Long Course

Sign-out of Medical Liver Disease and Liver Tumor Specimens in the Molecular Era:

Emerging Possibilities

Wednesday, March 27 – 10:00 AM – 3:20 PM

BCC 307

Course Description

Over the past decade there have been significant refinements of the morphologic classification of both benign and malignant liver tumors, partially as a result of better understanding of the underlying molecular alterations of the tumors. Perhaps surprisingly, identification of key allelic variants and other underlying molecular alterations can provide just as valuable information for the diagnosis of a large range of medical liver diseases as well. Integration of various molecular analyses as part of the diagnostic process is becoming a routine part of surgical pathology practice, but there are logistic and economic constraints such that careful case selection is of critical importance. Surgical pathologists are best positioned to identify the circumstances where molecular testing can be valuable for precise diagnosis, and also where it might be helpful for prediction of prognosis and for optimal patient management.

This course will cover a variety of hepatic neoplasms and medical liver diseases where there are opportunities for ancillary molecular testing to produce refinement of the diagnosis and provide clinically relevant prognostic information. For each of the topics addressed, the most up to date morphologic features and criteria used for diagnosis will first be reviewed, and then the potential for additional molecular testing will be covered. Resources regarding the availability and technical requirements for molecular testing will also be discussed. The potential of selected exciting emerging technologies to have clinical impact in the near term future will also be included.

Learning Objectives

  • Recognize the utility of germline testing to identify disease risk alleles for selected medical liver diseases
  • Identify circumstances where molecular testing of benign and malignant liver tumors can be helpful for both diagnosis and patient management decisions
  • Understand the circumstances where molecular testing can supplement immunohistochemistry in the identification of the origin of hepatic metastatic tumors

DIRECTOR

John A. Hart, MD

University of Chicago

Drug Induced Liver Injury in the Era of Molecular Medicine - Lessons for the Surgical Pathologist
Learning Objectives:
  • Recognize the histologic patterns of liver injury that can be utilized to formulate a differential diagnosis for medical liver disease biopsies.
  • Understand how clinical and laboratory data can help narrow the differential diagnosis for medical liver biopsies.
  • Identify situations where pharmacogenetic analysis can provide insight into the diagnosis of drug induced liver injury.
Biography

Dr. John Hart joined the faculty of the University of Chicago Department of Pathology as an assistant professor in 1991, rose to the rank of full professor in 2004, and became Vice Chair for Anatomic Pathology in 2023. He served as chief of the Gastrointestinal and Hepatology Pathology section and director of the fellowship program for more than 20 years. The fellowship has graduated 30 GI pathologists who are now working in leading academic pathology departments throughout the United States and Canada. Dr. Hart has published more than 250 articles in the fields of gastrointestinal and hepatic pathology. He has lectured throughout the United States and in Europe, the Middle East, and Asia. He currently is the Past President and a member of the Board of Directors of the United States and Canadian Academy of Pathology. He is a past president of the Rodger Haggitt Gastrointestinal Pathology Society and is currently the head of the Membership Committee of the Hans Popper Hepatopathology Society.

CO-DIRECTOR

Daniela Allende, MD, MBA

Cleveland Clinic

A Rational Approach to Liver Metastases in the Molecular Era
Learning Objectives:
  • Discuss a morphologic pattern approach to liver metastasis
  • Highlight the most useful ancillary stain panels and stains’ pitfalls
  • Understand the role of molecular testing in the diagnosis and prognosis of metastatic tumors
Biography

Daniela Allende, MD, MBA is an Associate Professor of Pathology and serves as Director of Clinical Affairs for the Pathology Department and Board of Governor for Cleveland Clinic (OH). Before this role, she served as HPB and GI subspecialty director for ~10 years and Vice-Chair of Research for the Pathology and Laboratory Medicine Institute at CCF. She is the Secretary/Treasurer for the Hans Popper Hepatopathology Society, among other leadership positions in major national/international societies in the field of pathology. She contributes to the abstract review committee for the Education Committee at USCAP. She is actively engaged in teaching at all levels nationally and internationally. To date, she has published over 100 peer-reviewed manuscripts, multiple book chapters, and a recently edited book in GI/HPB pathology. She is involved in many federal and industry-sponsored studies in alcoholic and non-alcoholic steatohepatitis.

