who classification of tumours of haematopoietic and ... · pdf filetumours of haematopoietic...
Post on 09-Mar-2018
218 Views
Preview:
TRANSCRIPT
QML PathoLogy NewsLetter // Issue 4, 2012 // Page 1
INSIDE THIS ISSUE:> WHOclassificationof
TumoursofHaematopoieticandLymphoidTissues byDrDebraNorris
> ManagementofWomen withAbnormalCytology byDrJasonStone
Issue 4, 2012
The guiding principle introduced in the REAL classification (1994)2 and 2001 WHO Classification (3rd edition)3 remains; that is, entities are defined by a combination of clinical, morphology, immunophenotype and genotype.
Thelongawaitedupdateofthe2001WHOlymphomaclassificationwasreleasedin2008¹. Thisclassificationbuildsonthe2001WHOclassificationandremainsacollaborativeeffortbetweentheAmericanandEuropeanhaematopathologysocieties,clinicaladvisorycommitteesandmorethan130authorsfrommorethan22countries.
WANT TO rEcEIvE THIS NEWSlETTEr vIA EmAIl INSTEAD? plEASE SEND yOUr DETAIlS TO INfO@qml.cOm.AU Or pHONE (07) 3121 4506.
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues(4th Edition) - Lymphoma Classification in the Third Millennium
Dr Debra Norris FRCPA
QML PathoLogy NewsLetter // Issue 4, 2012 // Page 2
TheguidingprincipleintroducedintheREALclassification(1994)²and2001WHOClassification(3rdedition)³remains;thatis,entitiesaredefinedbyacombinationofclinical,morphology,immunophenotypeandgenotype.Therelevantimportanceofthesefeaturesdiffersbetweendifferentdiseaseentitiesandnoone‘goldstandard’isrecognised.
Advancesandclarificationofdiseaseentitiesisincluded.Minorterminologychangesareseen,reflectingadvancementinknowledge,e.g.,hepatosplenicT-celllymphoma,whilstpredominantlyofgammadeltaphenotypemayoccasionallybealphabeta.SystemicALCLisseparatedintoALK+andALK-becauseofprognosticdifferences.TwostudieshaveshownatendencyforALCL,ALK-todiffergenetically(intermsofchromosomelossesorgains)fromALK+andPTCLNOS,althoughoverlappingfeaturesmaybefound¹.
Changesthatreaderswillnoteinclude:
• Theintroductionofprovisionalborderlinecategories; incorporationofrareprimarycutaneousT-cell lymphomaprovisionalentitiestakenfromthe WHO-EORTCconsensusclassificationforcutaneous lymphoma(released2005)4
• Therecognitionofsmallclonallymphoidpopulations, suchasMonoclonalB-celllymphocytosis,paediatric follicularhyperplasiawithmonoclonalB-cells
• Identificationofdiseasescharacterisedbyinvolvement ofspecificanatomicsites(e.g.,PrimaryDLBCLofthe CNS),orbyotherclinicalfeaturessuchasage(e.g., EBV+DLBCLoftheelderly;paediatricnodalmarginal zonelymphoma1,5)orclinicalscenario(e.g.,DLBCL associatedwithchronicinflammation).
Thereremainunresolvedissues,andtheclassificationwillalwaysbeaworkinprogress,e.g.,predictorsofprognosisinFL,DLBCLandperipheralT-celllymphomas5.SeparationofDLBCLintoGCBversusABCtypesbygeneexpressionprofilesclearlyhasprognosticimportance6.This,asyet,doesnotdirecttherapy.Norcanthisseparationbereliablyreproducedbycurrentroutinemorphology,immunophenotypeandcytogeneticanalysis;assuch,thissub typinghasnotbeenincorporatedinthecurrentclassificationforeverydayuse5.
