Caris Diagnostics Holds Annual Review Courses in GI and Liver

Caris Diagnostics Holds Annual Review Courses
continued from page 1
4
course simply as a refresher on all major topics in GI pathology.
Fellows, residents interested in gastroenterology, and regional
clinicians were also invited to attend.
Participants were actively engaged, and lively question and
answer sessions followed each lecture. “You could feel the
academic pulse at the course,” said Dr. Salima Haque, who is
director of the Irving course and had directed a similar course
for 16 years as Professor of Pathology at Tulane University.
Physicians who attended offered positive feedback. “Thanks so
focus
much! Word has spread about how great this conference is!”
said one Boston participant. Especially popular with attendees
was the complimentary CD-ROM distributed at both courses,
which contains all lecture material and is ideal for self-study and
review.
Caris Diagnostics is pleased to have had the exciting
opportunity to offer this educational service to the
gastroenterology community. Be on the lookout for information
on future review courses.
Caris Diagnostics Newsletter for GI Clinicians Winter 2012
Faculty1 and Lecture Topics for Caris Diagnostics’ Annual Review Courses in GI and Liver Pathology
Irving Faculty
Boston Faculty
Caris Diagnostics provides
Richard H. Lash, MD: Polyps and Carcinomas of the Lower GI Tract
Jeremy S. Ditelberg, MD: Esophagus.
the best of both worlds
Carlos M. Torres, MD: Inflammatory Conditions of the Esophagus
Tanya Rege, MD: Stomach and Duodenum, Inflammatory
with no compromises. We
Robert M. Genta, MD: Inflammatory Conditions of the Stomach
Maria McIntire, MD: Upper GI Tract Polyps and Neoplasms
combine academic-caliber
M.H. Saboorian, MD: Polyps and Tumors of the Upper GI Tract
Mahmoud Goodarzi, MD: Inflammatory Disorders of the Intestines
diagnostic services with
Giovanni M. Luján, MD: Idiopathic Inflammatory Bowel Disease (IBD)
Mark Redston, MD: Lower GI tract Polyps and Neoplasms
advanced GI business
Cristian I. Robiou, MD: Inflammatory Conditions of the Intestine
Jonathan N. Glickman, MD, PhD: Liver and Biliary Tract
solutions to support the
Salima Haque, MD and Marlyn J. Mayo, MD2: Hepatitis A-Z, NASH, ASH
quality of care your patients
Shari L. Taylor, MD: Biliary Tract Disease and Metabolic Liver Disease
deserve. Our expert GI
1 For more information about each Caris Diagnostics faculty presenter, please visit our website:
www.carislifesciences.com/gi-pathology-experts/.
2 Dr. Mayo is an Associate Professor of Internal Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center.
pathologists, comprehensive
quality initiatives, world-class
client services, and leading
edge technologies position
Caris Diagnostics as your
long term GI pathology
Caris Diagnostics Holds Annual Review Courses
in GI and Liver Pathology for Gastroenterology Boards
In keeping with our established commitment to academic caliber education, Caris Diagnostics, a
Miraca Group Company, held its annual review courses in GI and Liver pathology for GI fellows and
practicing gastroenterologists this fall. These courses, offered to participants free of charge, took place at
the Irving and Boston locations. The faculty consisted of an impressive array of Caris Diagnostics’ experts
in GI pathology, as well as a clinical instructor from the University of Texas Southwestern Medical Center
(see faculty and lecture topic list on page 4).
The courses provided clinicians a comprehensive review of GI pathology in preparation for their
certifying or re-certifying board examination in gastroenterology. Unlike other review lectures, these were
focused on pathology images, ensuring that participants would later be able to navigate the pathology
portion of the board exam with confidence. In addition, since each lecture included the relevant clinical
information for each diagnostic entity, the images were discussed in the context of actual clinicopathologic scenarios. Although the primary purpose was board review, some physicians enjoyed the
continued on page 4
partner.
Under the Microscope: How would you diagnose this case?
6655 North MacArthur Boulevard
Irving, Texas 75039
A 39-year-old woman with external hemorrhoids underwent a hemorrhoidectomy. Grossly, the specimen
was described as an ellipse of dark brown skin and underlying soft tissue, which on sectioning contained
a tan, fleshy nodule (0.9 cm). Photomicrographs of the nodule are shown below (Figures 1 and 2).