SPEAKERS

Julien Calderaro, MD, PhD

Henri Mondor University Hospital

Diagnosis of Primary Malignant Liver Cancers in the Era of Molecular Medicine and Artificial Intelligence
Learning Objectives:
  • Recognize the histologic patterns that allow distinction of HCC from ICCA in difficult, borderline cases
  • Understand how the pathological diagnosis impacts the clinical and therapeutic management
  • Identify diagnostic situations where molecular profiling AI can help
Biography
Pr Julien Calderaro is Full Professor in the Department of Pathology of Henri Mondor University Hospital in Créteil, France. He is specialized in the field of liver diseases and tumors diagnosis. His works noticeably led to the establishment of a refined morphomolecular classification of liver cancer. He now focuses his research on the immune micro-environment of liver cancers and develops innovative, artificial-intelligence based approaches to extract meaningful prognostic and molecular data from digital histological slides.

Rondell Graham, MBBS

Mayo Clinic Rochester

How Do I Diagnose Fibrolamellar Carcinoma?
Learning Objectives:
  • Describe the genomic basis of fibrolamellar carcinoma
  • Discuss the work up of cases of suspected fibrolamellar carcinoma
  • Outline an algorithmic approach to diagnosing fibrolamellar carcinoma
Biography

Dr. Graham, originally from Barbados, is a Professor of Laboratory Medicine and Pathology at the Mayo Clinic in Rochester Minnesota. He received his medical degree from the University of the West Indies in Jamaica in 2006 before completing residency and fellowships, at Mayo Clinic,in Molecular Genetic Pathology, Surgical Pathology and GI/Liver Pathology. At the Clinic, Dr. Graham serves as the Executive Vice Chair of Academics and People in the Division of Anatomic Pathology, as well as the Associate Vice Chair of Test Development and the Lead Consultant for Business Development in the Department of Lab Medicine and Pathology. He is a member of the institution’s Academic Appointments and Promotions Committee and the Mayo Clinic Cancer Center Hepatobiliary Disease Group Executive Team.

Dr. Graham is an academic GI/Liver pathologist whose scholarly interests are at the intersection of GI/Liver pathology and molecular genetics. He has authored over 195 peer-reviewed publications along with 27 book chapters and has been a contributor to the WHO Classification of Tumors of the Digestive System and the WHO Classification of Pediatric Tumors. He serves on the Editorial Board of Modern Pathology, is an Associate Editor for Journal of Molecular Diagnostics and reviews for over 2 dozen biomedical journals. He has been invited to give over 100 presentations at academic meetings and visiting professorships at national and international venues. In 2023, he was awarded the Arthur Purdy Stout Society Pathology Annual Prize

Dr. Graham has served the USCAP in several administrative capacities including Abstract Review Committee, Lead Reviewer for the Liver Section, Focus Group on Diversity Equity and Inclusion (2018), the USCAP Membership Committee (2018-2021), Foundation Committee (current) and the CME Subcommittee (current) as well as educational roles such as moderator and course director.

Dr. Graham lives in Rochester, Minnesota with his wife and 3 children. He is an avid soccer fan and loves growing orchids.

Valérie Paradis, MD, PhD

Hôpital Beaujon, Chichy, France

Benign Hepatocellular Nodules: When, Why and How of Molecular Testing?
Learning Objectives
  • Recognize focal nodular hyperplasia, be aware of the atypical forms and clinical context
  • Identify the main molecular subtypes of hepatocellular adenomas
  • Be aware of the main complications of hepatocellular adenomas according to their molecular subtype
Biography

Valérie Paradis, MD PhD and Professor in Pathology, is the chairman of Pathology department (Beaujon hospital, Clichy, FRANCE) and leader of the INSERM team “From inflammation to neoplasia in digestive diseases” (INSERM UMR 1149). Fields of her research include pathological and molecular aspects of chronic liver diseases and tumorigenesis. Her team has developed MALDI imaging for identification of tissue biomarkers, and ex vivo culture model using thin tissue slices & organoids.

She is coordinating a collaborative FHU project MOSAIC aiming to identify imaging signatures “Imagomics” through integration of radiological and histological features and Artificial intelligence and a SIRIC programme InsiTu “Insights into cancer: from inflammation to tumor” merging research and clinical teams mostly devoted to digestive & lung cancers and hematological proliferations. She is member of the Steering committee of Institut Universitaire du Cancer Paris Nord, Medical and administrative manager of the Tumor Biobank Beaujon hospital and French network of liver tumors biobank. She is a member of International groups of liver pathologists, Scientific commissions Research Institutes (INSERM, ANRS) and Conseil National des Universités. V Paradis is involved in teaching activities, chairing Master Degrees and tutoring Master degree and PhD students.She has published more than 500 articles and received international invitations.

