IAPMD Conference & Scientific Meeting 2014 Programme Book

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CONTENT

IAP President’s Mesage..............................................................1

IAP MALAYSIA President’s Message................................... ..... 3

Organizing Committee Chair’s Message.......... ......................... 4

IAP Malaysian Division Committee Members............................ 5

Organizing Committee............................................................... 6

Programme......................................................... ......................7

Speaker’s Profile & Abstracts...................................................11

Poster Presentations Abstracts................................................24

Acknowledgements..................................................................31

visit www.iapmd.net or scan the QR code below for a

pdf version of the programme book

IAP PRESIDENT’S MESSAGE

I am delighted that the First Meeting of the Malaysian Division of the International Academy of Pathology (IAP) is being held in the charming city of Kuala Lumpur. It represents the first activity of the Division after its establishment by a group of dedicated Malaysian pathologists. This meet-ing ushers an era of a new organization for pathologists in Malaysia with global connections under the umbrella of the International Academy of Pa-thology, and an excellent starting point for more future scientific activities of the Malaysian Division of IAP. The scientific program is dealing with two difficult areas in surgi-cal pathology, namely bone and soft tissue tumors. I am happy that pa-thologists from other Divisions, namely the Arab Division (Prof Fouad Al Dayel, Past President of the Arab Division of IAP), and the Australasian Division, Dr Fiona Maclean are contributing to this meeting along with their Malaysian colleagues.

I expect that this meeting shall expand in the future with guest speakers from more Divisions of IAP as well as Malaysian pathologists and scholars in Malaysia and abroad. Hopefully, this shall advance knowl-edge and education in this rapidly evolving and progressing medical spe-cialty of ours, all for the noble goal of better patient care.

One of the main goals of IAP is reaching out to under-served areas of the world, to help pathologists there in catching up with new con-cepts and advances in pathology. There had been collaboration between IAP and its various Divisions in reaching out to under-served or developing countries in Asia, Africa, Europe, the Middle East, and South America. As judged from the enthusiasm and great interest of the Malaysian patholo-gists who initiated the formation of their Division and organized this meet-ing, I can see that the Malaysian Division of IAP has a great potential of growth, scientific activity, and continuing medical education for its mem-bers. This Division can in the future reach out to neighboring underserved areas and give support in education in pathology.

The IAP Secretariat headed by Prof David Hardwick in Vancou-ver, Canada and the Education Committee of IAP, headed by Prof HK Ng from Hong Kong, had been quite instrumental in promoting and supporting educational activities on a global level. In addition to helping, supporting, and planning for meetings and seminars or workshops in many countries, the Committee had offered many bursaries for pathologists, particularly thosein training, from many countries to enable them to attend IAP interna-tional meetings. At the last IAP International Congress held in Cape Town, South Africa in 2012, a record number of 157 bursaries were offered.

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Similar bursaries shall be offered at our next congress to be held in Bang-kok, Thailand next month on October 5-10, 2014.

I would like to extend my sincere thanks and appreciation to the Malaysian organizers of this meeting including pathologists from various medical schools and other institutions for the tremendous efforts in putting together the needed work and logistics to make this meeting a successful one. Special thanks go to the Secretary of the Malaysian Division of IAP Prof Nor Hayati Othman, and her colleagues, especially Dr Effat Omar and her team, for their relentless and untiring efforts to make this meeting a reality. I like also to thank Dr Norain Karim, Vice President of the Divi-sion, with who I made initial contact with a few years ago, regarding the establishment of the Malaysian Division.

I hope that we all are going to have a successful meeting in Malaysia, a country with great natural beauty, rich cultural heritage, and friendly hospitable people.

Samir S Amr, MDPresident, International Academy of Pathology

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IAP MALAYSIAN DIVISION PRESIDENT’S MESSAGE

Assalamualaikum and greeting of peace to all participants of bone and soft tissue pathology update. This conference is held together with the inaugural annual general meeting of Malaysian Division of Inter-national Academy of Pathology

I am delighted to welcome you to another pathology update seminar in Malaysia. Anatomic pathology is a very dynamic subject and as such we have to keep update with whats new in the subject throughout our carrier as a pathologist. Many of you may have come from faraway places in Malaysia and abroad. I hope you will enjoy the sessions that have been prepared by the organizing committee.

I would like to thank the speakers who have come from Saudi Arabia, Australia and Malaysia. I have to specially mention my apprecia-tion to the president of International Academy of Pathology, Dr Samir Amr who has helped us a great deal in making this session a reality

Enjoy the conference!

Dr Nor Hayati OthmanPresidentInternational Academy of Pathology, Malaysian Division.

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CHAIR OF ORGANIZING COMMITTEE MESSAGE

Warm greetings!

I am pleased to welcome everyone to this inaugural IAP-MD Scientific Meeting, themed “Bone and Soft Tissue Pathology: An Update”.

I hope you will find this three-day event invigorating and stimu-lating. We had planned the occasion so as to provide you with a depth of information on matters pertaining bone and soft tissue pathology. I would like to invite you to set a target on what you wish to achieve in these three days; be it in terms of attainment of new knowledge and best practices, as well as forming fresh collaborations while meeting old and new friends.

My gratitude goes to our esteemed speakers for their gener-ous contribution to the conference. Special thanks to Prof Dr Samir Amr, IAP President for his unwavering support in the formation of IAPMD and launching of the Inaugural meeting.

I would also like to thank all the committee members for their hard work and dedication in making this conference a reality.

Wishing you a great conference!

Best Regards

Dr. Effat OmarChair of the Organising Committee, IAPMD ASM. 24-26 September 2014

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INTERNATIONAL ACADEMY OF PATHOLOGY, MALAYSIAN DIVISION

COMMITTEE MEMBERS

PresidentProf. Dr. Nor Hayati Othman

Universiti Sains Malaysia

Deputy PresidentDato Dr. Norain Karim

Hospital Raja Perempuan Bainun, Ipoh

Secretary IDr. Wan Faiziah

Wan Abdul RahmanUniversiti Sains Malaysia

Secretary IIDr. Effat Omar @ Abd. Rahman

Universiti Teknologi MARA

TreasurerDr. Lee Bang Rom

Universiti Putra Malaysia

MEMBERS

Dr. Arni TalibHospital Kuala Lumpur

Prof. Dr Wong Kum Thong

University of Malaya

Dr. Chan Kai SoonPantai Premier

Laboratory

Prof. Dr Sabariah Abdul Rahman

Universiti Teknologi MARA

Datin Dr. Nik Raihan Nik Mustapha

Hospital Sultanah Bahiyah, Alor Setar

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CONFERENCE ORGANIZING COMMITTEE

CHAIRDr Effat Omar

SECRETARYAssoc Prof Dr. Noor Kaslina

Mohd Kornain

SCIENTIFIC COMMITTEEProf Sabariah Abdul Rahman

Prof Nor Hayati OthmanDato’ Dr. Norain Karim

PUBLICITY AND HOSPITALITY Dr. Nor Salmah BakarDr. Norizal Mohd Noor

Dr. Mohammad Afif Munshi

PARTICIPANTS AFFAIR AND ABSTRACTSDr. Mardiana Abdul Aziz

SECRETARIATNurrein Marlia Omar

Mohd Saiful Nizam OthmanMohd Fazrol Rasol

Muhammad Fa’iz HussinNor Hafizah binti YahyaSari Aspara binti Bakri

Khairil Izwan JamaludinRosilawati Zakaria

Zahana Abdul HamidMohd Izwan Ibrahim

Rohaizat RahmatSharizam Kamarudin

Robiatul Adawiah Ahmad ShahNurul A’in Binti IsmailMohd Erwan Ramli

Mohd Ridzuan Hussin

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PROGRAMME

DAY ONE ( 24 September 2014, Wednesday )