Low Grade B-Cell Lymphomas: TheupdatedclassificationincludesentitiestoemphasisethatamongthelowgradeB-celllymphomastherearebothagerelatedandsiterelateddifferences.Inaddition,aninsitulesionofFLhasbeenrecognised¹.
Bothpaediatricfollicularandpaediatricmarginalzonelymphomashavebeenincludedasprovisionalentities,whichtendtobelocalisedandhaveanexcellentprognosis.PaediatricFLtypicallylacksBCL2expressionandthet(14;18)(q32;q21)isabsent.Similarly,prognosisofpaediatricnodalMZLisexcellentwithlowrelapserateandlongsurvivalafterconservativetreatment¹.
PrimaryintestinalFLtypicallyoccursintheduodenum;mostpatientshavelocaliseddisease(stageIEorIIE)andsurvival appearsexcellent,evenwithouttreatment.ItwouldappearthatintestinalhomingreceptorsretaintheclonalB-cellswithintheintestinalmucosa¹.
Primarycutaneousfolliclecentrelymphomaisadistinctlymphomaofneoplasticfolliclecentrecells,occurringontheheadortrunk.ThisrepresentsthemostcommontypeofcutaneousB-celllymphomaandisdistinctfromnodalfollicularlymphoma.Irrespectiveofgrowthpattern,thediseasehasanexcellentprognosiswithfiveyearsurvivalover95%.Cutaneousrelapses,seeninapproximately30%ofpatientsdonotindicateprogressivedisease1, 4.
Gradingoffollicularlymphomahasalsobeenaddressed.ItisacknowledgedintheupdatedclassificationthatGrade1andGrade2FLhavesimilaroutcome,arenotaffectedbyaggressivetherapy,andarenotdiagnosticallyreproducible;assuch,the2008classificationplacesthesecaseswithfewcentroblastsas‘FLGrade1-2(lowgrade)’.StratifyingGrade3FLisnowmandatory,withFLGrade3BmorecloselyrelatedtoDLBCLonthemolecularlevel.AlsoemphasisedisthatANYareaofDLBCLinanyFL,receivesaseparatediagnosisofDLBCL,i.e.,thereisnosuchthingasFLGrade3Awithdiffuseareas¹.
Provisional Borderline Categories:B-cell lymphoma unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma
Overthelast20yearstherehasbeenacknowledgementofthemorphologicandimmunophenotypicoverlapbetweenCHLandsomecasesofDLBCL(usuallyprimarymediastinallargeB-celllymphomaPMBL,andmediastinalnodularsclerosissubtypeofclassicalHodgkinlymphomaNSCHL). Inthemajorityofcases,aspecificdiagnosiswillbeabletobemade.However,therewillbecases,typicallyinvolvingyoungmaleswithmediastinaldisease,whereboththemorphologyandimmunophenotypeexhibittransitionalfeaturesbetweenCHLandPMCL,e.g.,CD45+,preservationofB-cellprogram, togetherwithHodgkinmarkersCD30andCD15.InothercasesthatmorphologicallyfavourPMBL,theabsenceofCD20,expressionofCD15orEBV,wouldalsofavourthisdiagnosis.AcloserelationshipbetweenCHLandPMBLhasbeenshownbygeneexpressionprofiling,butgenomicstudiesof‘greyzone’or‘borderline’lymphomasareawaited.TheselymphomasgenerallyhaveamoreaggressiveclinicalcourseandpooreroutcomethaneitherPMBLorCHL.Thereisnoconsensusonoptimaltherapy¹.
B-cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma SomeoftheselymphomaswerepreviouslyclassifiedasBurkitt-likelymphomaoratypicalBurkitts.Thisterminologyhasbeenremoved.ThecasesinthiscategorymayhavemorphologicalfeaturesintermediatebetweenBLandDLBCL,andconsistentBLimmunophenotype;morphologicallybemoretypicalofBLbutatypicalimmunophenotype;orgeneticfeaturesthatprecludeadiagnosisofBL.CaseswhicharemorphologicallytypicalofDLBCLwithahighproliferativeindexdoNOTbelonginthiscategory;otherwisetypicalBLwithoutdemonstrableMYCrearrangementwithcharacteristicimmunophenotypearenotinthiscategory.
