Virginia Society for Pathology
2019 Annual Meeting
Saturday, November 16, 2019
Omni Charlottesville Hotel
Pathologists and laboratory directors are constantly being asked to perform additional test to aid oncologists in patient management. A recently introduced diagnostic method is cell free DNA for the identification of mutations that are present in DNA shed from neoplastic cells into the peripheral circulation. We will review the biological basis of cell-free DNA in the setting of neoplasia and review factors that influence the results of these tests. Advantages, disadvantages, and limitations will be discussed; highlighting the role that pathologist in advising and interpreting the results of these advanced diagnostic tests.
Pathologists need to be aware of the advantages of various methods for detection of pan-cancer biomarkers so that they can select the correct test, for the correct patient, at the right time. Multiple different tests are available for detecting NTRK rearrangements and microsatellite instability, and test selection is critical to maximizing the likelihood of detecting the relevant alterations. This presentation will review 2 pan-cancer biomarkers, the related treatments, and the available ancillary methods. We will discuss the advantages, disadvantage, limitations, and unique considerations of each method, so that pathologists can select the most appropriate method for each patient and their unique clinical situation.
Mucinous ovarian tumors are commonly encountered by the practicing pathologist, but remain an area of common diagnostic missteps due to difficulties at the interface of benign, borderline, and malignant tumors as well as the morphologic overlap between primary and metastatic neoplasms. This lecture takes a systematic approach to mucinous ovarian tumors and focuses on mistakes and how to avoid them. We will review not only pure mucinous tumors of the ovary, but also ovarian seromucinous tumors and endometrioid tumors with prominent mucinous metaplasia. We will discuss both gastrointestinal and endocervical metastases to the ovary with a review of ancillary studies that can be useful for identifying these malignancies.
The menu of mesenchymal neoplasms that occur in the uterus seems to be ever-expanding. Pathologists practicing in 2019 need to be comfortable not only with run-of-the-mill smooth muscle tumors, but also with high and low-grade endometrial stromal sarcoma, perivascular epithelioid cell tumors (PEComas), inflammatory myofibroblastic tumors, SMARCA4-deficient uterine sarcomas, and NTRK-rearranged uterine sarcomas. They must also be attuned to epithelial mimickers of sarcoma, such as dedifferentiated carcinoma and carcinosarcoma. This lecture takes a practical approach to these tumors, emphasizing when routine diagnostic tools are sufficient and when sending for molecular testing may be warranted.
At the conclusion of this meeting, attendees will be able to:
- Identify the legislative challenges faced by Virginia Pathologists.
- Recommend appropriate treatments to clinicians based on transfusion reactions symptoms exhibited by patients.
- Identify possible sources of false-positive and false-negative results of cell-free DNA tests.
- Describe the advantages and disadvantages of MMR IHC, MSI PCR, and MSI by NGS for the detection of mismatch repair deficiency for determining immunotherapy eligibility
- Recognize that both dedifferentiated carcinomas and carcinosarcomas may mimic uterine mesenchymal tumors, and careful assessment for a malignant epithelial component is critical as this distinction may have therapeutic an prognostic significance.
- Develop tools to differentiate benign, borderline, and malignant primary mucinous ovarian tumors.