Romil Saxena, MD, MBBS, FRCPath

Emory University

Molecular Pathology of the Bile Canaliculus: Small Structure, Big Function
Learning Objectives:
  • Recognize clinico-pathological patterns of liver injury caused by inherited disorders of bile formation.
  • Understand the molecular pathophysiology of inherited disorders of bile formation.
  • Evaluate liver biopsies from cases suspected to be caused by inherited disorders of bile formation.
Biography

Romil Saxena is Professor in the Department of Pathology and Laboratory Medicine, Director of the Liver Pathology Service, and Director of the Gastrointestinal and Liver Pathology Fellowship at Emory University School of Medicine. Dr. Saxena graduated from Grant Medical College and JJ Group of Hospitals in Mumbai, India. She completed fellowships in Liver Pathology at King’s College Hospital, London, Liver Pathology and Gene Therapy at Mount Sinai School of Medicine, NYC and in Gastrointestinal Pathology at Yale University Medical Center. She is a Diplomate of the American Board of Pathology and a Fellow of the Royal College of Pathologists, U.K. She has previously served on the faculty of The Mount Sinai School of Medicine, NYC and Indiana University School of Medicine, Indianapolis. Dr. Saxena has taught several short courses at USCAP, given several invited talks and case presentations for the Hans Popper Hepatopathology Society and the USCAP Evening Specialty conference, respectively, and served as a mentor for the Mentoring Academy of the USCAP. She is the author of over a hundred articles and numerous textbook chapters on liver diseases, including in the 4th and 5th editions of the WHO Classification of Tumors of the Digestive System, and the debut volume on WHO Classification of Pediatric Tumors. She is the editor of Practical Hepatic Pathology: A Diagnostic Approach, a popular textbook on liver pathology published by Elsevier, currently in its second edition. She has served, by invitation, on the WHO working group for classification of liver tumors, and as guest editor for an issue of Seminars in Diagnostic Pathology on Liver tumors.

Heather L. Stevenson-Lerner, MD, PhD, FACP

University of Texas Galveston

Beyond the Microscope - Tips to Take Evaluation of Medical Liver Biopsies to the Next Level and Into the Future
Learning Objectives:
  • Discover new tools that may add value to medical liver biopsy reports.
  • Develop an appreciation for the heterogeneity of individual hepatic microenvironments, paving the way for precision medicine approaches.
  • Learn steps to implement a Liver Diseases Diagnostic Management Team, where complex cases and results can be discussed with trainees and experts.
Biography
Heather Stevenson-Lerner, MD, PhD, FACP, is a tenured professor in the Department of Pathology at the University of Texas Medical Branch (UTMB) where she trained for her combined degree and residency. She completed a fellowship in liver and transplantation pathology at the University of Pittsburgh Medical Center in 2014. At UTMB, she currently serves as the associate director of the Institute for Translational Sciences’ KL2 Scholars program as well as the pathology residency/fellowship program. Since 2016, Dr. Stevenson-Lerner has led UTMB’s Liver Diseases Diagnostic Management Team (DMT), where surgical pathology consults are ordered, reported, and billed in the electronic medical record. Her grant-funded research laboratory is focused on the study of the hepatic microenvironment in liver diseases such as hepatitis C, steatotic liver disease, autoimmune hepatitis, and hepatocellular carcinoma.

Lei Zhao, MD, PhD

Harvard Medical School

Cholangiocarcinoma in the Era of Molecular Medicine - Diagnostic Tools and Therapeutic Opportunities
Learning Objectives:
  • Understand diagnostic and treatment strategies for cholangiocarcinoma.
  • Understand the genetic landscape, the advantage and limitation of molecular analysis for cholangiocarcinoma.
  • Recognize the overlap of genetic alterations in pancreaticobiliary tumors.
Biography
Dr. Lei Zhao is an Associate Pathologist at Brigham and Women’s Hospital and an Assistant Professor at Harvard Medical School since 2017. She has taught and directed many courses for Harvard Medical School, the Harvard/MIT MD-PhD program, Mass General Brigham residency program, and Brigham surgical pathology fellowship program. She has also lectured at the United States and Canadian Academy of Pathology, Harvard Medical School CME courses, and The Brigham Board Review in Gastroenterology and Hepatology. Dr. Zhao has authored over 60 research manuscripts, book chapters and review articles. She is the guest editor for the recent issue of Surgical Pathology Clinics on Liver Pathology.