Manyofthelymphomasinthiscategorywillbe‘doublehit’lymphomas,i.e.,carrytranslocationsofbothMYCandBCL2.Geneprofilestudiesof‘doublehit’caseshaveshownthatsomeofthesecaseshaveaprofileintermediatebetweenDLBCLandBL,whereasothersaremoresimilartoBL.OtherwisetypicalDLBCLwithaMYCrearrangementarenotincludedinthiscategory.Conversely,lymphomaswithanIG-MYCrearrangementasthesoleabnormalitylikelyrepresentBLevenifmorphologicallyatypical.Theselymphomasareaggressive,withfrequentBM,PBandCNSinvolvement,andresistanttocurrenttherapies¹.
continuedpage4>
QML PathoLogy NewsLetter // Issue 4, 2012 // PAGE3
Table 1: WHO Classification of the Mature B-cell, T-cell, and NK-cell Neoplasms (2008)
MATURE B-CELL NEOPLASMS MATURE T-CELL AND NK-CELL NEOPLASMS
Chroniclymphocyticleukaemia/smalllymphocyticlymphoma T-cellprolymphocyticleukaemia
B-cellprolymphocyticleukaemia T-celllargegranularlymphocyticleukaemia
Splenicmarginalzonelymphoma ChroniclymphoproliferativedisorderofNKcells*
Hairycellleukaemia AggressiveNKcellleukaemia
Spleniclymphoma/leukaemia,unclassifiable* SystemicEBV+T-celllymphoproliferativediseaseofchildhood
SplenicdiffuseredpulpsmallB-celllymphoma* Hydroavacciniforme-likelymphoma
Hairycellleukaemia-variant* AdultT-cellleukaemia/lymphoma
Lymphoplasmacyticlymphoma ExtranodalNK/T-celllymphoma,nasaltype
Waldenströmmacroglobulinemia Enteropathy-associatedT-celllymphoma
Heavychaindiseases HepatosplenicT-celllymphoma
Alphaheavychaindisease Subcutaneouspanniculitis-likeT-celllymphoma
Gammaheavychaindisease Mycosisfungoides
Muheavychaindisease Sézarysyndrome
Plasmacellmyeloma PrimarycutaneousCD30+T-celllymphoproliferativedisorders
Solitaryplasmacytomaofbone Lymphomatoidpapulosis
Extraosseousplasmacytoma Primarycutaneousanaplasticlargecelllymphoma
Extranodalmarginalzonelymphomaofmucosa-associatedlymphoidtissue(MALTlymphoma) Primarycutaneousgamma-deltaT-celllymphoma
Nodalmarginalzonelymphoma PrimarycutaneousCD8+aggressiveepidermotropic cytotoxicT-celllymphoma*
Paediatricnodalmarginalzonelymphoma* PrimarycutaneousCD4+small/mediumT-celllymphoma*
Follicularlymphoma PeripheralT-celllymphoma,NOS
Paediatricfollicularlymphoma* AngioimmunoblasticT-celllymphoma
Primarycutaneousfolliclecentrelymphoma Anaplasticlargecelllymphoma,ALK+
Mantlecelllymphoma Anaplasticlargecelllymphoma,ALK-*
DiffuselargeB-celllymphoma(DLBCL),NOS HODGKIN LYMPHOMA T-cell/histiocyterichlargeB-celllymphoma Nodularlymphocyte-predominantHodgkinlymphoma
PrimaryDLBCLoftheCNS ClassicalHodgkinlymphoma
PrimarycutaneousDLBCL,legtype NodularsclerosisclassicalHodgkinlymphoma
EBV+DLBCLoftheelderly* Lymphocyte-richclassicalHodgkinlymphoma
