Wednesday, September 3, 2014

Annual Membership Dues via PayPal is now LIVE!

Dear Hans Popper Hepatopathology Society Members,

We are happy to inform everyone that you may now contribute your annual membership dues via PayPal within the HPHS website.

As you know, we will continue to have dedicated speakers each year, which, of course, requires ongoing funding. We appreciate your attention to our dues notice.

Once again, thank you for your exceptional support of the HPHS.

Grace E. Kim, MD
Secretary –Treasurer,
Hans Popper Hepatopathology Society

Tuesday, August 26, 2014

President's Message August 2014

Dear Friends and Colleagues,

I am delighted to inform you that, thanks to Grace Kim’s hard work and dedication, the Hans Popper Hepatopathology Society is now officially a Non-Profit Organization and has garnered 501(3)(c) tax-exempt status officially recognized by the IRS. Additionally, the HPHS bank account has been set up locally in California. Further details from Grace are found in this newsletter.

The HPHS Companion Society Meeting is scheduled for March 22, 2015 from 8:30am-12noon. The title is “Diagnostic Challenges and Update in Hepatopathology”. We have created a program that will not only be very educational to our members but will hopefully be interesting to non-members as well.

The Business meeting will immediately follow the companion meeting. Members are encouraged to attend as we will need to vote on some modifications to the bylaws as a result of the tax-exempt status of the HPHS, as well as some changes to the duties and responsibilities of the members of the Executive Committee, and finally to officially create a Website Committee. In the meantime, I would like members to volunteer to serve on this committee. Please email me directly (mariaisabel.fiel@mountsinai.org) if you are interested.  In the near future, we will have the ability to check off on-line our interest in committee membership when we pay our yearly dues. Currently, Arief Suriawinata is overseeing the website with the help of Vince Hoang, Grace Kim’s Administrative Assistant. Vince has replaced Julie Gutierrez, who was an invaluable help to Beth Brunt with the membership dues, correspondence, and all other HPHS matters for many years. We thank Julie for all of her efforts throughout the years!

The Call for Abstracts for the “Pathologist-in-Training Award” is now official. Deadline for submission to Dele Odeyi (oyedele.adeyi@uhn.ca), Chair of the Education Committee, is March 6, 2015. Please encourage your residents and fellows to submit their work to the HPHS.

Finally, please encourage both your junior and senior colleagues to officially become members of the HPHS. Residents and fellows can become Trainee members without having to pay any dues. They can easily transition to Regular membership once they finish their training. Application to membership is available on the website. Please email completed application to Maha Guindi (Maha.Guindi@cshs.org), chair of the membership committee.

I hope everyone is having a great summer. I look forward to seeing you in Boston.

M. Isabel Fiel
President,
Hans Popper Hepatopathology Society

Time to support the Hans Popper Hepatopathology Society - Membership dues for 2014-2015 or Donations

The Hans Popper Hepatopathology Society has an EIN (Federal Tax Identification Number for use to identify a business entity) and has become incorporated as:  Hans Popper Hepatopathology Society, Inc.  We are also tax-exempt (501(c)(3)); therefore your membership dues and donations are now tax-deductible. 

Membership categories:

Regular Member:  Any individual who has completed a postdoctoral program in Pathology or another specialty of Medicine, and has earned certification as a specialist in Pathology or another specialty of Medicine, with demonstrated interest and involvement in hepatobiliary pathology.  Dues: $50/year

Associate Member:   Any person holding a doctorate, or doctorate equivalent, degree, who is enrolled in a post-doctoral educational program in Pathology (PhD, post-doctoral fellowship, residency or fellowship) or another specialty of Medicine, and who has demonstrated interest in hepatobiliary pathology.  Dues:  None; limited to five years only.

Corresponding Member:  Any individual who satisfies the requirements for Regular Membership or Associate Membership, but does not reside in the United States or Canada.  No dues.  Corresponding members can apply for regular membership.

Ways you can contribute (membership dues or donations).