8.30 - 9.00am Registration

9.00 - 9.05am Welcome remarks Dr. Effat Omar

9.05 - 9.55am Non-neoplastic bone and cartilaginous lesions including infections Prof. Dr Samir Amr

9.55 - 10.55am Official launching of IAP-Malaysian Division IAP: The beginnings and its way ahead in global education in pathology Prof. Dr. Samir Amr , IAP President IAP MD Presidential Address Prof. Dr. Nor Hayati Othman Multimedia presentation Commemorative Plaque Presentation

10.55 - 11.10am Coffee Break/Poster viewing/Slide review/Trade exhibition/ Photography session

11.10 - 12.00pm Updates on Osteogenic lesions Prof. Dr Fouad Al Dayel

12.00 - 12.30pm Radiology of bone lesions: A clinical perspective Assoc. Prof. Dr. Wan Faisham Nu’man Wan Ismail

12.30 - 1.00pm Clinicopathological correlation of complex cases Assoc. Prof. Dr. Wan Faisham Nu’man Wan Ismail

1.00 - 2.30pm Lunch/Prayer/ Poster viewing/Slide review/Trade exhibition

2.30 - 3.30pm Updates on cartilaginous lesions Prof. Dr Fouad Al Dayel

3.30 - 4.30pm Slide Seminar 1: Bone and cartilaginous lesions (neoplastic) Prof. Dr Fouad Al Dayel

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PROGRAMME

4.30 – 5.30pm IAP-Malaysian Division Annual General Meeting (Venue: Auditorium 3) All IAP-MD members

5.30 – 7.00pm Induction of new members and Hi-Tea

Presentation of certificates to new members (Auditorium 3) Ethics and Professionalism in Pathology Practice Prof Samir Amr (Auditorium 3) High tea ( Foyer) * All delegates are invited

DAY TWO ( 25 September 2014, Thursday )

8.30 -9.15am Diagnostic approach on bone and cartilaginous tumour Prof. Dr Samir Amr

9.15 - 9.45am Slide Seminar 2: Bone and cartilaginous lesions (non-neoplastic) Prof. Dr Samir Amr

9.45 - 10.15am Radiology of soft tissue lesions: A clinical perspective Prof Dr. Zulmi Wan

10.15 - 10.30am Coffee Break/Poster viewing/Slide review/Trade exhibition

10.30 - 11.30am Pitfalls in diagnosis of bone lesions Prof. Dr Fouad Al Dayel

11.30 - 12.30pm Bone and cartilaginous lesions in children Prof. Dr Fouad Al Dayel

12.30 – 1.00pm Burden of bone and soft tissue tumours in Malaysia Dr Muhammad Anwar Hau

1.00p – 2.30pm Lunch/Prayer/ Poster viewing/Slide review/Trade exhibition

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PROGRAMME

2.30-3.15pm Recent development in the surgical management of bone cancers Prof Dr Zulmi Wan

3.15 - 4.15pm Slide Seminar 3: Bone and soft tissue lesions – Malaysian experience Dr Noraini Mohd Dusa

4.15 - 4.45pm Questions and Answers All speakers

4.45 - 5.30pm Poster presentation and judging

5.30pm Break/ Slide review/Trade exhibition

DAY THREE ( 26 September 2014, Friday )

8.30 - 9.30am Updates on soft tissue tumours : controversies and new entities Dr. Fiona Maclean

9.30 - 10.30am Slide seminar 4: Soft tissue lesions (fibrohystiocytic) Dr. Fiona Maclean

10.30-10.45am Coffee Break/Poster viewing/Slide review/Trade exhibition

10.45- 11.45am Immunohistochemistry and other ancillary tests on soft tissue lesions Dr. Fiona Maclean

11.45 -12.30pm Clinicopathological correlation of complex cases Prof Wan Faisham Nu’man bin Wan Ismail

12.30 – 3.00pm Lunch/Prayer/ Poster viewing/Slide review/Trade exhibition

3.00 – 4.00pm Slide seminar 5: Soft tissue lesions \ (Adipose, endothelial, misc) Dr. Fiona Maclean

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PROGRAMME

4.00 - 5.00pm Slide seminar 6: Soft tissue lesions (continued) Dr. Fiona Maclean

5.00 - 5.30pm Questions and Answers (All Speakers) All speakers

5.30pm Award presentation to poster presenters and \ closing remarks Prof Sabariah Abdul Rahman

END

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SPEAKER’S PROFILE & ABSTRACT

Professor Dr Samir S Amr MD, FCAP President International Academy of Pathology (IAP)

Dr Samir graduated from Faculty of Medicine, Cairo Universi-ty, Cairo, Egypt in 1971. He had his residency training in Anatomic and Clinical Pathology at Temple University Hospital and School of Medicine, Philadelphia, Pennsylvania, USA and o btained certification by the Ameri-can Board of Pathology (Anatomic and Clinical Pathology) in 1978. He returned to Jordan and worked at the Faculty of Medicine and Jordan Uni-versity Hospital, Amman, Jordan, from 1978 till 1986 as Assistant then Associate Professor of Pathology. He then joined Saudi Aramco Medical Services Organization (Dhahran Health Center), Dhahran, Saudi Ara-bia, in 1986 till 2009. He was also appointed as the Chief of Pathology at Dhahran Health Center in 1995 till 2005. He is currently working as Chairman of the Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia

Dr Samir is one of the founding member of the Arab Division of International Academy of Pathology in 1988. He was the President of Arab Division of International Academy of Pathology (IAP) (2003-2005), Vice President for Asia, IAP (1998-2010), President Elect, IAP (2010-2012) and curently the President of IAP (2012-2014).

He had visited many countries as representative of IAP volun-teering to give lectures, presentations and workshops. He also works as Deputy Commissioner for the Middle East, College of American Patholo-gists (CAP) Lab Accreditation Program. He had participated as CAP In-spector or Team Leader in over 80 inspections throughout the Middle East including Saudi Arabia, United Arab Emirates, Kuwait, Jordan, Lebanon, Egypt, and Iraq. In training, he had conducted, organized, or participated in 12 workshops related to CAP accreditation aiming at improving quality in Laboratory Medicine in the region. He also had helped several labs throughout the Middle East in getting on the right track to obtain CAP ac-creditation through visits, advice, and performance of mock inspections.

Apart from the clinical work, he is an author and co-author of over 100 papers in medical peer reviewed journals. Participated in over 110 local and international meetings related to pathology and laboratory medicine with oral or poster presentations. He also had authored seven articles on Arab and Muslim scholars and their contributions to medicine and science and delivered lectures on influence of Arabic and Islamic

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civilization on modern medicine in Greece, Morocco, Saudi Arabia, Italy, and USA. As a past President of History of Pathology Society for 2012-2013, he organized at USCAP meeting in Baltimore in 2013 a session on history of pathology in the Arab World.

