CURRENT ISSUES AND DIAGNOSTIC CHALLENGES
IN CYTOPATHOLOGY
PRESENTER:
Nikolaos Chantziantoniou, ART, BSc
MDS Laboratories
Niagara Regional Reference Laboratory
St. Catharines, ON
This one day symposium consists of four lectures.
Lecture 1
Pneumocystis carinii - Current significance, cytopathology and pathophysiology
Major topics:
Background, taxonomy and life cycle of Pneumocystis carinii
Pulmonary pathophysiology, clinical presentation and treatment of P. carinii pneumonia (PCP)
The role of cytology in the diagnostic monitoring of PCP in immuno-compromised patients
The specific role of bronchoalveolar lavage (BAL) and related cytopreparatory challenges
Physical properties and characteristic features of P. carinii alveolar casts, cysts and merozoites (using Papanicolaou, Diff-Quik, methenamine silver, dedicated fluorescent stains)
Morphologic features differentiating P. carinii cysts from fungal yeasts in pulmonary specimens
The significance of 'atypical' yeast morphotypes
Atypical (extra-pulmonary) pneumocystosis and future serologic considerations
Lecture objectives:
Raise the overall awareness of P. carinii referring to the current understanding of its life cycle, epidemiology, pathophysiology, and experience of P. carinii pneumonia in the clinical and laboratory diagnostic practice. Discuss the technical challenges associated with the cytopreparation and staining of pulmonary cytologic specimens (particularly bronchoalveolar lavage) emphasizing the cytologic identification of P. carinii alveolar casts, cysts and merozoites (using Papanicolaou, Diff-Quik, methenamine silver and dedicated antibody fluorescent stains). Discuss the morphologic features that differentiate P. carinii cysts from fungal yeasts in pulmonary specimens. The concept of 'atypical' yeast morphotypes and atypical (extra-pulmonary) pneumocystosis, including future serologic considerations, will also be presented. Copies of selected literature and suggested readings will be provided.
Lecture 2
Bladder cancer - Diagnostic and cytopreparatory challenges inherent in voided urine cytopathology
Major topics:
Background, epidemiologic significance and development of bladder cancer; risk factors: Schistosomiasis, aromatic compound exposure, tobacco intake, Human Papilloma virus involvement
Histologic variants of bladder cancer and particular relationship with urothelial cell exfoliation and voided urine cellularity
Physiochemical characteristics of voided urine and inherent affects on suspended urothelial cells; review of diagnostic criteria and pitfalls
Current role of voided urine cytopathology in the diagnostic surveillance of bladder cancer
Challenges in the cytopreparation of voided urine (direct smears, membrane filtration, automated imprints, cytocentrifugation)
Diagnostic challenges: degeneration, Polyomavirus infection
Future diagnostic considerations: DNA ploidy analysis, p53 tumor suppressor protein immunohistochemistry, MIB-1 proliferation markers, flow cytometry
Lecture objectives:
Raise the overall awareness of bladder cancer: background, epidemiology, development, risk factors, urothelial pathology and the role of cytology in its surveillance through voided urine examination. Discuss the effects of Schistosomiasis, aromatic compound exposure, tobacco intake, and the relatively recent identification of Human Papilloma Virus involvement in bladder neoplasms. Discuss the relationship between the physiochemistry of urine and the associated challenges in cytopreparation and the preservation of urothelial cells. The fundamental diagnostic criteria and pitfalls will be reviewed including Polyomavirus urothelial cytopathy. The principles of direct smears, membrane filtration, automated imprints, and cytocentrifugation will be reviewed. Future diagnostic considerations of bladder cancer will be presented emphasizing the role of DNA ploidy analysis, p53 tumor suppressor protein immunohistochemistry, MIB-1 proliferation markers, and flow cytometric studies. Copies of selected literature and suggested readings will be provided.
Lecture 3
Chromophobe renal cell carcinoma - significance and diagnostic features
Main topics:
Background, clinical presentation and epidemiology of Chromophobe renal cell carcinoma (CRCC)
Histopathological basis of CRCC: characteristic cell types (Type I, II and III cells)
Ultrastructural characteristics
Characteristic aneuploidy profiles, respective flow cytometric and image cell analysis identification
Differentiation from other renal neoplasms; particularly, oncocytoma and clear cell carcinoma
Chromosomal aberration, CRCC developmental theories
Lecture objectives:
Raise the overall awareness of a recently-described kidney neoplasm, Chromophobe renal cell carcinoma: background, epidemiology, development, and suspected risk factors. The histopathological basis and the morphologic features of the neoplastic cells (Type I, II and III cells) will be discussed. The ultrastructural characteristics of this neoplasm will be reviewed. The characteristic aneuploidy profiles of this renal cancer will be discussed commenting on the respective flow cytometric and image cell analysis identification and differentiation from other renal neoplasms; particularly, oncocytoma and clear cell carcinoma. The predisposing chromosomal transformations, and the theory of aberrant cell division will be presented. Copies of selected literature and suggested readings will be provided.
Lecture 4
Current significance of the Papovaviruses - Human Papilloma virus (HPV) infection of uterine cervix; Polyomavirus infection of renal tubules
Main topics:
Background, taxonomy and life cycle of Papovaviridae
Taxonomic sub-division into Papillomaviruses and, JC and BK Polyomaviruses: epidemiology, latency characteristics and significance
Genomic, pathophysiologic and carcinogenic characteristics of the Papovaviruses
Pathology and site-specificity of HPV sub-types. Cytopathology of cervical HPV Low-grade Squamous Intraepithelial Lesions; characteristic cytomorphology, HPV sub-type significance and recognition, role of high-risk HPV in cervical carcinogenesis and patient therapeutic management
The current role of liquid based monolayer technology, future HPV serologic considerations, and diagnostic triage schemes
Pathology and site-specificity of JC and BK Polyomaviruses. Cytopathology of urinary polyomavirus infection; characteristic cytomorphology, diagnostic pitfalls, role of cytology in monitoring viral load, renal transplant rejection, and patient immuno- suppression balance
Future Polyomavirus serologic considerations
Lecture objectives:
Raise the overall awareness of the Papovaviruses; background, taxonomy, life cycle, epidemiology, opportunistic and carcinogenic potential, and ensuing development of disease. Discuss the taxonomic sub-division into the Papilloma and Polyoma JC and BK viruses emphasizing specific pathogenesis. Review the site-specificities of HPV, and JC and BK viruses, and the cytopathology and histology of cervical HPV (Low-grade Squamous Intraepithelial Lesions) and urologic polyomavirus infection of renal tubules. Emphasize the current significance of low-risk and high-risk HPV cervical infection, monitoring and respective carcinogenic potential and the role of liquid based monolayer technology. Discuss the current role of cytopathology in the detection and surveillance of the Polyomaviruses; particularly in monitoring patient viral load, renal transplant rejection and immuno-suppression balance. Copies of selected literature and suggested readings will be provided.