What is your diagnosis?
www.carisdiagnostics.com
800.979.8292
© 2012 Caris Diagnostics, A Miraca Group Company, All Rights Reserved.
Caris Diagnostics is a registered trademark of Caris Life Sciences, Ltd.
GI0137 01.12
a) Fibrotic hemorrhoid.
b) Well-differentiated anal gland adenocarcinoma.
c) Endometriosis.
d) Fibroadenoma of the anogenital region.
e) Leiomyoma.
Figure 1
Figure 2
see answer on page 3
Under the Microscope
American College of Gastroenterology: 2011 Annual Scientific Meeting
Another Major Presence for Caris Diagnostics
2
continued from page 1
Washington, D.C., Oct. 2 - Nov. 2, 2011 – For the past four
presented a study on the controversial issue of focal intestinal
years, the conspicuous presence of researchers from Caris
metaplasia at the gastroesophageal junction. She concluded
Diagnostics (part of Miraca Holdings, Inc.) has become a
that, in order to meet AGA guidelines for the diagnosis of
tradition at the annual meeting of the American College of
Barrett’s esophagus, the pathologist must be aware of the
Gastroenterology. This year was no exception: Fifteen abstracts
endoscopic impression at the time of biopsy.
were selected for poster presentation, a number that compares
favorably with the most prestigious academic gastroenterology
(Lindberg, Morgan, and Kinsey) examined the prevalence
and pathology departments in the United States. One of these
of unexpected infections in gastrointestinal biopsy specimens
posters (see below for details) was honored with the ACG
and concluded that, although exceedingly rare, colonic
Presidential Poster Award.
amebiasis, spirochetosis, and herpes esophagitis occur in
immunocompetent patients. Since these patients usually present
This year, Caris researchers focused their efforts on several
with non-specific symptoms and minimal organism loads, the
esophagitis. In a highly innovative study and winner of the
diagnosis rests on the pathologist’s ability to consider rare, often
ACG Presidential Poster Award, Bedeir, Bhattacharya, and
neglected entities, and to be perseverant in the search for an
Ray discovered that young women (<40 years of age) with
etiology that can elucidate the origin of otherwise unexplained
collagenous colitis are eight times more likely than the general
inflammatory changes. Yang devoted two projects to the
population to have celiac disease. Therefore, these authors
investigation of the distribution patterns of colorectal adenomas
suggest that such patients should also have an EGD with
and carcinomas; he and his colleagues (SJ Tang and R Wu
duodenal biopsies to exclude concurrent celiac disease.
of the University of Mississippi; and J Yang, from the Medical
College of Wisconsin) determined that the distribution of colonic
geographic trends of reactive gastropathy, a condition of the
adenocarcinoma shares similar patterns with its precursors,
gastric mucosa related to bile reflux and possibly to the use of
but that its left-sided predominance gradually diminishes
NSAIDs that appears to be increasing in prevalence, Genta (in
and shifts to the right side with advancing age, particularly
collaboration with I Maguilnik of the University of Rio Grande
in women. Golembeski focused on unexpected signet ring
do Sul in Porto Alegre, Brazil) examined the demographic and
carcinomas that may be found in biopsy specimens from
epidemiologic patterns of this condition and concluded that it
otherwise benign-appearing areas of the stomach. Two studies
has been increasing in frequency in the last few years, that it is
were devoted to diarrheal diseases. After examining colonic
emerging in children and young people, and that its prevalence
biopsy sampling patterns in more than 100,000 patients with
is not as inversely related to the prevalence of H. pylori as
diarrhea, Golembeski and Genta concluded that representative,
previously believed. In collaboration with J Hurrell (University
topographically defined mucosal sampling is paramount in
of Texas Southwestern) and A Sonnenberg (University of
helping pathologists reach etiology-specific diagnoses in these
Oregon) Genta showed that, contrary to previous suggestions
patients.