Professor Dr. Fouad Al-Dayel MD, FRCPA, FRCPath Professor of Pathology, King Faisal University, Saudi Arabia

Dr Fouad graduated from King Faisal University, Dammam, Saudi Arabia in 1985. He obtained his Fellowship from the Royal College of Pathologists of Australasia (FRCPA) in 1993 and from Royal College of Pathologists, UK (FRCPath) in 2008.He is also an international fellow for the College of American Pathologists He is currently the Chairman for the Department of Pathology and Labo-ratory Medicine, King Faisal Specialist Hospital and Research Centre, Ri-yadh, Saudi Arabia and also a Professor of Pathology in College of Medi-cine, Al Faisal University, Riyadh, Saudi Arabia, He is currently a Consultant Anatomic Pathologist (1995 to present) in the Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre. He was appointed for the Section Head in the Molecular Genetics (2007 – 2010), Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre He is a current corresponding fellow for Saudi Arabia, Royal College of Pathologists of Australasia (2004 – present) and a correspond-ing Member of the Board of Censors, Royal College of Pathologists of Australasia (2005 – present)

He was the previous Chairman of the Arab School of Pathol-ogy and International Academy of Pathology (IAP) Arab Division (2003 – 2008). His subspeciality interest is in Lung Pathology, Bone Pathology, Diagnostic Molecular Oncology of solid tumors, Stem Cell Applications in Clinical and Research (Cell Therapy, Laboratory Accreditation and Qual-ity Management, Total Lab Automation and Cancer Genomic Research (ICGC Project). He currently have published 118 articles in various jour-nals.

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UPDATES ON OSTEOGENIC TUMORSProfessor Dr. Fouad Al Dayel

Department of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Below is the Classification of Osteogenic Tumors as per 2013 WHO Clas-sification of Tumours of Soft Tissue and Bone:• Osteoma• Osteoid osteoma• Osteoblastoma• Low-grade central osteosarcoma• Conventional osteosarcoma• Telangiectatic osteosarcoma• Small cell osteosarcoma• Parosteal osteosarcoma• Periosteal osteosarcoma• High-grade surface osteosarcoma

Osteoid OsteomaCommon tumor with classical presentation of dull plain, worse at night that is relieved by aspirin or other NSAIDs. These tumors arise usually in young adults, commonly in metaphysis and cortical in location. By defini-tion osteoid osteoma should not exceed 1.5-2.0 cm in size.

The characteristic radiological features is dense cortical sclerosis sur-rounding a radiolucent nidus. Histologically, the nidus is recognized as a focus of anastomosing bony molecular rimmed osteoblasts and delicate capillary proliferative in between the trabeculae.

OsteoblastomaIt affects same age group as osteoid osteoma, i.e. young adults, mainly male between 10-20 years of age. However, the anatomic distribution is different. 40-50% of osteoblastoma cases affect the spine and those af-fecting the long bones are usually medullary in location.

The histology of osteoid osteoma and osteoblastoma is somewhat identi-cal.

OsteosarcomasThe WHO has classified osteosarcoma into eight categories:• Conventional• Low grade central• Telangiectatic• Small cell

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• Parosteal• Periosteal• High grade surface• Secondary

Conventional osteosarcoma is the most common subtype arising in long bones of adolescents between 10-14 years and has a second small peak in adults above 40 years of age. The commonest locations are the me-taphysis of distal femur, proximal tibia and proximal humerus.

The diagnostic feature of osteosarcoma is presence of “malignant oste-oid”. Malignant osteoid is identified by cytologically malignant cells produc-ing the osteoid. Identifying osteoid is sometimes challenging. Osteoid is typically dense, eosinophilic and amorphous extracellular material with a “lacy” pattern. However, hyadinized collage or coagulated fibrin can show similar morphology. Currently, there is no histological or immunohisto-chemical stains that can separate osteoid from similar material. Osteo-sarcoma can produce malignant cartilage and fibrous tissue beside the osteoid.

It is important to note that chondrosarcoma is very rare below 20 years of age. So presence of malignant cartilage often represents chondroblastic osteosarcoma rather than chondrosarcoma. Fiobroblastic osteosarcoma can resemble other spindle cells sarcoma. Low grade subtype of fibro-blastic osteosarcoma can be quite challenging. Histologically these tu-mors which are called low-grade central osteosarcoma and can resemble fibrous dysplasia. The most helpful diagnostic feature is invasion of soft tissue on x-ray or pre-existing bone trabeculae on histology.

At molecular level, osteosarcoma is very complex. There is amplification of MDM2, CDK4, TOP2A and MACC1, overexpression of MET and FOD and LOH for chromosomes 39, 13q, 17p and 18q. Studies has shown that the overexpression of MDM2 and MACC1 is associated with poor outcome while TOP2A amplification is associated with good response to therapy. It should be emphasized that molecular testing of osteosarcoma as diagnos-tic, prognostic or predictive markers is not yet a standard practice.

Resected osteosarcoma specimens are assessed for percentage of post chemotherapy necrosis which is an important prognostic factor. More than 90% necrosis is associated with good response to therapy and good long-term survival.

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UPDATES ON CARTILAGINOUS LESIONSProfessor Dr. Fouad Al Dayel


The recent WHO classification in 2013 classify cartilaginous tumors as: 1.Osteochondroma 2. Chondromas: enchondroma, periosteal chondroma 3.Chondromyxoid fibroma 4.Osteochondromyxoma 5.Subungual exostosis and bizarre parosteal osteochondromatous proliferation 6. Synovial chondromatosis 7. Chondroblastoma 8. Chondrosarcoma (grades I-III) including primary and secondary variants and periosteal chondrosarma 9. Mesenchymal chondrosarcoma 10. Clear cell chondrosarcoma

Cartilaginous tumors can be divided based on their differentiation. Tumor that differentiate towards fetal type cartilage such as chondroblastoma and chondromyxoid fibroma and lesions that differentiate toward mature carti-lage. The latter tumors can be divided into surface and medullary lesions and can be benign and malignant tumors.

Chondroblastomas are benign tumors that typically have epiphyseal loca-tion mostly of long bones. Rarely flat bones can be affected. Histologically, the characteristic cell is the chondroblast with oval grooved nuclei in a background of chondroid matrix. A network of pericellular or “chicken-wire” calcification is usually seen. The main differential is clear cell chondro-sarcoma.

Chondromyxoid fibroma is a rare tumor arising in metaphysis of long bones and usually occurs in second or third decade. Histologically, they show lobular growth pattern with a hypocellular center and hypercellular periphery. These lesions should be differentiated from chondroblastic os-teosarcoma.

Osteochondroma is the most common surface benign cartilaginous tumor. It is characterized by osseous component (stalk) with both cortex and me-dulla which both continue into the bone. The cartilage cap which usually decrease with age should measure less than 1.5 cm.

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Chondroma is another common tumor of hyaline cartilage can be central (inner medullary), peripheral (periosteal) or combination. It usually occurs in long bones as small, painless lesions.

If it occurs in small bones of hand and feet, they are usually painful and associated with pathological fracture. Hypercellularity, myxoid change are acceptable histological features in this location.

The histologic subtypes of chondrosarcoma including clear cell, mesen-chymal and dedifferentiated are rare compared to conventional chondro-sarcoma. Accurate diagnosis of these entities is crucial because of their varied clinical presentation and prognosis.