1.      Bank Transfer: If you have a Wells Fargo account, you can transfer funds using the following bank information:
a.    Routing #: 121042882
b.    Account #: 8558608389

2.      PayPal: You may now contribute via PalPay using your personal credit card.

Membership Dues - 2014


Donations:

3.     Bank Checks: You can send a check via U.S. mail:  Make checks payable to: Hans Popper Hepatopathology Society, Inc. Include “membership dues” or “general donation” in the memo line of your check. Send checks to:

Grace E. Kim, Secretary-Treasurer
Hans Popper Hepatopathology Society, Inc.
505   Parnassus Avenue M561 Box 0102
San Francisco, CA 94143-0102

When using option 1 and 3, you will receive an electronic receipt from the Hans Popper Hepatopathology Society, Inc. to file your tax deductions.


Monday, August 11, 2014

Interesting Case August 2014


Clinical history

The patient is an 81 year old male with no significant past medical history who presented with abdominal pain, nausea and weight loss of several months duration.

Labs

ALT 15 U/L, AST 55 U/L, ALK PHOS 81 U/L, total bilirubin 0.3 mg/dl. Tumor makers: AFP 1 IU/ml, CEA 2.4 ng/ml CA19-9 55 U/ml, PSA 11.35 ng/ml.

Radiology

CT scan showed four liver masses which measured up to 3.6 cm, a 6.9 cm left kidney mass and an 8.9 cm mesenteric mass. A CT-guided biopsy of the liver mass was performed.

Microscopic images


Figure 1
Figure 2
Figure 3
Figure 4
Figure 5, HMB-45
Figure 6, Melan A
Figure 7, CD10
Figure 8, AE1/AE3
Figure 9, S-100

Diagnosis

Metastatic malignant epithelioid angiomyolipoma.

Discussion

This tumor demonstrates a proliferation of predominantly large epithelioid cells with abundant eosinophilic cytoplasm, vesicular nuclei, and prominent nucleoli (Figure 1). Focal tumor cell spindling is seen (Figure 2). Scattered ganglion-like cells and multinucleated giant cells are present (Figure 3). Mitoses, including atypical mitotic figures, are present (Figure 3 and Figure 4). No necrosis is identified. The tumor cells are positive by immunohistochemistry (IHC) for HMB45 (Figure 5), Melan A (Figure 6), CD10 (Figure 7), MiTF, and CD68; they are negative for cytokeratin AE1/AE3 (Figure 8), S100 (Figure 9), CAM 5.2, CD117, CD34, SMA, desmin, calponin, myogenin, and inhibin.

The differential diagnosis includes, but is not limited to, renal cell carcinoma with sarcomatoid differentiation, adrenal cortical carcinoma, melanoma, malignant GIST, undifferentiated/sarcomatoid carcinoma and malignant epithelioid angiomyolipoma. Combined epithelioid and spindle cell morphology, large ganglion-like cells and multinucleated giant cells are characteristic of epithelioid angiomyolipoma (E-AML). Positive IHC for HMB45, Melan A, MiTF and CD68, together with negative IHC for epithelial markers and S100 help confirm the diagnosis.  However, as we are always taught, “melanoma is the great mimicker” and rarely melanoma can be S-100 negative.

The usual renal angiomyolipoma (AML) is considered a benign mesenchymal tumor composed of a variable portion of fat, smooth muscle cells, and abnormal thick-walled vessels. E-AML is a rare variant and potentially malignant neoplasm composed partially or entirely of epithelioid cells. Up to one-third of E-AML patients experience local recurrences and/or distant metastases. Features that favor malignant E-AML include nuclear atypical in ≥70% of the epithelioid cells, ≥2 mitotic figures per 10 high power fields, atypical mitotic figures, and necrosis; the presence of 3 or all of these features is predictive of aggressive behavior (Brimo F, Robinson B, Guo C et al. Am J Surg Pathol 2010;34:715-722). E-AMLs are immunoreactive for one or more melanocytic markers (e.g., HMB45, Melan A, and MiTF). They often express smooth muscle markers such as SMA and desmin. The absence of S100 staining can help distinguish E-AML from melanoma. The absence of staining for epithelial markers can help distinguish E-AML from carcinoma.

