Education

2017 Modern Pathology  
Dermatofibrosarcoma protuberans (DFSP) is a dermal and subcutaneous intermediate tumour. Compared to other techniques, biopsy is not only a rapid outpatient procedure but also the optimal choice for unresectable patients with cutaneous tumor before neoadjuvant therapy. In DFSP, the rarity of tumours, atypical clinical manifestation and uncommon histological features may cause diagnosis pitfalls in the limited biopsy samples. The most remarkable cytogenetic characteristic of DFSP is the
more » ... of the COL1A1-PDGFB fusion gene. The aim of this study was to analyse the clinical application value of fluorescence in situ hybridization (FISH) in biopsy of DFSP. Design: Twenty-three consecutive biopsy specimens of DFSP, collected from 2007 to 2014, were reviewed for clinicopathological features and immunohistochemical staining results, and detected with the COL1A1/PDGFB Fusion Probe and the PDGFB Break Apart Probe using FISH analysis.Controls included 5 fibromatosis and dermatofibromas. The positive criteria for COL1A1-PDGFB gene fusion and PDGFB rearrangement were both 10% and more of the cells showed meaningful signals. Results: The 23 tumour samples consisted of 10 punch biopsies and 13 shave biopsies (11 males and 12 females; mean age at diagnosis, 37 y; range, 14 to 75 y). Eighteen conventional DFSP, 1 Bednar tumour, 2 myxoid DFSP and 2 DFSP with fibrosarcomatous areas were included in the group.CD34 expression was strong and extensive in the spindle cell component in 19 cases (83%) of DFSP, including FS-DFSP, whereas one case of a conventional subtype was negative for CD34;One case of a conventional subtype and 2 myxoid subtypes had patchy CD34 expression.SMA was focal positive staining in 3 cases (13%). All cases were negative for desmin, S-100 protein, myogenin, Bcl-2, CD99, p16, p63, cytokeratin and EMA. In FISH detection, 21/23 cases (91%) were both positive for the COL1A1-PDGFB fusion signal and the PDGFB break apart signal. The percentage of COL1A1-PDGFB fusion gene was above 70% in 20/21 (95.2%) of DFSP. A PDGFB split signal pattern was observed in approximately 20%-80% of the interphase tumour nuclei. Conclusions: This is one of the few study to demonstrate the great value of detecting COL1A1-PDGFB fusion translocation by both the Fusion Probe and the Break Apart Probe in biopsies of DFSP using FISH analysis. As a molecular cytogenetic technique, FISH could become a standard procedure to confirm unusual clinical presentation and validate complicated and suspected diagnosis in the routine biopsy of DFSP. Education 543 Mentoring Residents in Academic Centers, the Cleveland Clinic Experience Daniela Allende, Deborah Chute, Carol Farver. Cleveland Clinic, Cleveland, OH. Background: Mentoring is widely recognized in academic and non-academic centers as a critical component of professional development. Even though the prevalence of mentoring in academic medical centers has been reported in the literature varying from 19 to 84%, there is limited experience in the pathology field (Zerzan J et al, Acad Med 2009). The goal of this study is to present some preliminary data on our own experience and the impact of an organized mentorship program. Design: Our pathology department is a subspecialty based practice with more than 80 faculty members between anatomic and clinical pathology throughout the entire health system. Our ACGME accredited residency program includes a total of 29 PGY1-PGY4 residents. A pilot mentorship program was introduced to residents and staff volunteers, which included a training session that provided educational material, as well as basic guidelines and exercises examples on how to make the most out of the mentorship experience. Baseline and follow up surveys were obtained. Results: Our pilot program included 19 staff (2 to >25 years in practice) and 20 residents (12 female, 8 male, PGY1 to PGY4). The baseline survey revealed that >85% of residents were interested in having a mentor. Even though 37.5% reported having at least 1 mentor before starting the program, 4 out of 5 residents struggled to find a mentor during the first year of training. Out of the entire cohort, the mentor-mentees match was successful in 94% of cases. Anecdotal feedback as well as follow up surveys from residents reported that mentors could help them achieve their goals, including development of career objectives (86%), fellowship/job search (67%) and overcoming daily obstacles (40%). Conclusions: Our experience supports that mentor-mentee relations are greatly valued and key in professional development. Besides spontaneous mentoring, an organized mentorship program may be helpful as an additional tool to facilitate interactions early during residency and to support staff and residents through educational resources. Background: Observational data suggests seekers of pathology information (PI) have focused questions and value the ease of finding info, based on web statistics; however, PI consumption is still incompletely characterized and infrequently stratified by practicing pathologist and learner. Where information is sought and what is important may give insight into how PI may be delivered in the future. Design: An online survey was done using limesurvey (limesurvey.org). Participants were recruited from an open access pathology web site, via Twitter, email and word of mouth. Results: A total of 59 participants completed the survey (25 pathologists, 33 learners (3 fellows, 30 residents), 1 other health professional) and were from various regions (North America 39, Asia 9, Europe 5, Africa 5, Other 1). Among learners (L) and pathologists (P) elements rated very important (VI) were images (70% L/60% P), followed by microscopic criteria (58% L/56% P) and IHC info (52% L/56% P). Learners and pathologists differed on the VI ratings for spot diagnosis quizzes (39% L/28% P), sign out examples (45% L/28% P), image annotations (27% L/48% P) and references (12% L/28% P). Both groups very frequently (VF) sough info via search engines (30% L, 32% P) and open access web sites not involved in the survey (42% L/36% P). Learners preferred login web sites (24% vs 12% VF) and colleagues (30% vs 16%), while pathologists preferred the primary literature (36% vs 6%) and review articles (24% vs 6%). Offline textbooks (28% vs 21%) and Wikipedia (16% vs 9%) were more VF used by pathologists; however, learners less frequently 'never' used Wikipedia (16% vs 6%). Conclusions: The interest in images suggests that picture-matching is important and images showing variation likely desired. The interest in sign out examples among learners may indicate an increased desire for standardization. The differing importance placed on references and the medical literature may reflect a change in where individuals get information (media vs social media) and the ease of finding information/verification with other sources. PI seekers use a variety of sources. Offline resources remain important; however, learner-pathologist differences suggest that PI is increasingly being sough online and open access resources may be preferred. 545 Background: Patients occasionally request communications with pathologists. Pathologists express discomfort or avoid direct patient interactions, as these are often triggered by negative events. If not handled with sensitivity, transparency and concern for the patient, these may cause greater distress for the patient, and negative outcomes. Design: As part of the institutional communication and resolution program, several pathologists underwent structured communication training. This pilot evaluated comfort and quality of patient-pathologist conversations before and after training. Reports of patient experiences were collected from clinicians who interacted with the patients after the disclosure conversation. Results: There were 5 communication events. 4 generated from erroneous reports, 1 of which led to a delay in diagnosis. 1 was a complex clinico-pathologic event. 2 involved untrained pathologists. 2 (1 before and after) involved the same pathologist. The quality of the conversations, as reported by pathologists and the patients, was better and more comfortable with a pathologist with training/coaching. Both patients who communicated with untrained pathologists expressed dissatisfaction with the communication. One reported the pathologist as insensitive and unsympathetic. Untrained pathologists were apprehensive, felt ill-equipped for the meeting and reported that patients did not appear to understand the complexity of pathologic diagnoses. They did not offer patients the opportunity for follow-up conversations. They were disinclined to participate in additional patient interactions. Patients who interacted with trained/ coached pathologists expressed acceptance (1) and satisfaction for the transparency and quality for communication (1). Trained pathologists expressed greater comfort going into the meeting and navigating the discussion, and offered follow-up opportunities to the patients. They independently followed up with the patient (1) and the clinician (1). Conclusions: Difficult conversations are a necessary part of a physician's life. They are likely to increase in frequency for pathologists, because of greater access to the pathology report for patients, and increasing involvement of the pathologist by the clinician in disclosure conversations. Communication training for pathologists may aid the pathologist in more comfortably and empathetically navigating conversations with patients and result in a more positive experience for the patient and the pathologist. 546 Background: Cytology is a major subspecialty within anatomic pathology, accounting for ~30% of the "practical with images" section of the anatomic pathology board exam. Further, the ACGME requires residents to examine 1,500 cytology specimens by the end of residency. Cytology cases of the week (COWs) were instituted in 2011 in an effort to increase trainee exposure to cytology. Here, we assess the effectiveness of COWs as a teaching tool. Design: Images of 2-5 cases/week with basic clinical information are sent to residents on a weekly basis. Residents have one week to respond by email with diagnoses; after which, correct answers are emailed. Cytology resident in-service examination (RISE) scores were compared between participants in COWs and non-participants from 2011-2015. In addition, an anonymous survey was distributed to trainees using Qualtrics Survey Software to determine how often residents participated in COWs, reasons hindering or promoting participation, and perception of the effectiveness of COWs as a teaching tool. Results: An unpaired two-sided t-test showed residents who participated in COWs scored 15.4% higher on the RISE than residents who participated minimally or not at all (p<0.05) over the 5-year period. Analysis of the years separately showed residents who participated in COWs on average had higher RISE scores than non-participants (6.7-25.2%), and this difference was statistically significant in 3 of 5 years (p<0.05). In 2016, COWs were not sent. An unpaired t-test comparing RISE scores for residents
doi:10.1038/modpathol.2016.247 pmid:28134898 fatcat:m2adrijphzgodl6ac4l7kltidu