Cartilaginous tumors may harbor specific genetic abnormalities that pro-vide insight into tumorigenesis as well as provide basis for molecular diag-nosis of these tumors. Conventional cytogenetic analysis has shown that enchondromas and low grade central chondrosarcoma are near diploid whereas complex karyotyping occur in higher grade tumors. Studies has shown that cartilage forming tumors harbor heterozygous, somatic IDH mutations (IDH1/IDH2) encoding isocitrate dehydrogenase in both syn-dromic and sporadic enchondromas and central and periosteal chondro-sarcomas.

Additional studies are needed to clarify utility of molecular genetic findings in diagnosis and/or prognosis of cartilaginous tumors.

PITFALLS IN DIAGNOSIS OF BONE LESIONSProfessor Dr. Fouad Al Dayel


There are few osseous and periosseous pseudoneoplastic lesions that can impose diagnostic problem radiologically or histologically or both. Proliferative or reactive bone lesions can have cellular fibro-osseous or chondro-osseous areas that are difficult to separate microscopically from neoplastic bone lesions such as osteosarcoma, chondrosarcoma, giant cell tumor or chondroblastoma.

In this presentation, I will discuss selected osseous lesions that can be mistaken for neoplasms with emphasis on pathological differential diagno-sis. These include fibrous or fibro-osseous proliferations such as fibrous dysplasia. Fibrous dysplasia is considered as non-neoplastic lesion which can be monostotic or polyostotic. Polyostotic lesions affect young children

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below age of 10 years while monostotic lesions affect older children or young adults. The most common location of monostotic fibrous dysplasis is craniofacial bones as well as long bones especially femur and tibia. Pelvic involvement is usually seen in polyostotic type.

The radiological and pathological features of monostotic and polyostotic fibrous dysplasia are similar. The risk of malignant transformation; com-monly to osteosarcoma is extremely low and usually follow history of radia-tion therapy for fibrous dysplasia.

The most common diagnostic pitfall for fibrous dysplasia is low grade cen-tral osteosarcoma. Accurate diagnosis requires correlation of clinical, ra-diological studies and careful histological evaluation.

Fibroinflammatory and reactive-reparative lesions such as giant cell re-parative granuloma and brown tumors are another category that can raise diagnostic confusion with osseous neoplasm. Giant cell reparative granu-loma often involve the mandible and less commonly the bone of hand and feet. Brown tumor associated with hyperparathyroids is indistinguish-able from giant cell reparative granuloma. The clinical presentation such as age distribution, radiological and histological features overlap with the giant cell tumor of bone. However, the lack of epiphyseal involvement, fibroblastic proliferation and irregular distribution of giant cells are helpful features in separating these entities.

It is very important to accurately diagnose giant cell tumor because of its tendency to recur, rarely can develop sarcomatous transformation or metastasize.

Other entity that I will discuss is myositis ossificans. This is benign os-sifying process that is found most commonly in muscles. It can occur in subcutaneous tissue (called penniculitis ossificans). Early stage of this tumor can be confused with extraskeletal osteosarcoma because of high cellularity and immature bone formation. Histologically, it shows zonal pat-tern that reflects cellular maturation.

Related to myositis ossifican is fibro-osseous pseudotumor of the digits (Nora lesion). It affects young adults and unlike myositis ossificans, is more common in females. Histologically, this lesion resemble myositis ossificans with no zonal pattern.

Aneurysmal bone cyst is rapidly growing tumor that can be primary or sec-ondary to pre-existing benign tumor (e.g. chondroblastoma) or malignant tumor (e.g. osteosarcoma). It is common lesion in spine and in long bones and it is metaphysical in location. Telangiectatic variant of osteosarcoma is a differential diagnosis. However, this variant of osteosarcoma is usu-ally high grade malignancy.

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PEDIATRIC SARCOMAProfessor Dr. Fouad Al Dayel


Sarcomas are relatively rare tumors. However, in pediatric age group, sarcomas are more common percentage wise than adults. Sarcomas rep-resent 15% of pediatric malignant tumors and 1% of adult ones. Other major difference between adult and pediatric sarcomas are the subtypes. The most common pediatric sarcomas are rhabdomyosarcoma (RMS), Ewing sarcoma and osteosarcoma. In adults, liposarcomas, pleomorphic and spindle cell sarcomas are the commonest. The third major difference is the genetic abnormalities. Most of pediatric sarcomas show recurrent translocations while adult sarcomas show complex genetic alterations.

It is also common in pediatric age group to have sarcomas arising from epithelial tumors like Wilm’s tumor or pleuropulmonary blastoma. In adult, this is called “carcinosarcoma” but occurs less commonly.

Chromosomal translocations are one of the important features of pedi-atric sarcomas. Most of the diagnostic labs are using break apart FISH techniques to diagnose these translocations. It is important to know that these translocations are not present in 100% of specific tumor type. For example, PAX7-FKHR and PAX3-FKHR translocations are found in about 85% of alveolar RMS. Also, same translocation may present in different types of sarcomas. Typical example is EWSR1 translocation is not limited to Ewing sarcoma but other sarcomas like myxoid chondrosarcoma, clear cell sarcoma, etc. Some of the translocations like Alk rearrangements which are present in inflammatory myofibroblastic tumor are seen in non sarcomatous neoplasms like lymphomas.

Margins of resection has the strongest influence on local control of malig-nancy. In Ewing sarcoma, the children’s oncology group consideres the following margins as adequate (bone margin: 2-5 cm, fascia and intermus-cular: 2mm, muscle and medullary bone: 5mm). If surgical margins are inadequate, postoperative radiotherapy maybe indicated.

Pediatric sarcoma management requires a lot of information on prognos-tic factors. In Ewing sarcomas for example, favorable prognostic factors include less than 10 years of age at presentation, distal extremity involve-ment, size less than 8 cm, nonmetastic tumors and type I EWS-FLI-1 fu-sion. In rhabdomyosarcoma on the other hand, histological subtype is quite important. Embryomal rhabdomyosarcoma (RMS) of botryoid and spindle cell types are considered of favorable histology with superior prog-nosis while embryonal RMS, NOS type is considered favorable histology of intermediate prognosis. Alveolar RMS including the solid variant is con-sidered unfavorable histology with poor prognosis.

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Associate Prof. Dr Wan Faisham Numan, B. Sc . Med (UKM), M.D (UKM), M.MED.Ortho (USM) Consultant Orthopedic Surgeon, Universiti Sains Malaysia

Assoc. Prof Faisham is a faculty in the department of orthope-dics, in school of medical sciences, Universiti Sains Malaysia. He has sub-specilized in musculoskeletal oncology and traumatology. He obtained his medical graduation from the National University of Malaysia in 1994. Sub-sequently completed his post-graduation from Medical School of Universiti Sains Malaysia in year 2000. He joined in USM as a lecturer in orthope-dics. He received his fellowship in Musculoskeletal oncology from St Vincent/ Peter Mc Callum Cancer Center, Melbourne, Australia and Trau-matology from Landesklinikan Saizburg, Austria in 2004. His major inter-est in trauma is extremity vascular injury and pelvic surgery. Dr Faisham published more than 50 research papers in medical journals and 2 text-books related to his field. He is currently an active member of International advisor to Asian Pacific Musculoskeletal Oncology Society and Trauma Fellow of Association of Internal Fixation (AO ASIF).