Patient follow up:
Shortly after the diagnosis of malignant E-AML was made in August of 2013, the patient was started on Afinitor 10 mg daily (also called everolimus, an established medication for AML). He had an excellent initial response (CT scan in early 2014 showed significantly reduced size of the mesenteric mass with stable liver and kidney masses). However, the treatment was held several times due to severe side effects including hyponatremia, diarrhea and fevers. Afinitor was re-started in July of 2014 at a very low dose. Currently, one year since diagnosis, the patient is doing reasonable well with no new masses.

Contributed by
Wendy Cao, MD

Wednesday, June 4, 2014

President's Message May 2014

Dear Friends and Colleagues,

It is with great pleasure and honor that I assumed the position of President of the Hans Popper Hepatopathology Society (HPHS) during the United States and Canadian Academy of Pathology (USCAP) Annual Meeting this past March. I took over this position from Matthew Yeh who remains a member of HPHS Executive Committee. We thank Matthew for having ably led the HPHS for the last two years and particularly for having organized two excellent companion meetings at the USCAP. The attendance during these sessions was among the highest in the society’s history. Recruitment of new members also increased during Matthew’s stint as president.

Beth Brunt has stepped down from her position of Secretary-Treasurer, a position she has adeptly held for many years. Beth was instrumental in increasing the society membership and was key in keeping our society in an extremely sound financial state. I would like to express my sincere thanks not only for her past accomplishments and dedication but also for her continued support of the society. Grace Kim has now stepped into Beth’s shoes as our Secretary-Treasurer. She has enthusiastically taken on this challenging task from the get go. Lastly, Michael Torbenson has been elected as Vice President during the USCAP meeting. He will assume the position of HPHS president in 2016.

I expect that 2014 will be a busy one for our society. The HPHS will be participating in the International Academy of Pathology 2014 Congress to be held in Bangkok on October 5-10, 2014. The society was invited through the USCAP’s Bruce Smoller with the help of Beth Brunt and Matthew Yeh. The Scientific Committee of the IAP has requested the HPHS to conduct a two and a half hour seminar on liver pathology on Thursday, October 9.  

The Executive Committee is in the process of applying for a Non-Profit Organization status for the HPHS. Subsequent to this, we will be able to apply for a 5013C tax-exempt status with the IRS. This will enable the members to claim the annual HPHS dues as a tax deduction.

The website is up and running, courtesy of the Newsletter Committee. Details as to how to access the website are found in this newsletter. Cases that are interesting, challenging and have educational value will be regularly posted. The Education Committee, chaired by Oyedele Adeyi, is actively recruiting and encouraging submission of such cases. In addition, applications for membership will be made available in the website. We are working on having the ability to pay member dues via PayPal as well, and for payment to go directly into a secure web server that can be accessed from the website.

The number of liver specimens we all see has steadily declined because fewer biopsies are being performed by clinicians for hepatitis C staging. This is primarily due to the newly approved medications for hepatitis C wherein treatment can be initiated regardless of the stage of fibrosis. However, the role of liver pathology has shifted to evaluating biopsies from patients with metabolic liver diseases and drug-induced liver injury, and other more challenging cases. Additionally, molecular diagnostic modalities are being incorporated into the work up of liver tumors. We will try to continue to disseminate advances in the diagnosis of such entities via the website, newsletter and future companion meetings. The Executive Committee is also planning to propose an increased involvement and greater visibility of liver pathology in the American Association for the Study of Liver Diseases (AASLD). In the next few months, we will reach out to the AASLD Governing Board and the Education Committee to add a new liver pathology session during its Annual Meeting. When these meetings  were held in previous years they were well-attended not just by pathologists but also by clinicians. Having a liver pathology session at national meetings such as the AASLD will increase awareness and further promote liver pathology.

Lastly, I encourage you to advocate for greater membership and foster education and interest amongst your junior hepatopathology colleagues.

