Abstracts and Case Studies From the College of American Pathologists 2023 Annual Meeting (CAP23)

and case study poster sessions will be conducted during the 2023 College of American Pathologists Annual Meeting (CAP23), which is scheduled for October 7–10 at the Hyatt Regency Chicago Hotel. The poster sessions will occur in the Riverside Exhibit Hall. Specific dates and times for each poster session are listed below; “poster focus” times are dedicated poster-viewing periods. Also shown before each poster session are the subject areas that will be presented.(Poster No. 1)Jingjing Jiao, MD, PhD (jingjing.jiao@yale.edu); Tong Sun, MD, PhD; Chen Liu, MD, PhD; Mina L. Xu, MD. Department of Pathology, Yale School of Medicine, New Haven, Connnecticut.Context: Significance of prominent lymphoid aggregates (LAs) in the absence of Helicobacter pylori (HP) gastritis in bariatric sleeve gastrectomy (SG) specimens is largely unclear. We conducted the first systematic retrospective study to define their clinicopathologic characteristics.Design: A total of 2558 bariatric SG specimen diagnoses (2011–2022) were reviewed for key descriptors. A total of 118 candidate cases were identified and subjected to slide review. Prevalence was estimated using all 160 SG specimens in 2017. Clinical, demographic, and laboratory parameters were annotated.Results: Estimated prevalence of prominent LA (defined as >25 per 2 sections) was 16.3% (26 of 160). LA negatively correlated with age (r = −0.25, P = .001) but not with BMI (r = 0.136, P = .09). Patients with prominent LA were more likely to be female (100% versus 83.6%; P = .02). After excluding HP gastritis (by immunohistochemistry, breath test, or antibody test), lymphoma and atrophic gastritis, 41 patients remained with LA, not otherwise explained. Compared with HP gastritis patients, they were less likely to demonstrate germinal center (61.0% versus 91.7%; P = .009), with a trend toward autoimmune conditions (17.1% versus 4.0%, P = .24) but with similar LA number, intestinal metaplasia, active gastritis, age, sex, body mass index, and diabetes status (Table).Conclusions: In patients who underwent bariatric surgery, prominent gastric LA was a common phenomenon (16.3%) associated with female sex and younger age. A significant cohort were HP negative (59%) and without evidence of lymphoma, despite striking histologic features. Although there were few patients with autoimmune conditions, the higher prevalence, along with demographic predilection, raised the possibility that HP-negative LAs were associated with immune system dysregulation in obese patients.(Poster No. 2)Nicholas Lao, MSc (nick.r.lao@gmail.com); Tao Wang, MD; Christine Orr, MD. Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada.Context: The Whipple procedure has been widely used in the surgical management of pancreatic, ampullary, periampullary, and biliary cancers. Variations in gross examination have emerged, with some standardized methods showing increased lymph node yield and upstaging. Yet, uptake is still inconsistent and methodologic variation persists. Kingston Health Sciences Centre in Kingston, Canada, recently underwent protocol changes to increase sampling of peripancreatic fat in Whipple procedures. This retrospective analysis aims to assess its effect on nodal yield, positive node yield, and impact on nodal staging.Design: A retrospective analysis of the CoPath database was undertaken for Whipple procedures of adenocarcinoma tumors undertaken 1.5 years prior to protocol implementation and 1.5 years after. The difference in the number of nodes, positive nodes, and nodal staging between new and old protocols was assessed.Results: A total of 26 Whipple procedures for adenocarcinoma were identified, 8 of which encompassed the new protocol and 18 from the old protocol. There were on average 5 more nodes found by the new protocol compared with the old (P = .01), but no difference in staging. Of the 8 new cases, 3 were found to have positive nodes in peripancreatic fat, resulting in an average of 0.5 additional positive nodes found in peripancreatic fat only.Conclusions: Inclusion of peripancreatic fat in Whipple procedures yields an approximate increase of 5 nodes but does not seem to affect positive node yield or staging in our study. We intend to continue our study prospectively to expand our sample size and increase its statistical power.