RADIOLOGY OF BONE LESIONS: A CLINICAL PERSPECTIVEAssociate Prof. Dr Wan Faisham Numan,

Universiti Sains Malaysia

The management of osseous sarcoma has benefited tremendously from orthopaedic surgery, radiological evaluation, bioengineering, chemo and radiotherapy. Limb-sparing surgery for patients with primary malignant sarcomas of the extremities is now well established. Advances in orthopaedic and plastic surgery, radiological evaluation have all contributed to the development of safer and more reliable surgical tech-niques. Simple radiograph is still an important aspect in diagnosis despite advances in radio imaging. Magnetic resonance imaging and computed tomography scans now provide accurate tumor definition and enhance the possibility of achieving safe surgical margins and finally improves survival. However, due to the tumor heterogenecity, the management is always complicated and the results are inadequately optimized. Clinical correla-tion and multidisciplinary approach with radiologist, musculoskeletal pa-thologist and oncologist is the most important before embark on specific treatment

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Dr Mohd Anwar Hau, MBBS (UM), M.MED.Ortho (USM) Consultant Orthopedic Surgeon, Hospital Raja Perempuan Zainab II Kota Baharu, Kelantan

Dr Mohammad Anwar Hau bin Abdullah graduated with MBBS from University of Malaya in 1988. He then was granted the degree of Masters of Medicine ( Orthopaedic) from School of Medical Science, Uni-versiti Sains Malaysia in 1996. He had undergone Clinical and Research Fellowship program in Orthopaedic Oncology at both Massachusetts Gen-eral Hospital and Harvard Medical School, Boston, United States (2000-2001).

He is currently a Senior consultant of Orthopaedic Surgey and Orthopaedic Oncology in Hospital Raja Perempuan Zainab II in Kota Ba-haru, Kelantan. He is also an honorary lecturer for Universiti Sains Malay-sia since 1997. He is also a lecturer and facilitator for the National Institute of Occupation Safety and Health (NIOSH) on impairment disability assess-ment. He is appointed as a trainer and examiner for the Malaysian Ortho-paedic Oncology Fellowship program. He is a member of the Malaysian Orthopaedic Conjoint Board as well as the examiner for the board since 1997. He also contributes as a core member for the National Safe Sur-gery Save Life (SSSL) Initiative, Chairman for the National Wound-Care Management Committee, Council Member for Malaysian Orthopaedic Service, Ministry of Health, as well as core member for the National Ortho-paedic Subspeciality/Fellowship Committee.

He is also appointed as editor for the Malaysian Orthopaedic Journal. His main interest is orthopaedic oncology, wound and diabetic food and Orthopaedic traumatology

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Dr Noraini Mohd Dusa, M.D(UKM), M.Path (UKM) Consultant Pathologist, Hospital Kuala Lumpur,

Dr Noraini Mohd Dusa is a Consultant Pathologist in Histopathology Unit, Department of Pathology, Hospital Kuala Lumpur. She graduated from Universiti Kebangsaan Malaysia in 1992 with Degree of Medicine (MD). She the undergone postgraduate training in the same institution and ob-tained Master of Pathology (Anatomical Pathology) (MPath) , in year 2001. She then was appointed as Senior Clinical Training Fellow in Osteo-articular Pathology, University of Manchester, United Kingdom (2007) as well as Visiting Clinical Fellow in Bone and Soft Tissue Pathology, Royal Orthopaedic Hospital, Birmingham, United Kingdom in the same year.

Her consultative works involved mainly in receiving referral bone and soft tissue cases from KKM Hospitals and some local universities.Apart from being a pathologist, she is also the Quality Manager for Histopathology Unit HKL ( 2008 – 2011) , Technical manager for Histopathology Unit and Head of SCACC Pathology Laboratory & Phlebotomy Unit

She was invited to many soft tissue and bone pathology meeting, as speaker as well as plenary lecturer in The 9th Asia Pacific Musculoskeletal Tumour Society Meeting in Kuala Lumpur.

She is a member for the Academy of Medicine of Malaysia (College of Pathology), Malaysian National Specialist Registry, Postgraduate Society HKL, Malaysian Society of Cytology and IAP Malaysian Division.

She is also are involved with many research projects, mainly collaborative work with Universiti Putra Malaysia (UPM)

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Dr Fiona Maclean, MB, BS (Hons), BAppSc, FRCPA Douglas Hanly Moir Pathology, NSW, Australia

Dr Maclean graduated from Sydney University with first class honours in medicine, after which she pursued a career in Anatomical Pathology. She has interest in genitourinary pathology and musculoskeletal pathology, in particular. Currently, she is employed as a senior consultant histopatholo-gist at Douglass Hanly Moir Pathology in Sydney. She is a Senior Lecturer in Pathology at the School of Medicine, University of Notre Dame and also holds a teaching position with Macquarie University. She is passionate about quality in pathology as such has convened the Urology Module of the Royal College of Australasian Pathologists Quality Assurance Program since 2009. Fiona is the convenor of the soft tissue and bone special interest group of the Australian Division of the Interna-tional Academy of Pathology (IAP) (since 2013). She is the main author of two chapters of the forthcoming edition of Sternberg’s Diagnostic Surgical Pathology (non-neoplastic bone and joint). Fiona was recently involved as a committee member in writing clinical practice guidelines for the manage-ment of adult onset sarcoma for the Cancer Council of Australia. She has been a member of the Australasian Soft Tissue Tumour Registry since 2006. When presenting at conferences she strives to make advances and up-dates in anatomical pathology relevant and interesting to the practising pathologist and trainee pathologists alike.

IMMUNOHISTOCHEMISTY AND OTHER ANCILLARY TESTS IN SOFT TISSUE LESIONS

Dr Fiona MacleanDouglas Hanly Moir Pathology

Diagnosis of soft tissue lesions often offers a challenge to the reporting Anatomical Pathologist. More so than in other organ systems, the judicial use of ancillary tests including appropriate immunoperoxidase stains and molecular methods (most often FISH and PCR) is frequently essential. These tests need to be selected to confirm or exclude particular differential diagnoses on the basis of the histological appearance. A seemingly vast array of such tests are available, but all with added cost to the laboratory and/or patient. Thus, tests need to be selected with care, to minimise cost whilst providing the most reliable diagnostic adjuncts.

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In this lecture discussion regarding the more recently available immuno-peroxidase stains and molecular tests will be made, including benefits and pitfalls. Practical tips will be given to help use the armamentarium avail-able in an efficient and cost effective manner.

UPDATE ON SOFT TISSUE TUMOURS: CONTROVERSIES AND NEW ENTITIES

Dr Fiona MacleanDouglas Hanly Moir Pathology

The updated WHO Classification of Tumour of Soft Tissue and Bone (2013) has delivered new entities in the field, reclassified and expanded some old entities, introduced ‘hybrid’ tumours and heralded concept changes. Reflecting the enhanced genetic understanding that has developed since publication of the last edition, as well as changing concepts of sarcoma-genesis, the genetic components of the volume are markedly increased. With this increased knowledge there has also been controversy, with some entities not readily accepted by all, and the advent of challenging concepts of genetic ‘promiscuity’.

This lecture will catalogue the new entities incorporated in the 2013 WHO and those that have been established since its publication (many of which are presented in the slide seminars). A discussion will be made regarding the impact of genetics at the coal face of Anatomical Pathology. There will additionally be discussion regarding advances and controversies in grading.