DLBCLassociatedwithchronicinflammation MixedcellularityclassicalHodgkinlymphoma
Lymphomatoidgranulomatosis Lymphocyte-depletedclassicalHodgkinlymphoma
Primarymediastinal(thymic)largeB-celllymphoma pOST TrANSplANTATION lympHOprOlIfErATIvE DISOrDErS (pTlD) IntravascularlargeB-celllymphoma
ALK+largeB-celllymphoma Earlylesions
Plasmablasticlymphoma Plasmacytichyperplasia
LargeB-celllymphomaarisinginHHV8-associatedmulticentric Castlemandisease Infectiousmononucleosis-likePTLD
Primaryeffusionlymphoma PolymorphicPTLD
Burkittlymphoma MonomorphicPTLD(B-andT/NK-celltypes)†
B-celllymphoma,unclassifiable,withfeaturesintermediatebetweendiffuselargeB-celllymphomaandBurkittlymphoma ClassicalHodgkinlymphomatypePTLD†
B-celllymphoma,unclassifiable,withfeaturesintermediatebetweendiffuselargeB-celllymphomaandclassicalHodgkinlymphoma
* Provisional entities for which the WHO Working Group felt there was insufficient evidence to recognise as distinct diseases at this time.† These lesions are classified according to the leukaemia or lymphoma to which they correspond.
Source: Jaffe ES, Harris HL, Stein H, Isaacson PG. Classification of lymphoid neoplasms: the microscope as a tool for disease discovery. Blood. 2008; 112:4384-4399.
QML PathoLogy NewsLetter // Issue 4, 2012 // Page 4
References:1. SwerdlowSH,CampoE,HarrisNL,etal.WHOClassificationofTumoursof
HaematopoieticandLymphoidTissues(4thEd).Lyon,France:InternationalAgencyforResearchonCancer,2008.
2. HarrisNL,JaffeES,SteinH,etal.ArevisedEuropean-Americanclassificationoflymphoidneoplasms:aproposalfromtheInternationalLymphomaStudyGroup.Blood.1994;84:1361-1392.
3. JaffeES,HarrisNL,SteinH,VardimanJ.PathologyandGeneticsofTumoursofHaematopoieticandLymphoidTissues.Lyon,France:IARCPress;2001.
4. WillemzeR,JaffeES,BurgG,etal.WHO-EORTCclassificationforcutaneouslymphomas.Blood.2005;105:3768-3785.
5. JaffeES,HarrisHL,SteinH,IsaacsonPG.Classificationoflymphoidneoplasms:themicroscopeasatoolfordiseasediscovery.Blood.2008;112:4384-4399.
6. AlizadehAA,EisenMB,DavisRE,etal.DistincttypesofdiffuselargeB-celllymphomasidentifiedbygeneexpressionprofiling.Nature.2000;403:503-511.
EBV-positive DLBCL of the Elderly: EBV+clonalB-cellproliferationoccurringinpatients >50yearswithoutknownimmunodeficiencyorpriorlymphoma.Definedentities,suchasplasmablasticlymphoma,lymphomatoidgranulomatosisorDLBCLassociatedwithchronicinflammation;primaryeffusionlymphoma,areexcluded.InAsiancountriesthisconstitutes8-10%ofDLBCL.DataforWesterncountriesislargelyunknown.Approximately70%ofpatientswillpresentwithextranodaldisease.TheclinicalcourseisaggressiveandmediansurvivalapproximatelytwoyearsandnotpredictedbyIPIscore¹.
