Category: News

Challenging Case 1

Clinical history:
A 32-year-old male with a history of Hodgkin’s lymphoma and biliary atresia. He had undergone transplant and was found to have distal pancreas mass during surveillance.

Pathologic Findings:

Distal pancreatectomy revealed a 4.3 cm, well circumscribed, predominantly solid mass abutting the splenic vein.

Please see two representative scanned H&E slides for histologic features.

Performed immunohistochemical stains reveal that the tumor cells:

– Express: CAM 5.2 (scanned), CK19, CK5, Ber-EP4, claudin-4 (focal), calretinin (scanned), SATB2 (patchy), CD99 (patchy, membranous), inhibin (rare cells), CD10 (focal) and a Ki67 stain reveals a
proliferative rate of 15%.

– Do NOT express: CK7, CK20, CDX2, trypsin, chymotrypsin, carboxyl ester lipase, chromogranin, synaptophysin, INSM1, insulin, glucagon, somatostatin, pancreatic polypeptide, p40, p63, monoclonal CEA, EMA, TTF1, HepPar-1, Glypican-3, GATA3, PAX8, NKX3.1, SF-1, WT1, D2-40, SALL4, CD117, DOG1, CD34, SMA, calponin, ERG, CD45, S100, SOX10, melanoma cocktail

– Other: aberrant beta-catenin (nuclear and cytoplasmic, (scanned), E-cadherin (membranous), p53 wild-type, RB1 retained, ATRX retained, MMR retained, mucicarmine negative,

No mutations, deletions or fusions were seen by NGS.

HE-1

https://pathpresenter.net/public/display?token=f8789272

HE-2

https://pathpresenter.net/public/display?token=ca3927d4

Cam 5.2 IHC

https://pathpresenter.net/public/display?token=6e1b407d

Calretinin IHC

https://pathpresenter.net/public/display?token=b4d3bde0

Beta-catenin IHC

https://pathpresenter.net/public/display?token=cb61d7fb

NOTE: The case will be open for 2 weeks for discussion. Please leave a reply of your proposed diagnosis, differential diagnosis and suggested ancillary tests (bottom of this page). We will collect the replies and post the final diagnosis with discussion.

The PBPS is seeking a new Journal Watch Committee Member

The PBPS journal watch (JW) is seeking a new committee member to join our team for a term of 3 years. The JW is posted every 2 months and includes articles to be highlighted from the most relevant journals in pancreatobiliary pathology. The JW is a valued educational tool among our community and a great way to network with others in the field.  

Interested PBPS members should send CV to info@pbpath.org by June 8, 2022.  Applicants must be paid members of the Pancreatobiliary Pathology Society. 

Daniela Allende, MD MBA, PBPS JW Editor 

USCAP 2022 Companion Society Program

Pancreatobiliary Pathology Society Companion Meeting USCAP 2022

Clonal Evolution of Pancreatobiliary Neoplasms

Despite advances in the field, our understanding of the clonal evolution of neuroendocrine neoplasms and macroscopic precursor lesions of the pancreatobiliary tract remains incomplete. Until recently the genetic alterations that contribute to these tumors’ development, progression and resistance to treatment were poorly understood. New and specific genetic alterations have now been identified in precursor lesions and specific cancer phenotypes have been shown to be associated with targetable genomic events. These advances offer pathologists a better understanding of the underlying pathogenesis of these diseases and allow more precise diagnosis and classification. This session will focus on recent advances in our understanding of mechanisms and clinical implications of the clonal evolution of neuroendocrine neoplasms and macroscopic precursors of the pancreatobiliary tract.  Updates in grading and classification and the use of novel diagnostic/prognostic markers for characterization will also be included. These are essential to practicing pathologists and pathology trainees, as they play an increasing and critical role as consultants on test selection and integrated diagnostic interpretation. Dr. Aldo Scarpa will describe molecular tumorigenesis of pancreatic neuroendocrine neoplasia and its implications on diagnosis, disease progression, treatment and prognosis. Dr. Elizabeth Thompson will provide an overview of the genomics of pancreatic cancer development from its macroscopic precursors, including intraductal neoplasms and mucinous cystic neoplasms, along with their impact on our understanding of pancreas cancer biology, diagnosis, and treatment. Dr. Yoh Zen, who has worked on defining and classifying macroscopic precursor biliary tract lesions (tumoral intraepithelial neoplasia), and their molecular associations, will summarize the current state in this rapidly evolving area.