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POSTER PRESENTATION ABSTRACT

P1FINE-NEEDLE ASPIRATION OF THE THYROID GLAND IN HOSPITAL TUANKU FAUZIAH, KANGAR: A CYTO-HISTOLOGIC CORRELATION

STUDY (2011-2013).

Noorasmaliza Md Paiman1,2, Faizah Othman1, 1Pathology Department, Hospital Tuanku Fauziah, Kangar

2CRC Perlis, Hospital Tuanku Fauziah, Kangar.

Introduction: Fine needle aspiration cytology (FNAC) is a well-established tech-nique for pre-operative investigation of thyroid nodule(s). It is minimally invasive, reliable, and cost effective and is said to have a high sensitivity, specificity and overall accuracy. The aim of the study is to assess the accuracy of FNAC of the thyroid and critically evaluate the cytohistological discordant cases. Methodology: This retrospective study was conducted in the Cytology and Histopathology Unit, Hos-pital Tuanku Fauziah, Kangar. A total of 80 cytological and histological reports were retrieved for patients with thyroid nodules who underwent thyroid FNAC between January 2011 and December 2013, with subsequent surgical thyroid resection. The concordance between cytological and histological diagnosis was determined. Re-sult: Total of 80 FNAC samples obtained, 23 (28.8%) samples were considered cyto-logical inadequate/unsatisfactory in which 18 of them were non neoplastic (22.5%), 2 follicular adenomas and 3 papillary carcinomas. Overall cytohistological discordance in all categories was 10.5% (6 cases). Of the discordance cases, False positive was 2 (3.5%) and False negative for 4 cases (7.0%). FNAC of thyroid for prediction of malignancy/neoplasm; True positive was 13 cases (22.8%), False positive was 2 cases (3.5%), True negative was 35 cases (61.4%) and False negative was 4 cases (7.0%). Its sensitivity was 76.5%, the specificity was 94.6%, and the accuracy was 88.9%. The positive predictive value was 86.7% and negative predictive value was 89.7%. Conclusion: FNAC is a safe diagnostic method for defining thyroid disease, but inadequate sampling, false positive and negative diagnoses are the major limita-tion of thyroid FNAC. Essential to success of FNAC is an experienced and competent pathologist who is well-trained and prepared to give opinion. Correlation with other modalities which are clinical examination and imaging investigation as well as ad-equate sampling is still highly importance to reach the accurate diagnosis.

P2PROXIMAL TYPE EPITHELIOID SARCOMA OF THE RIGHT AXILLARY

TAIL: A DIFFICULT DIAGNOSIS IN AN UNUSUAL LOCATION

Marlina Tanty Ramli 1, Raja Rizal Azman Raja Aman2, Wong Kum Thong2

1Medical Imaging Unit, Faculty of Medicine Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Jalan Hospital,Sg Buloh 2Department of Biomedical Imag-

ing, University Malaya Research Imaging Centre (UMRIC).University Malaya Medi-cal Centre, Kuala Lumpur.

INTRODUCTION: Epithelioid sarcoma (ES) is a rare malignant soft tissue sarcoma (STS), accounting for 1% of all STS.Classically, it occurs in the distal extremities of young adults, A more rare and aggressive ‘‘proximal’’ or ‘‘large cell’’ type of ES was

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irst described as a distinct subtype in 1997. Clinically, the proximal-type differs from the classic-type ES by the occurrence in older age group and the origin in the deep soft-tissue at a proximal/axial location.To the best of our knowledge, there has been no previous report of proximal-type ES occurring in the breast. We present a case of proximal-type ES of the right axillary tail. CASE HISTORY: A 32 year old lady was referred to our centre with a month history of a right axillary tail mass. The mass occured at the site of prior excisions of fibroadenoma and a giant phyllodes tumour. Clinically, there was a fixed large tender nodular mass occupying the right axillary tail extending to the right axilla. The skin overlying the mass was shiny and erythema-tous with no ulceration. CT showed a large lobulated mass with central necrosis and minimal peripheral enhancement in the right axillary region measuring 9.6 (W) x 10.3 (AP) x 14.4(HT) cm. This mass was seen to infiltrate the right pectoralis minor muscle. In the lungs, there were multiple nodules bilaterally and right pleural effu-sion. Biopsy revealed a multinodular, infiltrative intradermal and subcutaneous tissue composed of an admixture of mitotically active plump, non-keratinising eosinophilic epithelioid cells and moderately pleomorphic, elongated spindle cells. The two cell types merged imperceptibly with one another. Many of the tumour nodules showed central degeneration and small foci of necrosis. There was widespread vascular inva-sion. These features are suggestive of epithelioid sarcoma

P3ADULT INTRAMUSCULAR ANGIOMYOLIPOMA OF THE

SHOULDER: A RARE CASE

B Nor Salmah1, KJ Obaid2, MA Yahya2, A Ramzi2, MT Ramli3, MK Shukry3, Khariah MN3

1Discipline of Pathology, Faculty of Medicine, UiTM, 2Discipline of General Surgery, Faculty of Medicine, UiTM, 3Discipline of Radiology, Faculty of Medicine, UiTM

Intramuscular angiomyolipomas of the shoulder are very rare. We report a case in a 22-year-old male with a well circumscribed lesion located on the back of the shoul-der. This lesion, differs from renal angiomyolipoma in terms of non-association with tuberous sclerosis, circumscription and male predominance. Another characteristic feature is the absence of epithelioid cells. Clinically, differential diagnosis includes lipoma, angiolipoma, angioleiomyoma, hemangioma, myolipoma and liposarcoma. It is distinguished from the above mentioned entities by the presence of a combination of thick-walled blood vessels, smooth muscle, and fat by microscopic examination of the lesion.

P4IMMUNOHISTOCHEMICAL STUDY OF ER, PR, C-ERBB2 AND ENDOCAN PROTEIN EXPRESSIONS IN OVARIAN NEOPLASM

Maryam Entezarian, Chandramaya Sabrina Florence, Geok Chin Tan, Noraidah Masir

Department of Pathology, Universiti Kebangsaan Malaysia, Malaysia

INTRODUCTION: Ovarian cancer is the fourth most common cancer in Malaysia. The usage of immunohistochemical staining has been proposed for the prognosti-cation in different types of ovarian tumours. Endocan is highly upregulated by pro-angiogenic molecules such as VEGF and fibroblast growth factor that are mediators involve in angiogenesis and cancer progression. The aim of this study was to assess

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the expression of four biomarkers including Estrogen receptor (ER), Progesterone receptor (PR), C-erbB2 and Endocan in ovarian tumours. METHODS : This was a cross sectional study conducted on 234 tissue samples of ovarian tumours for a pe-riod of 10 years. Samples were collected from all patients who were diagnosed with ovarian tumour based on universal sampling method. Tissue samples were prepared and stained using the immunohistochemistry (IHC) method. RESULTS: Mean age of the patients was 46±16 years. Most of the subjects were Malay (68%) followed by Chinese (23%), Indian (3%) and other ethnicities (6%). Amongst the tumours, 114 (49%) were benign, 37 (19%) were borderline and 83 (32%) were malignant. Most of the tumours were serous (50%) followed by mucinous (40%). ER and PR were positive in benign (42%, 56% respectively), borderline (24% and 50% respectively) and malignant tumours (77% and 76% respectively) while C-erbB2 was only posi-tive in borderline (18%) and malignant tumours (6%) and Endocan was positive in benign (14%) and in borderline (38%) in malignant tumours (90%). There was a sig-nificant difference between borderline and malignant tumors in Endocan (p<0.001).DISCUSSION : This is the first study that shows an increasing trend of Endocan expression from benign to malignant ovarian tumours. Therefore, Endocan could be considered as an adjunct in distinguishing borderline from malignant and benign ovarian tumours.

