparative investigation of kidney lesions of canine and feline by pathomorphological and immunohistochemical methods”. His main research areas are on neoplasia, pathomechanism of contagious disorders and experimental diseases in laboratory animals. He has been many experiences on special histochemical and immunohistochemical methods.

Spinal cord nephroblastoma has rarely been described neoplasm of the canine spinal cord. It occurs generally in young and large breed dogs. Generally it is located in throcal (T10) and lumbar (L2) spinal cord segments. The tumor located the thoracal (T10-11) spinal cord segments was aimed to describe clinically, histopathologically and immunohistochemically, 2- year old, male, mix dog, in the case. Clinically, paresis was observed on left and right legs. Diffuse myelitis was diagnosed by magnetic resonance imaging (MRI). Macroscopically, affected spinal cord was enlarged and firm in consistency. On the cut surface, 4 mm in diameter, grey, demarcated lesion was seen. Microscopically, the tumor had an intradural and extramedullary location. It was composed of uniform cells that were cuboidal to ovoid wıth indistinct cell borders and a scant to midly amphophilic. The nuclei were generally hyperchromatic with not seen nucleoli. Tumor cells formed tubules, ribbons and glomeruloid structures within fibrovascular background. Furthermore, the tumor was consisted of widely necrose, haemorrhagie and mononuclear inflammatory cells. Immunohistochemically, neoplastic cells especially in tubules and glomeruloid structures stained pan cytokeratin. On the other hand, fibrovascular stroma and capsule were stained α –smooth muscle actin (α – SMA) and vimentin sera.

Jyoti R Kini is a medical graduate with an MD in Pathology from Kasturba Medical College, Manipal University, Karnataka, India. She is currently serving as Associate Professor in the department of Pathology at Kasturba Medical College, Mangalore, a constituent college of Manipal University. She is actively involved in teaching undergraduate and postgraduate courses in the institution. She is also in-charge of the Clinical Pathology and Hematology laboratory attached to the KMC Hospital. She has more than 20 publications in reputed journals. Her fields of interest are neuro-oncopathology and gastrointestinal pathology.

Background: Primary lymphoma of the central nervous system represents a rare sub-category of extra nodal non-Hodgkin lymphomas which are confined to the brain, leptomeninges, eyes, and, rarely, spinal cord. PCNSL occurs without any systemic disease involvement at the time of diagnosis, and has to be distinguished. We herein report 11 cases of Primary Central Nervous System Lymphoma from a tertiary care institution in Coastal Karnataka, India. Aims: To study the clinicopathological and histopathological features of Primary Central Nervous System Lymphoma diagnosed in the Pathology department over the last 10 years. Material & Methods: The study is a retrospective analysis of 11 cases of Primary Central Nervous System Lymphoma (PCNSL) retrieved from the histopathology records of the Pathology department, from January 2005 to December 2014. Results: The majority of the patients were females (72%). The age range was 41 to 78 years. The majority of lesions were located principally in the cerebral hemispheres and two of the lesions were located in the posterior fossa in the left cerebellum. The symptoms were present for a varying duration, ranging from one week to three months. Histological examination of the sterotactic biopsies revealed diffuse sheets of medium to large atypical lymphoid cells with angiocentric pattern of distribution. Immunohistochemistry done in eight cases showed strong immunopositvity with CD 20 immunostaining. Due to the fact that PCNSL of the Diffuse Large B Cell Lymphoma type are highly aggressive tumours, early diagnosis is essential for successful treatment and improvement of prognosis.

Dr. RehamShehabhas received her master and doctoral degree from faculty of medicine, Cairo University, works as a pathology researcher in the National Research Center (NRC) and elected for its center of excellence. She published many papers and shared in NRC’s research projects. As well she is consultant of pathology in armed forces hospitals and ministry of health hospitals in Egypt.

The papillary patterned lesion of thyroid may be challenging diagnosis with many diagnostic pitfalls. Tumor stroma plays an important part in the determination of the tumor phenotype. CD34 is thought to be involved in the modulation of cell adhesion and signal transduction as CD34(+) fibrocytes are potent antigen-presenting cells. It was considered that SMA positivity could be diagnostic for fibroblasts activation during tumorigenesis. We aimed to examine the expression of CD34 and alpha smooth muscle actin (ASMA) in the stroma of papillary thyroid hyperplasia, papillary thyroid carcinoma and papillary tumors of uncertain malignant potential in order to elucidate their possible differential distribution and roles. A total number of 54 cases with papillary thyroid lesions were studied by routine H&E stains, CD34 and ASMA immunostaining. ASMA was not expressed in benign papillary hyperplastic lesions while it was expressed in papillary carcinoma pointing that the tumor have modulated stroma . Although the stroma was not well developed in papillary lesions with equivocal features of uncertain potentiality, CD34 was notable in such cases with higher incidence in malignant cases. So ASMA as well as CD34 could predict neoplastic behavior raising the importance of the stromal role, CD34 might be more effective and could help in differentiating the potential malignant tumors of the thyroid adding additional tools to the light microscopic picture, helping in diagnosis of problematic cases with H&E.

Dr. Abhinav Walia has completed his MBBS at the age of 24 years from Rajiv Gandhi University of Health Sciences, Bengaluru, India. He is currently pursuing his residency in MD Pathology at MGM Medical College, Navi Mumbai, India. He has participated and presented posters and oral papers in various conferences and workshops across India. He is exploring the possibility of adding value to his knowledge and curriculum by participating in various ongoing conferences and workshops across the globe.