Learning Objectives: Upon completion of this educational activity, learners will be able to:

  1. Describe the underlying molecular alterations in neuroendocrine neoplasms, and their involvement in diagnosis, association with tumor progression, newly updated WHO grading and tumor progression as well as prognosis.
  2. Describe the spectrum of molecular alterations involved in the development and progression of macroscopic precursor lesions of the pancreas (including intraductal neoplasms and mucinous cystic neoplasms) and their importance in diagnostic workup and therapeutic implications.
  3. Understand the classification system for macroscopic precursor lesions of the biliary tree, the genomic basis for invasive carcinoma development and prognostic implications of these molecular alterations.

Continuing Medical Education

The United States and Canadian Academy of Pathology is accredited by the ACCME to provide continuing medical education for physicians.

The United States and Canadian Academy of Pathology designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Session Chairs

Moderator(s)
Daniela Allende, MD, Cleveland Clinic, Lerner College of Medicine of Case Western University School of Medicine
United States

David Klimstra, MD, Memorial Sloan Kettering Cancer Center
United States

 

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The Pancreatobiliary Pathology Society is seeking new Committee Members.

The PBPath Website/Membership committee is seeking new committee members to join our team, for a term of 3 years.
The website/membership team member(s) will help the Pancreatobiliary Pathology Society maintain and expand our membership, post updates to our website, and send newsletters to our members. Experience with WordPress and/or HTML is a plus, but not required.

The ideal candidates possess a willingness to learn and a team-player mentality.

Interested PBPath members should send CV to info@pbpath.org. Successful committee members must be active members of the Pancreatobiliary Pathology Society.

The Pancreatobiliary Pathology Society Executive Committee

2021 PBPath Business Meeting agenda/minutes

Pancreatobiliary Pathology Society Members,

Alas, we will not be able to meet in person this year, therefore please find attached the 2021 Pancreatobiliary Pathology Society (PBPS) Annual Business meeting agenda/minutes for your review to learn what PBPS has accomplished: PBPath Business Meeting 2021

Two requests:
1. Listen to our PBPS Companion meeting speakers, submit your questions and attend the LIVE Question and Answer on Tuesday March 16, 2021 11-11:30 AM PST
2. Vote for our new member before March 20, 2021 (will only take 1 minute) https://www.surveymonkey.com/r/7PWVKV5

Can’t wait to see all of you in person next year!

Most appreciatively,
Grace E. Kim
Pancreatobiliary Pathology Society Secretary/Treasurer

USCAP 2021 Companion Society Program

Pancreatobiliary Pathology Society Companion Meeting USCAP 2021

Rondell Graham, MBBS, Mayo Clinic (Moderator)
Michelle D. Reid, MD, MSc, Emory University Hospital (Moderator)
Barbara A. Centeno, MD, H. Lee Moffitt Cancer Center & Research Institute
Vikram Deshpande, MBBS, MD, Massachusetts General Hospital, Harvard Medical School
Günter Klöppel, MD, PhD, Technical University of Munich
Giuseppe Zamboni, MD, University of Verona

Inflammatory Conditions of the Pancreatobiliary Tree 

This session includes 1.5 hours of on-demand educational content. This content can be viewed starting March 1. There will also be a live 30-minute Q&A session with the faculty on Tuesday, March 16, from 11:00 AM – 11:30 AM Pacific Time.