derived from smaller series, there was no evidence of monthly
or seasonal variation even within regions with variable climates
have already been submitted as full papers at the time of this
among 10,000 patients with eosinophilic esophagitis. While it
writing) there were several case reports: “Gastric Clear Cell
has been shown that H. pylori gastritis is inversely correlated
Carcinoid Tumor in a Patient with Von Hippel-Lindau Disease”
with Barrett’s esophagus, Trapasso took this concept one
and “Metastatic Breast Carcinoma to the Colon Mimicking
step further and showed that H. pylori infection seems to also
Microscopic Colitis” (both by Bhattacharya and Bedeir) as well
protect from dysplasia occurring in Barrett’s mucosa. In contrast,
as a clinicopathologic study of four adults with autoimmune
there is a positive correlation with squamous cell carcinoma,
enteropathy (Kinsey, Malhotra, and Gates).
possibly because of shared risk factors. McIntyre, who has a
long-standing interest in the diagnosis of Barrett’s esophagus,
Readers may recall meeting Dr. Ditelberg in the
July 2009 issue of this newsletter (see http://www.
carislifesciences.com/gi-pathology-news). He is
featured again here to highlight his significant
accomplishments as a member of the American
College of Gastroenterology (ACG). Of all the
physicians serving on ACG committees, Dr. Ditelberg
is one of only two pathologists.
In three separate studies, Saboorian and his colleagues
areas: infections, neoplasia, diarrhea, gastritis, and eosinophilic
As part of an ongoing effort to determine the temporal and
Answer: D. Fibroadenoma of the anogenital region.
In addition to these systematic studies (some of which
l
– Robert M. Genta, MD, Chief for Academic Affairs
Featured Pathologist:
Jeremy S. Ditelberg
MD, FCAP, FASCP
Dr. Jeremy Ditelberg has
been an active member of
the American College of
Gastroenterology since 2009.
Figure 3: Immunohistochemical stain for estrogen receptor.
For the past two years, he
has served on the ACG Public
Histologic sections show a well-circumscribed nodule
Relations Committee. The goal
that is sharply demarcated from the overlying skin. The lesion
of the committee is to develop
consists of both glandular and stromal elements. The stroma is
and implement an effective
fibrotic and hypocellular with no atypia. The epithelium lining
the glandular component is cuboidal to columnar with apical
snouts and is cytologically benign. The epithelium is variably
positive for estrogen (figure 3) and progesterone receptors
the past year, the committee has worked on many
cancer awareness and screening.
fibroadenoma.
Fibroadenomas are the most common benign tumors of
the breast, and they rarely occur in extramammary sites. In the
anogenital region, they are believed to arise from mammarylike sweat glands of the skin. These are most likely eccrine-
Throughout the year, and especially in March (CRC
Awareness Month), committee members participated
in radio interviews and created audio podcasts and
colonoscopy video tours to encourage screening and
help patients understand and feel more comfortable
type glands that undergo at least partial transformation to
about colonoscopy. In addition, the ACG teamed up
an apocrine phenotype, thereby gaining the ability to from
with Basketball Coach Gary Williams and the University
breast structures. It is important for pathologists to be aware
of this phenomenon, as these transformed anogenital glands
may not only give rise to benign breast lesions, but also to
malignant tumors, including extramammary Paget disease and
invasive adenocarcinoma. The lesion presented here, however,
is clearly benign as evidenced by its bland histomorphologic
features. Also, by immunohistochemistry (not shown), an intact
myoepithelial layer and very low proliferative rate provided
additional confirmation of the benign nature of this lesion.
advance the College’s public education mission. During
initiatives that were primarily focused on colorectal
by immunohistochemistry, supporting the diagnosis of
communication program to
l
Reference
Solomon GJ et al. A 65-year-old woman with a “hemorrhoid.” Fibroadenoma of
the anogenital region. Arch Path Lab Med 2006;130:e30-32.
of Maryland to create a CRC television public service
announcement that aired 1049 times in 16 media
markets reaching an estimated 7.4 million viewers.