The aim of the study was to correlate clinical and histopathological features of different types of leprosy. Skin biopsies for the study were obtained from patients clinically diagnosed as leprosy. H and E stained sections were studied. Wade Fite staining for identifying the bacilli was done. After studying the histopathological features and noting the bacteriological status, the diagnosis of leprosy was confirmed and classified according to Ridley and Jopling classification. Clinicopathological correlation was done. 50 skin biopsies were studied over a period of 2 years. Borderline tuberculoid type was the commonest type of leprosy which constituted 38 % biopsies followed by indeterminate leprosy (30%), borderline tuberculoid leprosy (10%), lepromatous leprosy (8 %), tuberculoid tuberculoid (1.5%), histoid leprosy (6%) and borderline borderline type (2 %). Most common clinical feature was loss of sensation followed by nerve thickening and hypopigmented skin lesions. Most of the biopsies were of paucibacillary type (72%) and the rest (28%) were of multibacillary type. Good concordance was observed in indeterminate leprosy type (100%) followed by borderline tuberculoid leprosy (69.2 %). Least concordance was present in borderline lepromatous leprosy (55.5%). High Bacillary Index of 5+ to 6+ was noted in lepromatous and borderline lepromatous leprosy. Low bacillary index of 1+ was observed in borderline borderline type. Correlation of clinical and histopathological features along with bacteriological index appears more useful for accurate typing of leprosy than considering any of the single parameters alone. This helps the clinician for better care and management of the patients.

Sherine Salama was graduated from faculty of medicine in 1994 from Alexandria University, Egypt. She had a master degree in anatomic pathology and in medical education from Maastricht University. She is currently a gynecological pathology fellow at Sunnybrook Health Sciences Centre (2014-2015) Toronto, Canada, and appointed for breast fellowship in the same institute (2015-2016). She had several publications; her last publication was a poster presentation the CAP-ACP National Conference, July 12-14/2014. Toronto, ON (award winning poster)

Hysterectomy or myomectomy morcellation is optional when malignancy is not suspected. Histopathologic assessment of incidental malignancies in morcellated specimens is limited regarding to margin status, tumor size, depth of invasion and extension beyond the uterine fundus, which precludes accurate staging. Concerns about dissemination to the peritoneum and abdominal wall through laparoscopic ports have been reported. We reviewed the incidence and outcomes of morcellated hysterectomies and myomectomies with incidental significant pathology. We retrospectively searched the Laboratory Information System for all in-house uterine resections performed by general gynecologists between 9/1999-5/2014 to identify any morcellated specimens. Reports were searched for malignancies, complex atypical hyperplasia (CAH), cervical dysplasia and leiomyoma variants. In positive cases, data on age, imaging, preoperative pap smears or endometrial sampling, presenting symptoms and follow up were extracted from the medical records. The mean age of women with morcellated specimens was 45±6 years. Follow up for positive cases was available for 1 - 89 months (median 23). Among 602 morcellated specimens; 4 (0.66%) patients had a malignant diagnosis: 1 leiomyosarcoma (LMS), 1 endometrial endometrioid adenocarcinoma (EEA), 2 endometrial stromal sarcoma (ESS).There were 11 (1.8%) CAH and 16 (2.6%) leiomyoma variants, none of which recurred. The patient with leiomyosarcoma was followed up for 25 months and died with disseminated disease in the pelvis and abdomen. In our practice, incidental malignancies were found in less than 1% of morcellated specimens affecting women ≥40. Given the rare likelihood of cancer diagnosis, it is not possible to identify predictors of incidental malignancy in this cohort.

Dr. Sucheta completed her MBBS followed by Internship at the age of 23 years from Pt. B. D. Sharma Post Graduate Institute of Medical Sciences. Presently she is doing residency in Pathology from the same institute. She has keen interest in learning about new updates in Pathology.

Biopsy of the pleura has been an important diagnostic tool since its first description by DeFrancis et al in 1955. Pleural biopsy is of greatest value in the diagnosis of granulomatous and malignant diseases of the pleura. It is performed on patients with undiagnosed exudative effusions, with non-diagnostic cytology, and a clinical suspicion of tuberculosis or malignancy. Present study was carried out on 50 pleural biopsies over a period of three years (mid 2011 to mid 2014) out of which 40 were males and 10 were females with a male to female ratio of 4:1. Age of patients ranged from 20 - 80 years with mean age of 50 years. Majority of cases belonged to age group of 41-60 years. 90% of the pleural biopsies were adequate for opinion. Out of the adequate biopsies 33 cases (73%) revealed benign lesions (predominant inflammatory) whereas 12 cases (27%) were diagnosed as malignant comprising adenocarcinoma (4 cases), squamous cell carcinoma (3 cases), small cell carcinoma (2 cases), poorly differentiated carcinoma (2 cases) and mesothelioma (1 case). 6 cases belonged to tubercular etiology. It was concluded from the study that inflammatory lesion was the commonest finding observed followed by malignant lesion and tuberculosis. Pleural biopsies are important in diagnosing pleural lesion which were earlier missed in other investigative procedures carried for detecting respiratory lesion.