Thank you for your continued support of the HPHS. I look forward to seeing you at the Companion Meeting during the USCAP Annual Meeting in Boston on March 22, 2015.

Sincerely,

M. Isabel Fiel, M.D.
President,
Hans Popper Hepatopathology Society

Tuesday, June 3, 2014

Interesting Case May 2014

Clinical History 
This 23 year old woman is status post allogeneic BMT for Fanconi anemia 15 years prior. She was generally doing well, but was lost to follow up at our institution since 5 years ago. She presented to an outside pediatrician with complaint of fatigue, malaise, abdominal pain and pruritus for the past couple of months.

Labs
At the time of presentation her alkaline phosphatase >700 U/L, AST 100-200 U/L, ALT 200-300 U/L and total bilirubin 18-20 mg/dL.

Microscopic Images
Figure 1

Figure 2 

Figure 3

Figure 4

Figure 5

Figure 6
Diagnosis
Chronic graft versus host disease

Discussion
Figure 1 shows a large portal area with several vascular profiles and lack of interlobular bile duct. Figure 2 shows the only bile duct identified on multiple levels. This duct shows features of injury including loss of nuclear polarity and nuclear hyperchromasia.
Figure 3 shows marked canalicular cholestasis.
Figure 4 is the keratin 19 stain confirming a lack of interlobular bile duct and essentially no ductular reaction.
Figures 5 and 6 show portal-portal bridging fibrosis at least.

The paucity of interlobular bile ducts and lack of ductular reaction raises several possibilities. The top of the list in this setting would be chronic graft versus host disease (GVHD). However, advanced fibrosis with chronic GVHD is rarely described. From the available clinical records, this patient has a history of chronic skin and liver GVHD that has responded well to immunosuppression in the past. Furthermore, the patient intermittently electively takes herself off immunosuppressive therapy with resultant flares, as happened in this case.

The differential diagnosis would also include drug/medication induced “vanishing bile duct syndrome”. The lack of a history of drug induced cholestatic hepatitis, the presence of what appears to be well documented chronic cutaneous GVHD, along with prompt symptomatic and laboratory improvement with reestablishment of immunosuppression support chronic liver GVHD. In this age group, the differential diagnosis would also include primary sclerosing cholangitis. Although no cholangiogram was performed, the patient underwent abdominal MRI with and without contrast which showed no evidence of intra- or extrahepatic biliary ductal dilation and she has no history of inflammatory bowel disease.

As the outcomes for BMT patients continue to improve and the duration of patient survival is extended, perhaps we will see more cases of chronic GVHD with advanced fibrosis.

Contributed by
Cynthia D. Guy, MD

Sunday, March 2, 2014

Hans Popper Hepatopathology Society Best Trainee Abstract Award, 2014 USCAP Annual Meeting, San Diego, CA

Hans Popper Hepatopathology Society Best Trainee Abstract Award was presented to Juan Putra, M.D. (PGY-2, Dartmouth-Hitchcock Medical Center, Lebanon, NH).

Abstract title:
Altered Expression of MiR-21, MiR-27b, MiR-10b and MiR-146a in Different Stages of Nonalcoholic Fatty Liver Disease
Putra J, Abreu FB, Burchard P, Toor A, Tsongalis GJ, Suriawinata AA

Juan Putra and the MiR abstract
Award presentation by Dr. Matthew Yeh

Companion Meeting 2014

Hans Popper Hepatopathology Society Companion Meeting
Sunday, March 2, 2014 - 8:30 a.m.
San Diego Convention Center, San Diego, CA, USA

Update on Liver Neoplasms
Moderator: Matthew M. Yeh, University of Washington, Seattle, WA

Hepatocellular adenoma: an Update.
From Molecular Biology to Pathological Diagnosis
Paulette Bioulac-Sage, Bordeaux University, France

Update on the Liver Imaging Reporting and Data System –
What the Pathologist Needs to Know
Claude Sirlin, University of California, San Diego, CA

Mesenchymal Tumors of the Liver:  What's New and Unusual
Linda Ferrell, University of California, San Francisco, CA

Update on Pediatric Liver Tumors
Milton Finegold, Baylor College of Medicine, Houston, Texas

Wednesday, January 15, 2014

Committees 2014

The new slate of Standing Committee members who volunteered and agreed to serve were appointed by the Executive Committee of HPHS last summer: 

Education Committee:
Oyedele Adeyi (Chair), Cynthia Guy, Charles Lassman, Wenqing Cao.