(Poster No. 3)Jingjing Jiao, MD, PhD (jingjing.jiao@yale.edu); Raffaella Morotti, MD. Department of Pathology, Yale School of Medicine, New Haven, Connecticut.Progressive familial intrahepatic cholestasis (PFIC) is a group of autosomal recessive disorders causing a defect in bile secretion, usually presenting as cholestasis during the pediatric years. PFIC types 1, 2, and 3 are caused by mutations in genes ATP8B1, ABCB11, and ABCB4, respectively. PFIC classification keeps evolving with the identification of additional genes by mutational analysis. Here, we report 2 unusual presentations of PFIC. Case 1 involves a male with hepatomegaly since age 2 months with a putative clinical diagnosis of congenital hepatic fibrosis. Liver biopsies at age 8 months (Figure 1.3, A) did not support the diagnosis of congenital hepatic fibrosis because of a lack of typical morphology. He developed gallstones and underwent a cholecystectomy at age 10 years. At age 17 years he presented with pruritus and direct hyperbilirubinemia. Liver biopsy showed progression to cirrhosis, with chronic cholestasis and ductular proliferation (Figure 1.3, B). Whole exome sequencing (WES) identified homozygous splice site mutations in ABCB4 (c.2784-12T>C), supportive of a diagnosis of PFIC-3. Case 2 was a 2-year-old child who presented with cholestasis, pruritis, and jaundice that began after treatment with amoxicillin/clavulanate. Liver biopsy showed a relative paucity of bile ducts (Figure 1.3, C), and rare small, multinucleated hepatocytes (Figure 1.3, D). A drug-induced etiology was considered. After the cessation of medication, her symptoms persisted, and bilirubin levels remained stagnant. WES found a heterozygous frameshift mutation (p.Asp300Trpfs*19) and a heterozygous missense mutation (c.1357T>C) in Myosin 5B (MYO5B), associated with PFIC-6. Our cases highlight the histology in 2 rare subtypes of PFIC and the value of WES in defining the diagnoses.(Poster No. 4)Saba Shafi, MD (saba.shafi@osumc.edu); Wendy L. Frankel, MD; Somashekar G. Krishna, MD; Samuel Han, MD; Peter Lee, MD; George Papachristou, MD; Wei Chen, MD, PhD. Department of Pathology and Laboratory Medicine, the Ohio State and more recently biopsy and biopsy are for the of At our all biopsies and few specimens are as surgical In we our surgical with specimens in a of with to and A identified specimens for of biopsies and cases and specimens by a surgical and a The age was were size was The common on specimens that were as and the cases that and were with the in cases of the cases on the = and a few cases with clinical diagnosis = biopsy a higher and versus and versus P = biopsy is a in and and No. MD, MD, MD, MD, of Pathology, School of Medicine, of Laboratory and and of the and its diagnosis on and The histology classification is a with = We the that A was with a to using 5 on and for = = was using biopsies before and after clinical = (Figure (Figure (Figure C), and (Figure are all from increased with higher = = P of and were = = P and = = P biopsy with in = of = of and = of of for and with and additional not with be developed to and be to biopsy for clinical No. of Pathology and Laboratory Medicine, of Pathology, is by proliferation and of with of from to for biopsies were for clinical or of or because of the for patients with age years a total of biopsies 26 8 and were as or on patients a or for In 18 patients the for and and 1 1 showed in the to per developed in the 2 showed 5 to per in the developed 3 a diagnosis of chronic a diagnosis of emerged, was and of of in the was identified, with of (Table).Conclusions: for be in biopsies in to clinical or for histology with or of in the is identified by a No. MD Wang, MD; MD. Department of Pathology, of adenocarcinoma and of the is a rare autosomal gastric first in and in 10 as of We report a of with a of who presented with gastric without additional in the of the from gastric showed and A total gastrectomy was because of the for gastric the and body with of the was (Figure showed (Figure of with and and 1 of gastric (Figure by (Figure D). We a case of in a was on a of genes associated with and in which no were mutation in of the which is on that not for sequencing of the be for diagnosis in the clinical This and of for of patients, and for their No. Chen, of Pathology, to School of Medicine, of Pathology, to of and The diagnosis of on each all be and for and and is to to support in and We the of a in with the diagnosis of by the by with and without on slide of to and in of The system the at 0.5 0.5 to more diagnoses at the and levels (Figure and 1 from patients and the of and with to the the and the the and of the at the and The identified with at the slide and tumors with in by subtypes of the of that or The system has the to be widely in and patients.