Another task of the committee is to identify scientific
findings from abstracts presented at the ACG Annual
Meeting that are particularly “newsworthy” for the
consumer health media as well as the gastroenterology
and internal medicine trade press. These selected
abstracts form the scientific underpinning for ACG’s
media outreach, which includes press releases and media
briefing sessions at the Annual Meeting.
l
3
Under the Microscope
American College of Gastroenterology: 2011 Annual Scientific Meeting
Another Major Presence for Caris Diagnostics
2
continued from page 1
Washington, D.C., Oct. 2 - Nov. 2, 2011 – For the past four
presented a study on the controversial issue of focal intestinal
years, the conspicuous presence of researchers from Caris
metaplasia at the gastroesophageal junction. She concluded
Diagnostics (part of Miraca Holdings, Inc.) has become a
that, in order to meet AGA guidelines for the diagnosis of
tradition at the annual meeting of the American College of
Barrett’s esophagus, the pathologist must be aware of the
Gastroenterology. This year was no exception: Fifteen abstracts
endoscopic impression at the time of biopsy.
were selected for poster presentation, a number that compares
favorably with the most prestigious academic gastroenterology
(Lindberg, Morgan, and Kinsey) examined the prevalence
and pathology departments in the United States. One of these
of unexpected infections in gastrointestinal biopsy specimens
posters (see below for details) was honored with the ACG
and concluded that, although exceedingly rare, colonic
Presidential Poster Award.
amebiasis, spirochetosis, and herpes esophagitis occur in
immunocompetent patients. Since these patients usually present
This year, Caris researchers focused their efforts on several
with non-specific symptoms and minimal organism loads, the
esophagitis. In a highly innovative study and winner of the
diagnosis rests on the pathologist’s ability to consider rare, often
ACG Presidential Poster Award, Bedeir, Bhattacharya, and
neglected entities, and to be perseverant in the search for an
Ray discovered that young women (<40 years of age) with
etiology that can elucidate the origin of otherwise unexplained
collagenous colitis are eight times more likely than the general
inflammatory changes. Yang devoted two projects to the
population to have celiac disease. Therefore, these authors
investigation of the distribution patterns of colorectal adenomas
suggest that such patients should also have an EGD with
and carcinomas; he and his colleagues (SJ Tang and R Wu
duodenal biopsies to exclude concurrent celiac disease.
of the University of Mississippi; and J Yang, from the Medical
College of Wisconsin) determined that the distribution of colonic
geographic trends of reactive gastropathy, a condition of the
adenocarcinoma shares similar patterns with its precursors,
gastric mucosa related to bile reflux and possibly to the use of
but that its left-sided predominance gradually diminishes
NSAIDs that appears to be increasing in prevalence, Genta (in
and shifts to the right side with advancing age, particularly
collaboration with I Maguilnik of the University of Rio Grande
in women. Golembeski focused on unexpected signet ring
do Sul in Porto Alegre, Brazil) examined the demographic and
carcinomas that may be found in biopsy specimens from
epidemiologic patterns of this condition and concluded that it
otherwise benign-appearing areas of the stomach. Two studies
has been increasing in frequency in the last few years, that it is
were devoted to diarrheal diseases. After examining colonic
emerging in children and young people, and that its prevalence
biopsy sampling patterns in more than 100,000 patients with
is not as inversely related to the prevalence of H. pylori as
diarrhea, Golembeski and Genta concluded that representative,
previously believed. In collaboration with J Hurrell (University
topographically defined mucosal sampling is paramount in
of Texas Southwestern) and A Sonnenberg (University of
helping pathologists reach etiology-specific diagnoses in these
Oregon) Genta showed that, contrary to previous suggestions
patients.
derived from smaller series, there was no evidence of monthly
or seasonal variation even within regions with variable climates
have already been submitted as full papers at the time of this
among 10,000 patients with eosinophilic esophagitis. While it
writing) there were several case reports: “Gastric Clear Cell
has been shown that H. pylori gastritis is inversely correlated
Carcinoid Tumor in a Patient with Von Hippel-Lindau Disease”
with Barrett’s esophagus, Trapasso took this concept one
and “Metastatic Breast Carcinoma to the Colon Mimicking
step further and showed that H. pylori infection seems to also
Microscopic Colitis” (both by Bhattacharya and Bedeir) as well
protect from dysplasia occurring in Barrett’s mucosa. In contrast,
as a clinicopathologic study of four adults with autoimmune
there is a positive correlation with squamous cell carcinoma,
enteropathy (Kinsey, Malhotra, and Gates).
possibly because of shared risk factors. McIntyre, who has a
long-standing interest in the diagnosis of Barrett’s esophagus,
Readers may recall meeting Dr. Ditelberg in the
July 2009 issue of this newsletter (see http://www.
carislifesciences.com/gi-pathology-news). He is
featured again here to highlight his significant
accomplishments as a member of the American
College of Gastroenterology (ACG). Of all the
physicians serving on ACG committees, Dr. Ditelberg
is one of only two pathologists.