P5BILATERAL GLUTEAL DYSTROPHIC CALCIFICATION: A CASE REPORT

MFM Miswan1, KN Rozali1, MF Sikkandar1, AR Hussin2, S Thangaraju2 1Discipline of Orthopedics, Faculty of Medicine, MARA Univesity of Technology,

Sungai Buloh Campus, Selangor, Malaysia2Department of Orthopedic & Traumatol-ogy, Hospital Sungai Buloh, Selangor, Malaysia

BACKGROUND: Soft tissue tumours are common. There is a wide range from small lumps, self limiting and benign condition to large masses, aggressive and invasive tumors. Deposition of calcium in injured, damaged or necrotic tissue is not uncom-mon in human. The body will reacts physiologically to this injury by evoking the ge-neric inflammatory response reaction. It can be classified into three major categories: metastatic calcification, dystrophic calcification and calcinosis. CASE REPORT: We report a case of 46 years old gentleman with progressive swelling of bilateral gluteal region for couple of years. Unfortunately, he denied of any previous history of signifi-cant trauma and there was no background of tumour in family. He only presented to us when the swelling become very painful which cause him limited in movement and patient has to depend on wheelchair for ambulation. Clinical examination revealed multiple bony lumps on bilateral gluteal region varying in size, hard, immobile and tender. Blood investigation did not point towards malignancy. Radiographic investiga-tion revealed multiple ossifications mass distributed in gluteal area which is not com-municate to bony structure. MRI showed subcutaneous calcification involving fascia of gluteus maximus muscle bilaterally. Intra-operatively, the mass located within the gluteal fascia and very well capsulated. The calcification lumps was surgically re-moved without any complication. HPE reported as extensive calcification of fascia, muscular and adipose stroma with fibrosis and hyalinization. Patient was discharged well and symptom free after that.CONCLUSION : Dystrophic calcification may vary in pathology. Even though it is not rare with prevalence of 95%, proper investigation must be done to exclude more sinister causes.

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P6MALIGNANT APPEARANCE OF BENIGN CHONDROBLASTOMA

Khariah MN1, MT Ramli 1, George J2, Looi LM3, Vivek Ajit Singh4

1 Discipline of Radiology, Faculty of Medicine UiTM, 2 Diepartment of Radiology, Faculty of Medicine UM,3 Department of Pathology, Faculty of Medicine UM,

4 Department of Orthopedic Surgery, Faculty of Medicine, UM,

Chondroblastoma is a disease of the young that characteristically arises from the epiphysis of a long bone and is a rare benign cartilaginous tumour. Benign chondro-blastoma is cartilage containing giant cell tumour with a peak age incidence in the second decade of life (10-26 years) before cessation of enchondral bone growth. Histopathologically, it consists of a polyhedral chondroblast with multinucleated giant cells and nodules of pink amorphous material, which derived from primitive cartilage cells. A linear deposition of calcification is one of the most characteristic findings in histological examination creating a chicken-wire pattern.To date, there are few cases reported in the literature of radiological aggressive lesion that turn out to be histologically benign cases of chondroblastoma. These aggressive appearances is often a cause of confusion and misdiagnoses. Locally aggressive chondroblastoma is considered by some authors to be malignant transformation of chondroblastoma eventhough there is no evidence of distant metastasis. In this report, we illustrate a case of a 16-year-old boy with a recurrent benign chondroblastoma of the right humeral head, which demonstrated radiologically aggressive features, suggestive of malignant transformation. He underwent surgical curettage twice. However, on both occasion histopathology reports were consistent with a benign chondroblastoma.

P7INFECTIOUS AGENTS IN SKIN BIOPSIES: A REVIEW OF

ORGANISMS AND THEIR HISTOMORPHOLOGICAL DIAGNOSIS

Effat Omar, Sabariah Abdul Rahman, Mardiana Abdul Aziz, M. Kannan KuttyCore of Drug Development and Health, Universiti Teknologi MARA, Shah Alam

Campus, Shah Alam, Selangor,Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh Campus, Sg Buloh, Selangor

INTRODUCTION:Microorganisms in skin biopsy are rarely seen. Our centre receives skin biopsy specimens from an infectious disease centre, where many patients with human immunodeficiency virus infection and patients with inflammatory skin condi-tions are diagnosed and treated. It is important to recognize and diagnose these infections so that the patients can be treated. OBJECTIVE: To study the type of microorganism prevalent in the skin samples and capture the histomorphological characteristics for reference. Method: All skin biopsy specimens from mid 2013 to mid 2014 were retrieved and reviewed. The cases with infectious etiology was in-cluded in the study. RESULT: A total of 22 cases with infectious etiology was found. Six of the cases (27%) were leprosy, with the majority belonging to lepromatous type. All showed presence of acid fast bacilli in macrophages on Ziehl-Neelsen and Wade Fite stains. Four other cases show granulomaotus inflammation favouring tuberculo-sis; four cases with peniciliosis, two with histoplasmosis, and one each with syphilis (spirochetes demonstrable on Warthin Starry stain), Herpes (immunohisto chemistry.

27


positive) and cytomegalovirus infections. Three of the biopsies show necrotizing granulomas, but no microorganisms can be demonstrated. CONCLUSIONS: Atten-tiveness to histomorphological characteristics of infectious organisms in skin biop-sies is paramount in the identification of these microorganisms

P8LOOSE BODY IN A YOUNG KNEE – A CASE REPORT

MFM Miswan1, FM Effendi1, MI Ibrahim1, NAMA Rahman2, AR Hussin2, S Thangaraju2

1Faculty of Medicine, University of Technology MARA, Sungai Buloh, Malaysia, 2Hospital Sungai Buloh, Sungai Buloh, Malaysia

BACKGROUND: A painful knee joint following the trivial injury is very troublesome and annoying. It is more curious if it occur in young age and all possible non-invasive investigations could only reveal near normal pictures. However we couldn’t deny the necessity of invasive but less aggressive procedure to further investigate the primary cause. CASE REPORT: We report a case of a small body built sixteen year old girl with complaint of left knee limited range of motion associated with pain for 1 year duration. The problem started when she fell from her classroom table. Her knee hit directly on the floor in flexed position. Even though in severe pain, she was able to walk at the time and did not seek proper medical attention. Subsequently she noted that she had progressive pain on popliteal fossa area especially on full extension of the left knee. Examination during her 1st presentation showed left knee ACL laxity grade 1 with reduced range of motion with extension lag of 10 degrees. She under-went physiotherapy for 2 months in which her pain and knee motion did not improve. MRI of the left knee showed an intrasubstance ACL tear with intact meniscus. Diag-nostic arthroscopy was performed and noted a loose body 1.5 cm x 1.0 cm medial to the popliteus which grossly resemble cartilage. The surrounding synovium appeared inflamed however the ACL and the menisci were intact. The loose body was removed and debridement of the inflamed synovium was performed. Histopathological exami-nation revealed that the loose body was in fact chondromatoses. Postoperatively the patient regained full range of motion. CONCLUSION: The case highlights the fact that the mechanical block although commonly caused by meniscus injury, can also be due to loose body which was not detected by radiograph or MRI of the knee.