(Poster No. MD MD, PhD. Department of Pathology and Laboratory Medicine, of School of and is a in all be to because of its In the cases have been and were in surgical We identified 2 cases of with at our cases were in biopsy from Case 1 was a with a mass and 2 and The biopsy was as showed with (Figure (Figure was in the (Figure and in the hepatocytes and Case 2 in a with no of He presented with a mass and lymph node biopsy showed a prominent in to the (Figure D). He 2 months after diagnosis to and 2 cases to the of occur in a age an was not in the have been as a This is likely to be in clinical No. MD MD; MD; MD; MD; MD; MD; MD. Department of Pathology, There are on the of and We a retrospective study to assess of genes and in and Our database was for patients with and The and clinical were for and were A total of were identified and of patients 5 1 and 1 associated with 3 tumors 3 and 2 There were male and female patients, with a age of years showed of its adenocarcinoma showed showed its adenocarcinoma showed of and The cases showed of in the 3 with no of was and are The common is with Although rare cases showed they were and mutations are not the key that the of in No. MD MD. Department of Pathology and School of Medicine, be a or from the of The is not at additional A using and is used for The of a and for to our has not been for cases of and cases of with were identified of and were on all were reviewed for clinical age at diagnosis was years and of patients were patients were as on of = or = for and are shown in the Of the cases, showed of or and of were and in with the and of which were and and in the of The of an in and the in the was has to and be a additional in cases the diagnosis is not No. MD MD, PhD. Department of Pathology and Laboratory of New gastritis is by in the with associated chronic in the A database was using the key and from to were reviewed in to clinical and biopsy specimens from patients male and 10 were There was a age patients were to and were pediatric to = and disorders = and were the presenting there was and as or gastric body and were the pediatric biopsies more of versus 1 of P = and of versus the patients, difference was not was in 2 pediatric patients developed lymphoid 1 with lymphoma, and 1 increased and pediatric patients were to treatment and gastritis is a rare with and histologic is associated with autoimmune and be in the pediatric are to the for treatment No. MD. Department of Pathology, is the gastric occur in a to for A number of occur with familial and gastric adenocarcinoma and of the and are and similar and are and more to are or We the clinicopathologic of 5 cases of our we identified 5 patients with or and 3 cases of and histologic were 5 patients a of with and no clinical of or of 5 cases and 1 of 5 8 The were 2 to the were to showed the of raised clinical for and (Figure are of all are with of and and no or despite for and but are No. MD. Department of Pathology, are a of the female at the and A of and and similar to occur in the is a which we reviewed from our The database from our center identified HP in female patients clinicopathologic and were Of cases, were at the 1 was the and 2 in the from the from to 2 The of were for or The 2 were and the 5 were with negative were and were to showed or all showed with and with of and (Figure are the of and occur in are for common as or and are and no and are and no or No. MD, Wang, MD, MD, MD, of Pathology, of Pathology, School of at New New biliary and autoimmune are chronic Patients with are as is in a a in in biliary has not been in In cases were 5 5 was as or in in biliary analysis was using and statistical was at P of 5 cases in the biliary of ductular (Figure of the group of or cases of and of of cases (Figure showed in in the group was higher compared with the group (P = and the group (P = the difference between the group and the group was not In the group the group showed significant difference compared with the We found in ductular in cases of be a in of No. MD, PhD MD, PhD. Department of Pathology, are tumors with a of clinical to the but tumors have of and A rare of to adenocarcinoma for and We the clinicopathologic of rare We an retrospective of the histologic and clinical of cases of in from our was using sequencing was using an A total of 26 cases direct the and 1 case nodal was in cases, and cases cases 5 of which showed by in cases with with and 2 with patients with at 1 of patients for 10 and patients 3 years of in is a rare clinicopathologic have for clinical are to its histologic and clinical in with No. Wang, MD, PhD MD; Wendy Liu, MD, PhD. Department of Pathology, is an in pediatric patients, associated with and Here, we an who