In three separate studies, Saboorian and his colleagues
areas: infections, neoplasia, diarrhea, gastritis, and eosinophilic
As part of an ongoing effort to determine the temporal and
Answer: D. Fibroadenoma of the anogenital region.
In addition to these systematic studies (some of which
l
– Robert M. Genta, MD, Chief for Academic Affairs
Featured Pathologist:
Jeremy S. Ditelberg
MD, FCAP, FASCP
Dr. Jeremy Ditelberg has
been an active member of
the American College of
Gastroenterology since 2009.
Figure 3: Immunohistochemical stain for estrogen receptor.
For the past two years, he
has served on the ACG Public
Histologic sections show a well-circumscribed nodule
Relations Committee. The goal
that is sharply demarcated from the overlying skin. The lesion
of the committee is to develop
consists of both glandular and stromal elements. The stroma is
and implement an effective
fibrotic and hypocellular with no atypia. The epithelium lining
the glandular component is cuboidal to columnar with apical
snouts and is cytologically benign. The epithelium is variably
positive for estrogen (figure 3) and progesterone receptors
the past year, the committee has worked on many
cancer awareness and screening.
fibroadenoma.
Fibroadenomas are the most common benign tumors of
the breast, and they rarely occur in extramammary sites. In the
anogenital region, they are believed to arise from mammarylike sweat glands of the skin. These are most likely eccrine-
Throughout the year, and especially in March (CRC
Awareness Month), committee members participated
in radio interviews and created audio podcasts and
colonoscopy video tours to encourage screening and
help patients understand and feel more comfortable
type glands that undergo at least partial transformation to
about colonoscopy. In addition, the ACG teamed up
an apocrine phenotype, thereby gaining the ability to from
with Basketball Coach Gary Williams and the University
breast structures. It is important for pathologists to be aware
of this phenomenon, as these transformed anogenital glands
may not only give rise to benign breast lesions, but also to
malignant tumors, including extramammary Paget disease and
invasive adenocarcinoma. The lesion presented here, however,
is clearly benign as evidenced by its bland histomorphologic
features. Also, by immunohistochemistry (not shown), an intact
myoepithelial layer and very low proliferative rate provided
additional confirmation of the benign nature of this lesion.
advance the College’s public education mission. During
initiatives that were primarily focused on colorectal
by immunohistochemistry, supporting the diagnosis of
communication program to
l
Reference
Solomon GJ et al. A 65-year-old woman with a “hemorrhoid.” Fibroadenoma of
the anogenital region. Arch Path Lab Med 2006;130:e30-32.
of Maryland to create a CRC television public service
announcement that aired 1049 times in 16 media
markets reaching an estimated 7.4 million viewers.
Another task of the committee is to identify scientific
findings from abstracts presented at the ACG Annual
Meeting that are particularly “newsworthy” for the
consumer health media as well as the gastroenterology
and internal medicine trade press. These selected
abstracts form the scientific underpinning for ACG’s
media outreach, which includes press releases and media
briefing sessions at the Annual Meeting.
l
3
Caris Diagnostics Holds Annual Review Courses
continued from page 1
4
course simply as a refresher on all major topics in GI pathology.
Fellows, residents interested in gastroenterology, and regional
clinicians were also invited to attend.
Participants were actively engaged, and lively question and
answer sessions followed each lecture. “You could feel the
academic pulse at the course,” said Dr. Salima Haque, who is
director of the Irving course and had directed a similar course
for 16 years as Professor of Pathology at Tulane University.
Physicians who attended offered positive feedback. “Thanks so
focus
much! Word has spread about how great this conference is!”
said one Boston participant. Especially popular with attendees
was the complimentary CD-ROM distributed at both courses,
which contains all lecture material and is ideal for self-study and
review.
