Colorectal Cancer – grossly understaged – or just gross!
Colorectal resections are common pathologic specimens yet their gross examination should be considered anything but routine.The final patient tumor stage is typically derived from the resection specimen, with additional treatment and prognosis heavily dependent on staging.The focus is thus on us to provide complete and accurate information to the clinicians to best serve our patients.
The objective of this presentation is to provide an overview of the gross examination of colorectal cancer resections.Points of discussion will include anatomy of the large intestine and ano-rectum, identifying radial margins at different anatomic sites, the significance of serosal involvement and the importance of lymph node dissection (despite the tedium!). Correlation between gross examination, staging and treatment will be discussed.The audience will be challenged to leave the session with a more anal retentive approach to these odious and often misunderstood specimens.
Dr. Neil Hoffman – Reading Hospital
Contributory Cause of Death: the interplay between natural disease and trauma in assessment of death causation
The topic of death causation, along with others relating to forensicmedicine is quite often neglected in American medical education. Practicing pathologists, for the most part have little time to devote to matters forensic nor little interest.
The Pathologist’s Assistant in most hospital settings is likely to be the first to examine the decedent’s chart and have to make triage decisions concerning the disposition of the case, acting as the “eyes and ears” of the pathologist.The PA therefore must have some understanding of the forensic implications of hospital death cases, and that understanding derives from a knowledge of death certification and the proper use of cause of death.
This lecture will deal with the theory an mechanics of cause of death assessment with particular emphasis on the forensic implications of those causes.Supplemented by illustrative cases, the presenter will discuss the concepts of Immediate, Intermediate and Underlying causes of death and then go on to discuss in detail the difficult concept of Contributory Cause. The various Manners of Death will also be included.The discussion will also address interactions with the coroner or medical examiner.
Dr. Art Crist – YorkHospital
This presentation will review tick-borne diseases that occur in the United States.The primary focus will be on the three most common diseases: Lyme disease; Rocky Mountain Spotted Fever; and Ehrlichiosis.Each disease will be discussed in terms of its history, clinical manifestations, etiology, epidemiology, clinical and laboratory diagnosis, treatment andprevention.
Cara Strock M.S. PA (ASCP) – YorkHospital
Medullary Thyroid Cancer:Palpation to Prognosis
Thyroid cancer is the most common endocrine cancer with almost 24,000 new cases diagnosed each year in the United States.Making up approximately 5-10% of the cases is medullary thyroid cancer (MTC). Because of its relative infrequency many healthcare workers are unfamiliar with MTC and its unique characteristics.This lecture will focus on those characteristics and will include the classification, presentation, diagnosis, treatment and prognosis of the disease.Unlike the more common papillary cancers of the thyroid, MTC has a genetic component which can not only influence prognosis, but it can also greatly impact a patients close relatives.The audience will learn the genetic testing available, and exactly what impact it has on a family.Comparisons throughout the lecture to other thyroid neoplasms will also be covered.
Dr. John Yelcick – LancasterGeneralHospital
Breast cancer is the most common cancer diagnosed in women today, and therefore represents one of the most common types of specimens encountered in pathology today.This course will present an overview of the spectrum of breast disease from benign disease to carcinoma, with a focus on the latter.There are several major types of breast cancer, and the salient features (radiographic, gross, microscopic and clinical) that merit their subcategorization will be reviewed, using actual case material. Finally, we will review the relevance of molecular and genetic studies to patient care.
Saturday June 17th
Breakfast outside conference room
Dr. James Eastman – LancasterGeneralHospital
Cultural Sensitivity and its Impact on Pathology:
A Study of the Old Order Amish
There are a number of ethnically, culturally, and genetically distinct communities in this country (and certainly worldwide).The Old Order Amish in LancasterCounty are an example of such a community and offer us a model by which to study the impact of such a community’s religious beliefs and culture on health care.In particular their attitudes regarding the human body, death, and end-of-life issues often have implications for handling of surgical pathology specimens, autopsies, and specimen disposal.Moreover, the Amish, like many such communities, chose to remain separate from the mainstream, and thus constitute a genetically distinct population.We will examine some of the inherited disorders that characterize this population and the special needs that these may create in processing specimens and assuring accurate diagnosis.Finally we will discuss several cases where misinterpretation of pathology and autopsy findings of some of these disorders have had potentially disastrous effects.
Dr. Thomas Adamec- Reading Hospital
Pathology of the Uterus and its Adnexa
The uterus and its adnexa constitute a major fraction of the specimens received in a general surgical pathology laboratory. The pathology ranges from functional disturbances through benign proliferations of its components to premalignant and malignant tumors. Because the uterus is composed of multiple anatomically and histologically distinct compartments, prosection techniques need to vary according to the pathology, its location, and the clinical information needed. My discussion will address common lesions of the uterus and cervix (and, if time permits, the adnexa) from the standpoint of the cutting bench, focusing on how to approach the pathology at hand in an efficient and clinically useful manner, often using nationally established protocols and staging criteria as a guide.
Dr. Mark Regan – LancasterRegionalHospital
The Prostate in Surgical Pathology
Gross and microscopic prostate anatomy will be reviewed, with emphasis placed on what information is important to the clinicians and why.
1.Review of the surgical anatomy of the prostate from the urologist’s perspective.
2.Review of the gross and microscopic anatomy of the prostate from the
3.Review of the staging of prostate cancer and how that information is
used by the urologist, oncologist, and radiation oncologist.
Dr. Linda Ernst – Children’s Hospital of Philadelphia
Placental and Fetal Pathology Case Studies
The placental pathology of three interesting cases will be discussed involving placental infection, fetal vascular abnormalities and maternal vascular abnormalities.The gross and microscopic features will be shown with particular emphasis on recognizing gross lesions and proper sampling of the placenta.
Dr. Ander Pindzola – YorkHospital
A brief background of the evolution of lymphoma classifications will be discussed followed by a more detailed presentation of the most current system as outlined by the World Health Organization.Four basic parameters are assessed and contribute to defining a lymphoma as a distinct clinicopathologic entity. These are clinical presentation, histo/cytomorphology, immunophenotype, and detection of molecular/cytogenetic abnormalities. Case studies will be presented as examples, including explanation of various routine ancillary diagnostic techniques such as immunohistochemistry, flow cytometry, karyotyping, polymerase chain reaction, and florescence in situ hybridization. The audience will also be subjected to various cute pictures of my children.