Presentation abstracts from the 2020 General Pathology Conference

1. Distinguish high risk from low risk basal cell carcinomas.
2. Distinguish high risk from low risk squamous cell carcinomas.
3. Understand the new WHO classification of dysplastic naevi into low grade and high grade.
4.  Understand the best Skin  biopsy techniques for each clinical situation.
5.  Know when to order ancillary tests on skin biopsies.
6. Understand the importance of clinicopathologic correlation in Dermatopathology.
7. Improve understanding of adequate clearance margins in neoplastic Dermatopathology.
8. Know about the high risk tumour Merkel cell carcinoma.
9. Know about the high risk tumour Sebaceous carcinoma.
10. Know about the high risk tumour Desmoplastic melanoma.
11. Improve knowledge on the newly unravelled genetic landscape of cutaneous melanoma.
12. Know about the high risk tumour microcystic adnexal carcinoma.
13. Become aware of the association between cutaneous sebaceous neoplasia and Muir Torre Syndrome.
14. Become aware of the association between cutaneous leiomyoma and familial renal cell carcinoma leiomyoma syndrome.
15. Understand Keratoacanthoma as a distinct variant of squamous cell carcinoma.
16. Know what is and isn’t high risk perineural invasion in cutaneous neoplasia.
17. Understand the importance of the distinction of Atypical Fibroxanthoma from Pleomorphic Dermal Sarcoma.
18. Understand the difference between Bowen’s disease (in-situ squamous cell carcinoma) and in-situ squamous cell carcinoma arising in a solar keratosis.
19. Understand the likely viral aetiology of seborrhoiec keratosis lesions in the anogenital region.
20. Know when to refer a newly diagnosed cutaneous melanoma patient to a specialist or melanoma unit.

Having decided to take a biopsy in a clinical presentation of rash, more decisions follow. Which part of a rash is best sampled? iopsy technique is best? Should immunofluorescence be performed? And what history does the pathologist need?

Serum protein electrophoresis: how to interpreting the results.

Dr Huynh has special interest in cardiovascular imaging, non-invasive cardiac testing for ischaemic heart disease, diagnosis and management of valvular heart disease and difficult to control hypertension. He will review the latest research and opinions on troponin, condensing the overwhelming deluge of available information into simple tips which can be relied upon in every day clinical practice.

Learning objectives:

  1. To understand the widely available troponin tests, when to order a troponin, and what is normal?
  2. An 82 year old lady presents to the emergency department. She has navel pain. The ED intern orders a troponin T, which comes back as 12. Is this normal or abnormal?

The presentation will address the pathological challenges of accurate subtyping of breast cancer and the role of the pathologist in assessing prognostic and predictive markers for “personalized” therapy. This encompasses traditional and newer molecular assays. The role of fine needle aspiration cytology in the diagnosis of breast cancer will be briefly discussed in the light of new Practice Guidelines and the new International Academy of Cytology Yokohama system for reporting Breast FNA.

Presentation topics

PGx; Pharmacogenomics (PGx) is the analysis of genes involved in drug metabolism, enabling personalised selection of drug and dose to improve outcomes and reduce adverse reactions. Recent evidence shows that PGx-informed prescribing increases the probability of remission of depression being managed in the community. 

Carrier screening; The routine offer of antenatal screening for chromosome disorders has long been effective in providing informed choices for pregnant women. However, the majority of severe genetic disorders in childhood are due to the inheritance of recessive genes, not chromosome disorders. Reproductive carrier screening has the potential to dramatically reduce the risks of severe genetic disorders in childhood. 

Lactose intolerance; With few exceptions, all babies can digest lactose. However, the majority of teens and adults globally cannot. The transition from a lactose tolerant baby to a lactose intolerant adult is not predictable, and is complicated by various intestinal disorders. A genetic test can now identify those who will retain lactose tolerance in adulthood, simplifying the management of intestinal symptoms. 

NIPT; Non-invasive prenatal testing is now a feature of mainstream care. However, familiarity should not blind the doctor or patient to the limitations of the test – or the interpretive challenges that may be encountered.  

FH; Hypercholesterolaemia is common, and usually due to the interactions of many genes, diet and lifestyle. However, there are a few genes in which a single mutation is sufficient to drive severe hypercholesterolaemia, and dietary and lifestyle modifications make relatively little difference to outcome. This is familial hypercholesterolaemia (FH). It is common (100,00 people affected nationally), underdiagnosed (<5,000 documented cases), and treatable (effective medications). GPs are crucial in identifying patients (and families) and giving them access to rebated tests and therapies.