Newsletter December 2015 Association of Pathologists, Singapore

Transcription

1 Newsletter December 2015 Association of Pathologists, Singapore (Singapore Division of the International Academy of Pathologists, SGIAP) EDITOR S NOTE A very warm welcome to our inaugural newsletter of the Association of Pathologists, Singapore! We represent the Singapore Division of the International Academy of Pathologists (SGIAP). SGIAP was formally formed in January 2015, led by our first and current President Dr Angela Chong. Since its inception, the SGIAP has been actively organizing a number of educational courses for the benefit of our members and the pathology community. Our newsletter editorial team will bring you the latest updates on SGIAP activities as well as upcoming events. As part of our commitment to continuing medical education to the pathology community, we have an interesting case puzzler that will deliver learning points for everyday practice. Hope you will enjoy perusing this newsletter! Editor s note Message from the President Local Committee and Founding Members of the SGIAP Latest News Upcoming Events Case Puzzler Puay Hoon Dr Tan Puay Hoon Publications Secretary, SGIAP singaporepathology@gmail.com Website: singaporepathology.org Page 1

2 MESSAGE FROM THE PRESIDENT Dear Colleagues Thank you! I would like to take this opportunity to thank everybody for the help, encouragement and hard work in putting together the Singapore Division of the International Academy of Pathology (IAP). We formed this division with the aim of promoting the discipline of anatomical pathology in Singapore and for pathologists in Singapore to be able to better interact with the greater IAP community. Our Society is registered with the Registry of Societies as a division of the IAP, under the name of the Association of Pathologists, Singapore with an initial founding committee and an approved constitution. In 2014, we co-hosted visits by Prof Roger Mclendon, Prof Andrew Nicholson and Dr Mari Mino-Kenudson. We were also involved in the very successful 2014 SGH Breast Pathology Course. In October, together with Beijing, Cancun and Glasgow, we tried to bid for the privilege of hosting the 2020 IAP Congress. This was however eventually accorded to Glasgow. In 2015 we were again involved with the SGH Breast Pathology Course and the Prostate Pathology Masterclass where we showed off our lovely logo for the first time. Next year promises to be even more interesting as we kickstart 2016 with a breast pathology update in January with Prof Ian Ellis, and a neuropathology seminar in February led by Prof Roger Mclendon and Prof KT Wong. The committee has planned many more seminars and workshops so watch this space! As we look toward the future, perhaps we should also look back at the great Singapore Pathologists who have helped shape our discipline as we know it today. We trace our roots back to Dr George Alexander Finlayson who came to Singapore in 1903 as a Government microbiologist, but who also did quite a bit of histopathology. For me, the person who inspired me to Pathology (and who continues to inspire and still sees my cases) is Professor K Shanmugaratnam. I still remember sitting in the old Pathology Lecture Theatre, watching in awe as the Professor came striding down the steps of the lecture theater in his short starched white coat to address my wide eyed rookie class. The sight of this distinguished gentleman and his cultured tones are permanently etched in my memory and indeed of my whole class. Dr Angela Chong President, SGIAP Professor Ratnam was appointed as an assistant government pathologist in 1948 and rose to become Head of the University Department of Pathology. He also served as Professor K Shanmugaratnam Dean of the Faculty of Medicine from and was the leading author of the 1st (1975) and 2nd (1991) editions of the World Health Organisation (WHO) Histological Classification of the Upper Respiratory Tract and an editor of the 3rd (2000) edition of WHO's International Classification of Diseases for Oncology (ICD-O). He was also the Founding Director of the Singapore Cancer Registry from Page 2

3 On another note he is remembered by earlier generations of medical students as a student with exceptional academic and cricketing skills both of which he used in his own student days to good effect his bat and fast ball always driven by a strong sense of (sharp wry) humour. A multifaceted man, Prof Shanmugaratnam has always been inspiring and will always be to me, the Father of Pathology in Singapore. All of us wish him enduring good health so that we can continue to seek his wise advice. Angela Dr Angela Chong, President, SGIAP Page 3

4 OUR LOGO Our logo reflects our multicultural diversity with interlocking collaboration within the pathology community. LOCAL COMMITTEE AND FOUNDING MEMBERS OF THE SGIAP From Left to Right: Dr Tan Yongcheng Dr Hakan Aydin Dr Jabed Iqbal Dr Tan Puay Hoon Dr Inny Busmanis Dr Angela Chong Dr Syed Salahuddin Dr Norman Chan Dr Cheng Chee Leong Not Present: Dr Chong Siew Meng Dr Anjula Thomas President: Committee Members: Angela Chong MBBS, FRCPA Chong Siew Meng MBBS, FRCPath, FRCPA Vice-President: Anjula Thomas MBBS, FRCPA, MIAC Jabed Iqbal MD, PhD Inny Busmanis MBBS, FRCPA, MIAC Treasurer: Rafay Azhar FRCPath Norman Hok Ling Chan MDCM, FRCPC Honorary Secretary: Tan Yongcheng MBBS, FRCPath SGIAP Newsletter: IT Secretary: Editor Tan Puay Hoon Cheng Chee Leong MBBS, FRCPA, FRCPath Associate Editor Tan Yongcheng Publications Secretary: Tan Puay Hoon MBBS, MD, FRCPA, FRCPath, MIAC Page 4