was but was found to have he presented with and and and along with all of which were to during an for he was found to have and persisted, and an examination and a A biopsy with fibrosis (Figure with (Figure and chronic with (Figure a of and the absence of that he developed autoimmune examination and of the with biopsies showing and increased (Figure with This case the of after an the of symptoms and in pediatric patients, in patients with diagnosis and treatment with a or the progression of which have significant No. MD Department of Pathology, of New is not in Patients usually with and usually or with We are presenting a case of first the clinical and with A with a of diabetes and presented for a were 2 in the showed of on higher there was active the was and with with and (Figure B). immunohistochemistry, was excluding the diagnosis of (Figure was the of was The were positive for (Figure the diagnosis of and were after the the developed and and the of in the a which a The was and on In we to be the first report of positive for in and a No. MD, New of Pathology, of New is a recently found to be in in a for diagnosis and We to the of in and its with at our for were on of as in is analysis was using A total of cases were for analysis. cases were positive for in and 8 cases showed or in of cases positive in was more likely in and with the did not statistical analysis positive in to be a significant for (P = and with (P = .02). in or was not associated with (Figure A in is a for in The of in to in a to the of which No. of Pathology, College of of and and of Medicine, of of Pathology, is the of The is be found and in an without lymph node The of a is a We retrospective for in gastric from to was used to a and the relative and their were were using and analysis was to for the with patients were The between and P = and and P = were for analysis was by 2 from The after analysis did not and still showed a significant of with with no between for P P = = and P P = = Our found that is associated with a of gastric are to associated with in gastric to No. MD, Lee, of and New New tumors are tumors showing and and are in is with cases of in with 2 cases showing and with We the case of a found on to have a mass in the that to during gross a mass was causing and of the the mass was and of with showed increased per and proliferation was between and was negative or the was positive for and and negative for and (Figure a lack of and an unusual were a and the diagnosis of a more in case was the of a Although tumors are tumors with a and have not been in the the of of for be of clinical No. of Pathology, of Health of Pathology, The of MD The system is the common for and The of study is to their clinicopathologic A retrospective for patients with and was in our database from to for a of their clinicopathologic A total of patients with and patients with and were Compared with and were common with conditions, the and and and were common and were the common in with and The were identified in of cases, and was identified in of the cases of showed There was absence of or in and of the cases with and were identified in of the case of showed in the diagnosis (Figure and are rare in the with the and the of their is to No. MD MD; MD, Chen, MD. Department of Pathology and Laboratory Medicine, New of tumors of the on histologic by The is a of which be and our no study has using a in the (Figure We tumors from to from our each we from from by and from by a a and Of the cases to age, were 1, were 2, and 2 were 3 in the In our of cases in a compared with compared with of cases by The for was and for was were significant by (P The was found to be more and more The be an to with more and of each and be No. MD, of Ontario, of Ontario, of Pathology, Ontario, Canada.Context: The of Helicobacter pylori gastritis and cases, is estimated to be less have been for of the of the to or of the from of as the and from There are on we did not the difference between in of and patients with more 1 of were identified, and their sex, age at the of the and of were We identified patients with more 1 case of were female and were male of There was no significant difference between the in the average age of the diagnosis years years average number of times times or average between first and diagnosis years years a higher of Although the of difference is be to protocols after treatment of No. MD, PhD MD; MD. Department of Pathology in of are a rare as or tumors are We a rare case of hepatic in a with a The presented with showed the The in 1.5 which to during the of the showed a with and features. was by positive and for and (Figure