Chronic pancreatitis is a complex inflammatory process with rising incidence and prevalence, and no curative treatment for frequently intractable chronic pain. Despite advances in the field, challenges remain in the radiologic, endoscopic and histologic diagnosis, and the distinction of pancreatitis from cancer. Although some specific pathologic subtypes of pancreatitis have been described and characterized in the past decade, many pathologists are still unaware of their existence, clinicopathologic characteristics, management and genetic implications. Pathologists also struggle with formulating diagnoses, reporting terminology, and determining etiology, particularly on small biopsies, fine needle aspirations and bile duct brushings. In the past year alone numerous multidisciplinary international, consensus guideline manuscripts have made new recommendations regarding risk factors, etiology, management (endoscopic, surgical/non-surgical), and histopathology of chronic pancreatitis. The latter was aimed at clarifying the pathologist’s role in diagnosis, histopathologic criteria, standardizing reports, and limiting confusion in reporting and the literature. The Pancreatobiliary Pathology Society executive committee determined the theme, titles, content and speakers for this year’s companion meeting, with a mission to educate surgical and Cytopathologists on recent advances in inflammatory conditions of the pancreatobiliary tree. This year’s meeting will provide a 360-degree expert analysis and update on acute and chronic inflammatory conditions of pancreatobiliary tree, including specific entities acute/alcoholic pancreatitis (Dr. Günter Klöppel), paraduodenal pancreatitis (Dr. Giuseppe Zamboni), IgG4-related (autoimmune) pancreatitis (Dr. Vikram Deshpande), and the cytopathology of inflammatory lesions of the pancreatobiliary tree (Dr. Barbara Centeno).

 The program can be accessed by USCAP attendees here:

USCAP 2021 Annual Meeting

 Continuing Medical Education

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The United States and Canadian Academy of Pathology and the Pancreatobiliary Pathology Society. The United States and Canadian Academy of Pathology is accredited by the ACCME to provide continuing medical education for physicians.

The United States and Canadian Academy of Pathology designates this Other activity (enduring materials and internet live activity) for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Live Q&A Session: Tue, March 16, 11:00 AM – 11:30 AM PT

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Message from the President

Message from the President

 

Pancreatobiliary Pathology Society (PBPS) Members,

We will all remember 2020 as a year filled with challenges and new ways of doing things, and many of our modified processes are spilling into 2021 as well.  With the upcoming USCAP meeting being virtual, we have been working to prepare a compelling agenda for our PBPS Companion Meeting, and I am pleased to report that we have a very fine program devoted to the topic of pancreatitis.  Our speakers will include Dr. Barbara Centeno (Cytopathology of inflammatory lesions of the pancreatobiliary tree), Dr. Vikram Deshpande (IgG4-related (autoimmune) pancreatitis), Dr. Günter Klöppel (Acute/alcoholic pancreatitis) and Dr. Giuseppe Zamboni (Paraduodenal pancreatitis).  The lectures will be prerecorded, so you can listen to them any time after they go live on March 1.  Because of the modified format, the session will only be 90 minutes this year.  Please access the talks via the USCAP website.  There will be a 30 minute live question and answer session, hosted by Michelle Reid, PBPS Education Committee Chair, on Tuesday, March 16 at 2:00 PM Eastern time.  You can enter your questions on-line as well, and Michelle will review them with the speakers.  We hope this will be a highly interactive Q&A session, and that the virtual format will allow even more participants to hear these lectures.

I also want to remind everyone about the PBPS Abstract Award competition. Our PBPS Education Committee will select the winning abstract for 2021, and the first author will receive a $500 prize.  All applications should be submitted no later than 2/15/2021.  Please see the PBPS website for details.

In other news, we have recently revamped our Journal Watch feature, kindly edited by Daniela Allende, PBPS Chair of Journal Watch Subcommittee – please keep an eye on our website for updates about excellent publications related to pancreatobiliary pathology.

We truly regret that we cannot gather in person this year – one of the hardest things about the pandemic of course is the restriction on seeing family, friends, and colleagues – but there is a light at the end of the tunnel, and we will look forward to future meetings when we can gather again to share our interests and catch up on our professional lives!

