96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...
96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...
96. Jahrestagung der Deutschen Gesellschaft für Pathologie e. V ...
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DO-002b<br />
Impact of terminologies in tumor pathology structured reports<br />
G . Haroske 1 , T . Schra<strong>der</strong> 2<br />
1 Dresden-Friedrichstadt General Hospital, Institute of Pathology, Dresden,<br />
2 University of Applied Sciences Brandenburg, Department Informatics and<br />
Media, Brandenburg<br />
Aims. For information exchange and data mining structured reports in<br />
tumor pathology have to be based on controlled vocabulary as to get a<br />
model of meaning. So far there is no universal terminology for the wide<br />
variety of concepts in tumor pathology. SNOMED CT will probably become<br />
a global health terminology standard. National and international<br />
initiatives are necessary to reach a growing agreement on particular<br />
aspects and needs towards it. Interface terminologies are a tool for drawing<br />
existing separate terminology systems to a finally global standard.<br />
Methods. Controlled vocabularies in guidelines of German pathologists<br />
for a series of tumors, in the basic tumor documentation of cancer registries,<br />
and in the HL7 Germany have been mapped to PathLex, an interface<br />
terminology of IHE.<br />
Results. On average a pathology guideline describes 50 terms which have<br />
to be registered as to fulfill the minimum documentation requirements.<br />
PathLex provides between 30 to 40 terms per tumor entity, only 80% of<br />
them are identical with the German guideline vocabulary. The coincidence<br />
of PathLex with HL7 Germany vocabulary or the basic data set<br />
of cancer registries is still lower. In contrast to PathLex there is no separation<br />
between general and organ-specific information in the German<br />
guideline vocabulary.<br />
Conclusions. Although based on internationally agreed un<strong>der</strong>standing,<br />
sharing the same concepts of tumor pathology, the terminology differences<br />
among the different sources are quite obvious. They have to be<br />
overcome as to ascertain a reliable information exchange between different<br />
actors in the care of tumor patients. Terminology mapping is one<br />
solution, but not the optimal one. A closer collaboration with international<br />
terminology bodies as well as a sharpened realization of the impact<br />
of terminology in home made guidelines would contribute to a better<br />
standing of German pathology. A SNOMED membership of Germany<br />
would be very helpful.<br />
AG Dermatopathologie und AG Zytopathologie I –<br />
Endokrine Themen I<br />
FR-001<br />
Unusual HBME1-expression in a hyalinizing trabecular tumor of<br />
the thyroid gland: a case report<br />
D . Lenggenhager1 , E . Marques Maggio1 , B . Bösch2 , A . Elisa2 , M . Rössle1 1UniversityHospital Zurich, Institute of Clinical Pathology, Zürich, Switzerland,<br />
2Stadtspital Triemli, Institute of Pathology, Zürich, Switzerland<br />
Aims. Hyalinizing trabecular tumour (HTT) is a rare thyroid neoplasm<br />
of follicular cell origin with a trabecular growth pattern, marked intratrabecular<br />
hyalinization and nuclear features, which are typically found<br />
in papillary thyroid carcinoma (PTC). The role of HBME1 in the diagnostic<br />
process of PTC has been demonstrated in several studies. We<br />
present a case of HTT with patchy, but abundant, hitherto not reported<br />
membranous and intrabecular HBME1-positivity.<br />
Methods. A 70-year-old woman un<strong>der</strong>went total thyroidectomy because<br />
of cytological diagnosis of PTC. Pathomorphological investigation of the<br />
resected specimen was performed.<br />
Results. Histologically, the typical trabecular architecture of HTT with<br />
elongated tumor cells, markedly hyalinized intratrabecular stroma and<br />
oval shaped nuclei with grooves and inclusions was seen. Immunohistochemically,<br />
tumour cells were diffusely and strongly positive for thyreoglobulin<br />
and TTF1, focally and weekly positive for Galektin3 and<br />
HBME1, but negative for calcitonin, ki67 and CK19. The intertrabecular<br />
hyalinized material was positive for diastase-resistant PAS, Collagen IV,<br />
and HBME1, exhibiting a filiform and stellate staining pattern. Mutational<br />
analysis showed a BRAF wild type.<br />
Conclusions. This case shows that HBME1-positivity may occur in HTT,<br />
and therefore should be interpreted with caution in differentiating HTT<br />
from PTC.<br />
FR-002<br />
Secondary tumours to the thyroid an uncommon but potentially<br />
challenging entity: the experience of a single general hospital<br />
C . Cacchi1 , H . Jähnig1 , G . Schenkirsch2 , M . Füller 3 , H . Arnholdt1 , B . Märkl1 1 2 Klinikum Ausburg Insitute for Pathology, Augsburg, Klinikum Augsburg,<br />
3Klinikum Augsburg, Oncology and Hematology Unit<br />
Aims. Despite its rich vascular supply, thyroid is a very uncommon location<br />
of metastasis. It has been reported that secondary malignancies<br />
representing less of 2% of thyroid tumours; the aim of these study is to<br />
present experience of a single institution focusing on the differential histological<br />
diagnosis.<br />
Methods. A total of 13 (8 male and 5 female patients) cases with metastatic<br />
disease to the thyroid have been retrieved from the archive of our<br />
tumour-registry between 1985 and 2011. All patients have documented<br />
histology for both primary and secondary tumour. Patient age, sex, survival,<br />
outcome were reor<strong>der</strong>ed.<br />
Results. The median age of the patients is 69.8 years, actually 4 patients<br />
are still alive. Among the other patients only four died as consequence<br />
of progression of the primary tumour. The operable cases (9) received<br />
in four cases a simple lobectomy, in five cases a total thyroidectomy. A<br />
primary tumour was identified in 11 cases: of clear cell renal carcinoma<br />
in 6 cases, squamous cell carcinoma in 4 cases (two lung , one larynx<br />
and one oesophagus respectively) and one small cell carcinoma of the<br />
lung . In two cases the patients have had other malignancies (melanoma,<br />
colorectal carcinomas and bile-pancreatic adenocarcinoma). The time<br />
between the diagnosis of primary tumours and metastasis is interestingly<br />
longer in case of renal carcinoma (144 months) respect to an average<br />
value for all cases (77.5 months). Five cases have been studied pre-operative<br />
with a fine needle aspiration (FNA), in two cases this procedure<br />
were diagnostic.<br />
Conclusions. Patients with metastases to the thyroid gland are an uncommon<br />
but clinically pathologically relevant issue, particularly when<br />
the tumor mass is evident as a single nodule (in our experience in 3 of<br />
13 cases); for example a clear cell renal carcinoma could close mimic a<br />
clear cell thyroid adenoma or follicular carcinoma. Moreover, neuroendocrine<br />
tumor can metastasise to the thyroid gland simulating a primary<br />
thyroid tumour (particularly a medullary carcinoma): a rare but<br />
treacherous possibility. To avoid misdiagnosis and to ensure an optimal<br />
follow-up for these patients clinical data and a comprehensive immunohistochemical<br />
panel are mandatory.<br />
Der Pathologe · Supplement 1 · 2012 |<br />
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