Caris Diagnostics is pleased to have had the exciting
opportunity to offer this educational service to the
gastroenterology community. Be on the lookout for information
on future review courses.
Caris Diagnostics Newsletter for GI Clinicians Winter 2012
Faculty1 and Lecture Topics for Caris Diagnostics’ Annual Review Courses in GI and Liver Pathology
Irving Faculty
Boston Faculty
Caris Diagnostics provides
Richard H. Lash, MD: Polyps and Carcinomas of the Lower GI Tract
Jeremy S. Ditelberg, MD: Esophagus.
the best of both worlds
Carlos M. Torres, MD: Inflammatory Conditions of the Esophagus
Tanya Rege, MD: Stomach and Duodenum, Inflammatory
with no compromises. We
Robert M. Genta, MD: Inflammatory Conditions of the Stomach
Maria McIntire, MD: Upper GI Tract Polyps and Neoplasms
combine academic-caliber
M.H. Saboorian, MD: Polyps and Tumors of the Upper GI Tract
Mahmoud Goodarzi, MD: Inflammatory Disorders of the Intestines
diagnostic services with
Giovanni M. Luján, MD: Idiopathic Inflammatory Bowel Disease (IBD)
Mark Redston, MD: Lower GI tract Polyps and Neoplasms
advanced GI business
Cristian I. Robiou, MD: Inflammatory Conditions of the Intestine
Jonathan N. Glickman, MD, PhD: Liver and Biliary Tract
solutions to support the
Salima Haque, MD and Marlyn J. Mayo, MD2: Hepatitis A-Z, NASH, ASH
quality of care your patients
Shari L. Taylor, MD: Biliary Tract Disease and Metabolic Liver Disease
deserve. Our expert GI
1 For more information about each Caris Diagnostics faculty presenter, please visit our website:
www.carislifesciences.com/gi-pathology-experts/.
2 Dr. Mayo is an Associate Professor of Internal Medicine, Division of Digestive and Liver Diseases, UT Southwestern Medical Center.
pathologists, comprehensive
quality initiatives, world-class
client services, and leading
edge technologies position
Caris Diagnostics as your
long term GI pathology
Caris Diagnostics Holds Annual Review Courses
in GI and Liver Pathology for Gastroenterology Boards
In keeping with our established commitment to academic caliber education, Caris Diagnostics, a
Miraca Group Company, held its annual review courses in GI and Liver pathology for GI fellows and
practicing gastroenterologists this fall. These courses, offered to participants free of charge, took place at
the Irving and Boston locations. The faculty consisted of an impressive array of Caris Diagnostics’ experts
in GI pathology, as well as a clinical instructor from the University of Texas Southwestern Medical Center
(see faculty and lecture topic list on page 4).
The courses provided clinicians a comprehensive review of GI pathology in preparation for their
certifying or re-certifying board examination in gastroenterology. Unlike other review lectures, these were
focused on pathology images, ensuring that participants would later be able to navigate the pathology
portion of the board exam with confidence. In addition, since each lecture included the relevant clinical
information for each diagnostic entity, the images were discussed in the context of actual clinicopathologic scenarios. Although the primary purpose was board review, some physicians enjoyed the
continued on page 4
partner.
Under the Microscope: How would you diagnose this case?
6655 North MacArthur Boulevard
Irving, Texas 75039
A 39-year-old woman with external hemorrhoids underwent a hemorrhoidectomy. Grossly, the specimen
was described as an ellipse of dark brown skin and underlying soft tissue, which on sectioning contained
a tan, fleshy nodule (0.9 cm). Photomicrographs of the nodule are shown below (Figures 1 and 2).
What is your diagnosis?
www.carisdiagnostics.com
800.979.8292
© 2012 Caris Diagnostics, A Miraca Group Company, All Rights Reserved.
Caris Diagnostics is a registered trademark of Caris Life Sciences, Ltd.
GI0137 01.12
a) Fibrotic hemorrhoid.
b) Well-differentiated anal gland adenocarcinoma.
c) Endometriosis.
d) Fibroadenoma of the anogenital region.
e) Leiomyoma.
Figure 1
Figure 2
see answer on page 3