David Klimstra,  Pancreatobiliary Pathology Society President

 

 

Pancreatic Cancer Awareness Month

 

This month, with so many global issues in front of us, I want to remind everyone that November is Pancreatic Cancer Awareness Month.  Pancreatic cancer has been in the national consciousness this year, in part due to well-known figures who have been affected, but we also draw greater awareness to the disease through Pancreatic Cancer Awareness Month, to urge private and public agencies to extend more funding to study this disease and help researchers search for a cure and improve the lives of those affected.  This year, over 56,000 people in the United States will be diagnosed with pancreatic cancer, and many more around the world will be affected.  Recognition of the growing prevalence of pancreatic cancer, with the help of foundations and organizations like the Pancreatobiliary Pathology Society, can help direct resources towards research and clinical care efforts.  Thursday, November 19 is World Pancreatic Cancer Day – an even more focused opportunity to recognize this disease and the numerous efforts to improve the care of those affected.  Please remember to “wear purple” and spread the word that we are redoubling our efforts, so that the impetus to address pancreatic cancer is also felt throughout the year and reflected in renewed energy and enthusiasm for research collaboration and knowledge sharing.  Pancreatobiliary pathologists are charged with establishing the diagnosis of pancreatic cancer, and surely we should be leading advocacy efforts as well!

David Klimstra, President 

Pancreatobiliary Pathology Society

 

PBPath Journal Watch

The Pancreatobiliary Pathology Society Journal Watch for the articles on the pancreatobiliary pathology will be released every other month.

We are reviewing the journals to select the articles about pancreas, gallbladder and biliary system pathologies. Original research articles, case series and reviews in the surgical pathology, cytopathology, and molecular pathology as well as related fields (i.e. novel methods, database studies) are included.

We have created several categories for convenience; however, articles in each category are in no particular order.

See the Current Issue here, and the draft of the Upcoming Issue here.

Older Issues will be collected under the archive.

Please let us know your comments and suggestions. Please fill the feedback form.

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Below is the list of journals we search regularly:

Advances in Anatomic Pathology
American Journal of Clinical Pathology
The American Journal of Pathology
American Journal of Surgical Pathology
Annals of Diagnostic Pathology
Annals of Surgery
Annals of Surgical Oncology
Archives of Pathology & Laboratory Medicine
Cancer
Cancer Cytopathology
Cell
Clinical Cancer Research
Cytopathology
Diagnostic Pathology
Endocrine Pathology
Gastroenterology
Gut
Histology and Histopathology
Histopathology
Human Pathology
International Journal of Surgical Pathology
Journal of Clinical Pathology
Journal of Molecular Diagnostics
Journal of Pathology
Laboratory investigation
Lancet
Modern Pathology
Nature
Nature Reviews Gastroenterology & Hepatology
NEJM
Pancreas
Pancreatology
Pathology
Pathology International
Seminars in Diagnostic Pathology
Virchows Archiv

Message from the President

Message from the President

Dear Colleagues, 

I am sad to share news of the death on July 7 in Milan, Italy of Dr. Juan Rosai. 

Dr. Rosai was clearly one of the most influential figures in surgical pathology in the last 50 years, whose broad diagnostic expertise was recognized worldwide.  For much of his career, he served as a consultant to the international pathology community, providing expert second opinions and making enormous contributions to direct patient care.  As a researcher, Dr. Rosai was best known for his work on neoplasms of the thyroid, thymus, and vascular system, but essentially there is no subspecialty area that did not receive his investigative attention.  In fact, he wrote many papers on pancreatic neoplasms, and it was his encouragement of me to pursue a case of pancreatic acinar cell carcinoma that led me to the field of pancreatic pathology.  Dr. Rosai was among the first to embrace technologies like electron microscopy, immunohistochemistry, and molecular biology to enhance pathologic diagnosis. He was also one of the first pathology leaders to promote digital pathology and predicted the field’s evolution from microscopic to digital pathology many years before it occurred, and he pushed for subspecialization of academic pathology years before it became commonplace – ironic, given that he himself was the quintessential generalist.  But perhaps his most lasting contributions were made as a mentor and teacher, roles he took on with great enthusiasm. He fostered the careers of countless trainees, many of whom are now in leadership positions around the world.   Recitation of his numerous achievements, awards, and honors can await more formal tributes that will appear in time, but no one can doubt that Juan Rosai achieved as much as any individual can in our field, and his influence has been felt across all subspecialties.  A world-renowned surgical pathologist, as well as a treasured friend to many, Dr. Rosai’s generous spirit and ability to build consensus are as much a part of his legacy as his unparalleled expertise. Our thoughts are with his wife, Dr. Maria Luisa Carcangiu, and his children.

David Klimstra

President, Pancreatobiliary Pathology Society