Membership Committee:
Maha Guindi (Chair), Sandra Fischer.

Newsletter Committee:
Arief Suriawinata (Chair), Bita Naini.

The Executive Committee of HPHS sincerely thanks the former Standing Committee members who had contributed their great efforts in the past years.

Friday, January 10, 2014

President's Message January 2014


At the beginning of 2014, I hope everyone has had a nice holiday and New Year.   We had an extremely remarkable and successful meeting at the Companion Meeting in the U.S. and Canadian Academy of Pathology (USCAP) in March, 2013 at the Convention Center in Baltimore, MD.  The theme of our program was focused on the update of liver fibrosis.  At the meeting, excellent talks on the up-to-date research in liver fibrosis, image modalities of fibrosis, and assessment of fibrosis progression and regression in liver biopsy were given by Drs. Alastair Burt, Scott Reeder, and Pierre Bedossa, respectively.  Our clinician guest, Dr. Jay Hoofnagle, shared his clinical insight on the clinical evaluation and the future perspectives of fibrosis in liver disease.  We have received a lot of positive feedback from the audience. 

The pathogenesis of primary liver neoplasms remains complex and the pathological diagnosis may be challenging at times.  There has also been recently developed nomenclature in the imaging reporting of liver cancer.  The theme of our 2014 meeting focuses on update of liver neoplasms.  The meeting will be held at the San Diego Convention Center in Ballroom 3 on Sunday, March 2nd, 2014 from 8:30 am to 12:00 pm.  We will hear about an update of hepatocellular adenoma from the aspect of molecular biology to pathological diagnosis from our pathologist colleague, Dr. Paulette Bioulac-Sage.  We will also hear an update on the liver imaging reporting of liver cancer from our radiologist colleague, Dr. Claude Sirlin.  After the coffee break, a talk about update on unusual malignant mesenchymal tumors will be given by Dr. Linda Ferrell.  Finally, Dr. Milton Finegold will give an update on pediatric liver neoplasms.   We sincerely hope you agree this is an excellent program with outstanding speakers and we look forward to your attending.

Right after the Companion Meeting we will have our business meeting where we will be voting on new officers, including the Vice President and Secretary-Treasurer.  Dr. Isabel Fiel will be stepping up to be President.  I will be moving on to be Past President.  We sincerely thank the current Past President, Dr. David Kleiner for his excellent service during his tenure. 

We are also especially indebted to Dr. Elizabeth Brunt, who has spent tremendous efforts and time, serving as Secretary-Treasurer in the past many years.  Without her, the Hans Popper Hepatopathology Society would not have thrived! It is important for you members to stay for the voting at the Business Meeting.  The Executive Committee welcomes names for the slate of officers after the persons’ consent by February 15. Feel free to send a suggestion to any of the current officers.

I appreciate all of the members for their support of our society.  The dues that you pay to be part of the HPHS help to support non-member guest speakers at our Annual  Meeting and our Annual Prize for best USCAP abstract by a pathologist-in-training.

We welcome and encourage abstracts from pathology trainees for the Best Abstract Award at HPHS again this year. Please send the accepted abstract to Dr. Oyedele Adeyi (email: oyedele.adeyi@uhn.on.ca) by January 25.  If you are not currently a member, but would like to join, applications are available from Dr. Elizabeth Brunt, our current Secretary-Treasurer, who may be reached at ebrunt@path.wustl.edu. And a final reminder, our international members are not assessed the annual membership dues.


Sincerely,
Matthew M. Yeh, M.D., Ph.D.
President,
Hans Popper Hepatopathology Society