showed number in proliferation was The was with of and which was by 1 remained for 2 showed significant A of the showed proliferation increased to but a similar The to in the and the are to the of There are no standardized for because of the of the and its and a are in No. Xu, Liu, MD, PhD. Department of Pathology, Molecular and Medicine, School of at New New are common found in the of who have sex with are associated with types and are without and types are in some We to the of and in in and histologic and in We biopsy and specimens of from between and and were reviewed to the and of and and and in 18 were on A total of cases and were in cases and cases respectively. was in of cases and more of the in of cases (Figure A and B). of and in The positive in the in 10 cases (Figure in are associated with a of and of likely a in its No. MD, PhD MD. Department of Pathology, of intestinal is to be a to gastric but after We report a and gastric biopsies with between and were reviewed versus and were during the study diagnoses of were in patients are in the The common diagnoses were chronic gastritis and Helicobacter pylori gastritis was common in patients (P = was more common in patients (P = was in patients and did not between (P = biopsies no in in and in = diagnoses were similar between the or was was times for for diagnoses (P = but did not by or In our cohort of the patients were and and were the common Although diagnosis did with and did The for or on did not on histologic diagnosis or at No. Chen, MD, PhD MD; MD; MD. Department of Pathology, State Health New is a rare of the to of patients a few and have which is a of diagnosis of a of is the and that of of were negative for and We report a case at our that with A with a of presented with a new mass in the hepatic and underwent because prior biopsy with The mass showing and (Figure B). The were negative for all (Figure C), (Figure and Molecular analysis identified a mutation in on the and the diagnosis of was the 1 after the to In patients with analysis is to the diagnosis of This case to the of of an unusual between the and No. Wang, of Pathology, Health Sciences New of Pathology, New New New of of and have been to and of in cancers. have been to have total and we conducted study to parameters in in with A cohort of patients with was in our study. and were 1 and 3 to months were used to and and status and was used to for age, and clinical A was used to by P was The cohort a age of of (59%) were a diagnosis in clinical 1 and 3 has a significant with = = after for age, and clinical = = was found between and with total is a of and be used as a in with be as a of to to No. MD MD. Department of Pathology, adenocarcinoma in the of the the of the and be first identified on In cases, for staging and an and with We cases of in the of the that were first identified by of biopsies on and for and and we compared with for in a our database cases were found was first identified on biopsies for and were showed mass in all of the cases were because of or in 8 cases or in 3 2 of cases were as to in the Of the cases, were 1 was with and 2 were with Whipple by as to to of patients for is first identified in the the of patients and not for is an of an for No. MD MD. Department of Pathology, hepatic in patients with be to a number of and A rare and etiology is by which as We report the case of a with with and who presented with status and Liver bilirubin and and and hepatomegaly with and no biopsies of the showed of the by of (Figure A and B). The were positive for (Figure C), (Figure and and were negative for and with the Our case the of in the diagnosis of hepatic in patients with in cases by with or no to the is usually to a biopsy is to a No. MD, PhD; MD MD. Department of Pathology and Laboratory Medicine, of College of Medicine, is a with are from or between of and be to We report a case of a who presented with and an mass in the gastric (Figure and hepatic were by of the and of the biopsy with (Figure and (Figure and were positive in the were A clinical no site in of cases of are found in the symptoms are and be or or diagnosis is the there is no staging system for the of body is to with a negative be in cases are at as in our because of symptoms the with the of was with in and showed of No. MD, PhD MD. of Pathology Laboratory Medicine, School of of is a rare caused by mutations in the to a in of patients with with but because of the and with more common of be we report a case of a with who at in a diagnosis of common and clinical and to which identified a of in the of The of the the

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.