5 LATEST NEWS SGIAP supported the 6th SGH Breast Pathology Course and the inaugural SGH Prostate Pathology Masterclass held at the Singapore General Hospital, Academia, College Road, from November Over 100 participants interacted over breast and prostate pathology slides and lectures. Invited faculty were Dr Timothy Jacobs from Seattle USA, Dr Lars Egevad from Stockholm Sweden, Dr Gary Tse from Hong Kong. Group photo of participants of the 6 th SGH Breast Pathology Course. Group photo of participants of the inaugural SGH Prostate Pathology Masterclass. Page 5

6 Participants of the SGH Breast Course Microscopy Workshop reviewing cases. Participants enjoying a lecture during the Breast Pathology Course in the Academia Auditorium. UPCOMING EVENTS SGH Breast Pathology update January 2016 Neuropathology slide seminar 3 5 February 2016 Page 6

7 CASE PUZZLER (CONTRIBUTED BY DR NORMAN CHAN) Clinical summary: A 67 year old Malay lady was referred to the hospital for evaluation of a lung mass. She was a never smoker with a clinical history of diabetes mellitus and breast carcinoma diagnosed and treated in A right lower lobe lung mass, measuring 2.7 x 2.5 x 2.2 cm, was identified by radiology. Resection followed staging and a transthoracic needle biopsy. A right lower lobectomy was performed and a tumour measuring 2.7 x 2.5 cm with circumscribed edges and a firm whitish cut surface with pleural puckering was received. What is your answer? A) Metastatic adenocarcinoma to lung B) Mucinous lung adenocarcinoma C) Secretory type lung adenocarcinoma D) Cribriform type lung adenocarcinoma E) Solid and acinar type lung adenocarcinoma. Image 1. Page 7

8 Image 2. Image 3. Page 8

9 Image 4. Image 5. FISH analysis was performed using the ALK gene dual-color break-apart probe (Abbott Molecular, IL, USA) on formalin-fixed paraffin embedded tissue. The 5 end of the ALK gene is labeled with SpectrumGreenTM and the 3 end of the ALK gene is labeled with SpectrumOrangeTM. Disruption of the ALK gene was observed resulting in a typical ALK gene rearrangement pattern consisting of one fusion, one red and one green signal. Page 9

10 Answer: The correct diagnosis is D) Cribriform type lung adenocarcinoma. Discussion: The histological sections showed solid nests of tumour, punctuated by gland-like spaces and frequently containing mucinous material, forming a sieve-like cribriform pattern. A metastatic adenocarcinoma to the lung was ruled out by negative GATA3 staining of the tumour as well as by morphological review of the original breast tumour which was a malignant high grade sarcoma. The pulmonary nature of the tumour was confirmed by strong dual staining with TTF-1 and Napsin A. So why should there be recognition of a cribriform subtype of adenocarcinoma of lung? Adenocarcinoma of the lung is the commonest type of malignant lung tumour. This adenocarcinoma is characterized by combinations of various patterns (papillary, micropapillary, acinar, lepidic, solid), which has high interobserver variability and lacks reliable correlations with the molecular profile. Reporting of a predominance of pattern is currently advocated, in order to improve on the correlations of the prognostic and molecular aspects of lung cancer. Cribriform pattern is a well-recognized form of adenocarcinoma, commonly encountered in tumours from various organ systems. Primary lung adenocarcinomas displaying such a predominant cribriform pattern are exceedingly rare and thus not surprisingly excluded from the current list of lung adenocarcinoma subtypes. They often are mistaken as pulmonary metastases from other sources. In 2014, Mackinnon et al (1) described a group of 15 cases they called cribriform carcinoma of the lung. These tumours were all TTF-1 and Napsin A positive, confirming their pulmonary nature. Six of fifteen cases had corresponding molecular studies, none of which harboured EGFRactivating mutations. 4/6 harboured ALK1 or ROS1 mutations (2 each) and 1/6 harboured KRAS mutations. Whereas recognition of this pattern is easily achieved and they have a high frequency of often targetable/targeted molecular profile, they would be included in the group of acinar type adenocarcinomas in the current classification. Continued interest and reporting of such tumours would allow us to determine the true significance of this pattern. Our current case is one such example, a cribriform type adenocarcinoma of lung with ALK1 gene rearrangement. Reference (1) Mackinnon AC Jr, Luevano A, de Araujo LC, Rao N, Le M, Suster S. Cribriform adenocarcinoma of the lung: clinicopathologic, immunohistochemical, and molecular analysis of 15 cases of a distinctive morphologic subtype of lung adenocarcinoma. Mod Pathol Aug;27(8): Page 10