320 / 366
Conclusion:
MBC is a rare and aggressive type of invasive breast cancer.
As it encompasses a variety of distinct histopathologic designations, di-
agnostic challenges abound.
E-PS-02-061
Perpendicular inked-margins versus tangential shaved-margins for
assessing margin involvement by breast cancer
T. Nakai
*
, S. Ichihara, T. Uchiyama, K. Morita, H. Itami, K. Hatakeyama,
C. Ohbayashi
*
Nara Medical University, Diagnostic Pathology, Japan
Objective:
Only a few previous studies have compared the two method
of margin assessment, perpendicular inked-margins versus tangential
shaved-margins. The effectiveness of intraoperative margin assessments
using frozen section also remains to be determined.
Method:
This study included 36 wide local excisions of breast carcino-
mas. We changed protocol for margin evaluation from perpendicular
inked margins (Group A,
n
= 18) to tangential shaved margins (Group
B,
n
= 18) during a 1.5 year-period. While the specimens were fixed by
ordinary method in Group A, the specimens were fixed by polygonal
method in Group B. In Group A, margins were classified as positive,
close and negative. In Group B, shaved margins were classified positive
or negative. And in Group B if shaved margin was considered positive,
we reviewed the intraoperative frozen diagnosis.
Results:
The rate of
“
positive
”
margins was significantly higher in Group
B than in Group A: 2 of 18(11 %) versus 8 of 18 (44 %). But when both
“
positive
”
and
“
close
”
were judged as positive in Group A, there was no
significant difference between the two Groups. In Group A, many ventral/
dorsal margin were positive, but they were originally classified as positive
lateral margins, due to flattening of specimen.Among the cases with pos-
itive shaved margin (Group B,
n
= 8), 4 cases had
“
positive
”
and the
remaining 4 cases were
“
negative
”
margins at intraoperative frozen
diagnosis.
Conclusion:
The tangential shaved-margin technique results in a higher
positive rate than perpendicular inked margin technique, suggesting
higher sensitivity for margin involvement by cancer. Intraoperative mar-
gin assessment was not effective.
E-PS-02-063
Triple negative breast cancers: PDL1 expression in neoplastic and
inflammatory cells
H. Sahin
*
, S. Y. Ercetin, U. Ugurlu, B. Gulluoglu, E. Aribal, H. Kaya
*
Marmara University, Dept. of Pathology, Istanbul, Turkey
Objective:
The Programmed cell death protein1/Programmed cell death
protein ligand1 (PD1/PDL1) axis plays an important role on inflamma-
tory response to tumour cells. We investigated PDL1 expression, a po-
tential biomarker for a potential therapeutic strategy, in Triple Negative
Breast Cancer (TNBC).
Method:
PDL1 immunohistochemistry (Clone CAL10, Biocare
Medical) was performed on TNBC cases.Membranous and cytoplasmic
expression were considered and assessed not only in neoplastic cells but
also lymphocytes in the stroma. Groups and cut-off values for PDL1
expression were 0(0 %), 1(1
–
10 %), 2(11
–
49 %), and 3(50 % and above).
Results:
We evaluated PDL1 expression in 49 patients, whose mean age
was 51.9.Diagnosis were ductal carcinoma(
n
= 19),medullary
carcinoma(
n
= 22),metaplastic carcinoma (
n
= 6),and basal like carcino-
ma (
n
= 2).PDL1 expression in neoplastic compartment was 1 % and
above in 51%of patients, however expression in lymphocytic compart-
ment was 1 % and above in 63.2 %. Scores of peritumoural lymphocytic
response were correlated with PDL1 expression in neoplastic cells
(rho = 0.42,
p
< 0.01). There was not statistically significant correlation
between PDL1 expression and other prognostic parameters
(age,diagnosis,histological grade, stage,lymphovascular/perineural
invasion,overall survival).
Conclusion:
Further investigation is needed to understand the role of
PDL1 expression in TNBCs more clearly.
E-PS-03-001
Extramedullary haematopoiesis in a healing myocardial infarct: A
commonly overlooked histopathological feature
S. H. Lai
*
, S. J. Aw
*
Singapore General Hospital, Dept of Anatomical Pathology, Singapore
Objective:
This case report aims to highlight the existence of
extramedullary haematopoiesis in the context of acute myocardial infarc-
tion, and empower pathologists in reporting such findings in myocardial
specimens.
Method:
The patient is a 54 year old Indian male who underwent
left ventricular assist device (LVAD) application due to end stage
ischaemic cardiomyopathy. The left ventricular apex removed dur-
ing the application of the LVAD was sent to the pathology labo-
ratory for evaluation.
Results:
Histologically, the specimen showed features of acute,
recurrent and chronic myocardial ischemia. Areas of coagulative
necrosis were seen, surrounded by granulation tissue and fibrosis.
Contraction band necrosis was also noted. Additionally, multiple
foci of extramedullary haematopoiesis was seen congregating
around the infarcted areas. These cells were confirmed with im-
munohistochemistry (CD61, CD71, CD117, CD34 and
myeloperoxidase), where the main precursors were from the eryth-
rocyte and the myelocyte lineage, with a rare megakaryocyte pre-
cursor noted.
Conclusion:
As the demand for histopathological analysis of myocardial
specimens increases, a pathologist should be well acquainted with com-
monly encountered conditions. EMH is an abnormal process that is most-
ly associated with haematological malignancies when it occurs outside
the liver and the spleen. However, in the context of a recent myocardial
infarction, it is prudent to note its likely benign nature; whereby its pres-
ence is probably due to the attraction of peripheral blood stem cells by the
underlying inflammatory process.
E-PS-03-003
Sudden cardiac death in calcific aortic stenosis
K. Wassilew
*
*
Rigshospitalet, Dept. of Pathology, Copenhagen, Denmark
Objective:
The underlying diseases for sudden cardiac deaths are in non-
forensic cases not well studied, as autopsy rates plateaued at lowest level
since decades. Even if relatives of the deceased agreed on an autopsy, the
underlying pathology is seldomly revealed on postmortem examination.
Aortic stenosis is rarely considered within the differential diagnosis.
Method:
The autopsy databases of two different pathology departments
were searched for sudden death cases which were associated with calcific
aortic stenosis.
Results:
Within a period of 2 years (2015
–
2016) were two cases identi-
fied. In both cases was the heart of the deceased thoroughly investigated
and multiple tissue samples were submitted. Within the tissue samples
which were submitted from the aortic valve annulus were calcific masses
present, which extended to and into the AV-node. Surrounding the calcific
deposits was an in part pronounced inflammatory reaction.
E-PS-03 Cardiovascular Pathology
Virchows Arch
(
2017
)
471
(
Suppl 1
):
S1
–
S352
S306