P9IMPACT OF 2013 REVISED ASCO/CAP GUIDELINES TO REPORTING

OF HER-2 IMMUNOHISTOCHEMISTRY – A SINGLE INSTITUTION REVIEW

Mardiana Abdul Aziz, Nor Salmah Bakar, Noor Kaslina Mohd Kornain, Norizal Mohd. Noor

Department of Anatomic Pathology, Universiti Teknologi MARA, Sungai Buloh.

INTRODUCTION:Human Epidermal Growth Factor Receptor 2 (HER2) gene is am-plified/over-expressed in approximately 15-20% of breast cancers. Tumours showing amplification of the HER2 gene respond to transtuzumab, which had previously been shown to offer progression-free survival and overall survival benefit with or after

28


adjuvant chemotherapy. HER2 amplification status is primarily determined via immu-nohistochemistry. The ASCO/CAP guidelines recently reverted to the original cut-off point of 10% diffuse and intense circumferential membrane staining from the previ-ous 30% cut-off. This review aims to identify the number of HER2 positive cases by immunohistochemistry and review whether the change in the cut-off value impacts on reporting of the breast cancer cases in our institution.METHODS:All invasive breast cancer cases (core biopsies and resection) material received in Department of Ana-tomic Pathology UiTM Sungai Buloh campus for the period of January – June 2014 are selected (n=35). Only invasive carcinoma cases which have hormone receptors and HER2 status determined are included (n=30). RESULTS:The specimens com-prise core biopsies (n=23), resections (n=5) and skin biopsies (n=2). Tumours are of Grade 2 (n=13) and Grade 3 (n=17). The HER2 immunohistochemistry results are as follows: negative (n=12), equivocal (n=3) and positive (n=15). The positive cases exhibit diffuse and intense circumferential staining in approximately 40% (n=1), 70% (n=1), 80-90% (n=2) and >90% (n=11) of tumour cells. Therefore, there is no change in HER2 amplification status using either criteria.CONCLUSION:Recent revision of the HER2 reporting guidelines does not impact reporting of HER2 amplification sta-tus in our institution. However, the HER2 positive rate in our institution is higher than reported in the literature (50% vs 15-20%). A detailed review is required to assess trend of HER2 overexpression in breast cancers in our institution.

P10TISSUE MICROARRAY ANALYSIS OF CELLULAR SENESCENCE

BIOMARKER IN THE ASSESSMENT OF BREAST CANCER PROGRESSION

R Pare1, 2, JS Shin1- 3, I Dissanayake1,3, NVA Abeyratne1,3, A Abubakar1- 3, CS Lee1-6

1University of Western Sydney, Sydney, Australia, 2Ingham Institute for Applied Medical Research, Sydney, Australia, 3Liverpool Hospital, Sydney South West

Pathology Service, Sydney, Australia, 4Royal Prince Alfred Hospital, Sydney South West Area Pathology Service, Sydney, Australia, 5Cancer Pathology, Bosch Insti-tute, University of Sydney, Sydney, Australia, 6South West Sydney Clinical School,

University of New South Wales, Sydney, Australia

Breast cancer is a hormonally driven age-related disease in women. Cellular senes-cence is an age-related irreversible cell cycle arrest at the G1 phase upon intrinsic or extrinsic induction. This study was conducted to assess and characterize the ex-pression of epithelial senescence marker of p16 during breast cancer progression in a large cohort. We conducted an 11 years retrospective study of invasive ductal carcinoma cases from six provinces in the South Sydney West. A total of 1080 breast cancer patients were included. We constructed tissue microarray blocks consist of two cores of each normal, benign, premalignant and malignant feature and manually performed immunohistochemical staining. Covariates such as age, tumour size, lym-phovascular and nodal involvement, tumour grade, stage, ER, PR and HER2 status were obtained. This study showed increase strong nuclear immunoreactivity as the tissue progress and slightly fall in the malignant (5.0%, 11.3%, 25.7%, and 23.4%). There were significant correlation of normal, benign, premalignant and malignant features (p<0.0001). P16 expression was significantly correlated with tumour grade,

29


ER and PR but not with other parameters. Strong expression of p16 associated with poor survival and increase risk of relapse. Multivariate analysis did not showed p16 as the significant factor. P16 expression can be detected in the early development of breast cancer progression. These finding suggest p16 may play important role in the progression to invasive breast cancer. Hence p16 expression may be useful as a prognostic factor.

P11BENIGN CYSTIC TERATOMA MIMICKING A LOCULATED PLEURAL

EFFUSION: A CASE REPORT

M Muhammad Afif1, Nor Salmah B1, Mardiana AA1,AI ismail2, NY Esa2, M.R Adli Azam3,MohdShukry MK4

1Pathology Discipline, Faculty of Medicine, UiTM, Sg. Buloh, Malaysia.2Respiratory Unit, Department of Internal Medicine, Faculty of Medicine, UiTM, Sg. Buloh,

Malaysia.3Cardiovascular and Thoracic Surgery, Surgical Science Cluster, Faculty of Medicine, UiTM, Sg. Buloh, Malaysia.4Medical Imaging Unit, Faculty of Medicine,

UiTM, Sg. Buloh, Malaysia.

Teratomas of anterior mediastinum are rare tumours and are often asymptomatic, slow growing and detected incidentally on chest imaging. This case report looks into an unusual case of a benign cystic teratoma seen as a loculated pleural effusion on CT thorax. Case presentation: A 41-year-old Indonesian man presented to the respi-ratory clinic due to 1 year history of cough, intermittent fever, weight loss and reduced appetite. Respiratory examination revealed right sided pleural effusion. A contrast CT scan of the thorax showed a well-defined homogenous anterior right mediastinal mass with adjacent lung collapse as well as loculated pleural effusion with passive lung collapse posteriorly. He underwent exploration thoracotomy which revealed a cystic mass measuring 10cm x 8cm x 3 cm.The excised specimen showed a dis-torted cut open fibro-fatty cyst wall measuring 95x80mm and 65x55mm. The wall thickness ranged from 2mm to 15mm. The internal surface bore multiple cream nod-ules with the largest measuring 20x13x10mm. Microscopic examination of the initial sections revealed fibrous cyst wall, largely lined by stratified squamous epithelium. In areas, the stratified squamous epithelium merged into cuboidal cell epithelium. The cream nodules were made up of smaller cyst containing keratin flakes. Subsequent additional tissue sampling showed the presence of columnar epithelium reminiscent of respiratory-type epithelium, gastrointestinal tract lining and cuboidal epithelium thrown into papillary structures reminiscent of choroid plexus. There were also mus-cularized vessels and occasional bundles of smooth muscle seen in the intervening stroma. Overall features confirmed a benign cystic teratoma with no evidence of malignancy. Discussion: This case represents an unusual presentation of cystic tera-toma. It also illustrates the importance of additional tissue sampling for diagnostic confirmation.

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ACKNOWLEDGEMENT

Sponsors :

We also would like to express our gratitude to :

Faculty of Medicine UiTMLibrary Faculty of Medicine UiTM

Anatomic Pathology, CPDRL, Faculty of Medicine UiTMPolis Bantuan, Faculty of Medicine UiTM

Bahagian Pengurusan Fasiliti, UiTM

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