EBV-positive T-cell Lymphoproliferative Disorders of Childhood: Twonewentitiesareincludedintheupdatedclassification,reflectingtwomajortypesofEBVassociatedT-celllymphoproliferativedisordersreportedinthepaediatricagegroup.Bothshowgeographicdifferences,occurringwithincreasedfrequencyinAsians,NativeAmericansfromCentralandSouthAmericaandMexico.Hydroavacciniforme-likelymphomaisacutaneouslymphomawithanindolentclinicalcourse,butwithprogressionovermanyyears.SystemicEBV+T-celllymphoproliferativediseaseofchildhoodhasafulminantclinicalcourse,sharingoverlappingclinicalfeatureswithaggressiveNK-cellleukemia.ItmaybeassociatedwithchronicactiveEBVinfectionoroccurshortlyafterprimaryacuteEBVinfection.TheassociationwithprimaryEBVinfectionandtheracialpredispositionstronglysuggestageneticdefectinhostimmuneresponsetoEBV¹.
Conclusion: Theupdated2008lymphomaclassificationbuildsonthe2001classification,benefitingcliniciansinvolvedinpatientcare,pathologistsresponsiblefordiagnosisandresearchersalike5. Weareindeedindebtedtothedrivingforceoftheprincipleauthors ofthistextandclassification.
GraduatingfromtheUniversityofQueensland(MBBSHons)(1984),DrNorristrainedinhistopathologyattheMaterandPrincessAlexandraHospitals,beforeobtainingafellowshipinpathologyin1994.ShethentookupapositionasStaffHistopathologistattheMaterHospitalbeforejoiningQMLPathologyinOctober2002asaConsultantHistopathologistattheCentralLaboratory.In1997,DrNorrisundertookafellowshipinhaematopathologywithworldrenownedauthorityDrNancyHarrisatMassachusettsGeneralHospital.
DrNorrisareasofexpertiseareparticularlyinlymphoma(bothnodalandextranodalincludingcutaneous),gastrointestinalpathologyanddermatopathology.Intheseareas,shelectureswidelyandreceivesconsultations.
Phone: (07) 3121 4429 Email: Debbie.Norris@qml.com.au
Dr Debra Norris frcpA
Medical director and Pathologist in charge: histology
Pathologist Profile
Cutaneous CD30+ Lymphoproliferative Disorder showing the morphologic overlap between Lymphomatoid Papulosis and Cutaneous Anaplastic Large Cell Lymphoma.
QML PathoLogy NewsLetter // Issue 4, 2012 // PAGE5
Education wrap up for 2012
Throughouttheyear,QMLPathologyhasbeenveryactiveinthefieldofContinuingEducation.QMLPathologyhashostedahighstandardofeducationtothemedicalcommunityinmetro,ruralandremoteareasacrossQueenslandandNewSouthWales.
Sinceitsinceptionin1992,QMLPathology’sContinuingEducationprogramhasreliedontheexpertiseofourleadingmedicalspecialistsandexpertpathologiststopresentthemostcurrentandrelevantdevelopmentstothemedicalcommunity.
Over2000medicalpractitionersthroughoutQueenslandandNewSouthWaleshaveparticipatedinaccreditedeventshostedbyQMLPathologyin2012.Ourprogramshavereceivedrecognitionfromthemedicalcommunity,aswellasgoverningbodies,fordeliveringtopicalandvariededucationforGeneralPractitioners(GPs),PracticeNursesandSpecialists,aswellasfulfillingaccreditationcriteriaforrespectivecolleges.
QMLPathologywouldliketothankourvaluedpresentersandparticipantsfortheirinvolvementthroughouttheyear.WewouldalsoliketothankoureventpartnersBDDiagnostics,Lilly,BoehringerIngelheimandSanofiDiabetesfortheirpartnershipandassistancein2012.
Toimproveourdeliveryofeducation,weareconstantlyevaluatingouractivities.Ifyouhaveanyfeedbackto assistusinthis,pleasedonothesitatetocontactusat QMLPathologyMarketingore-maildirectly jo.wilsonfarr@qml.com.au.
clINIcAl AUDIT UpDATESWelcometotheendofanotherbusyyearforourClinicalAudits.AsweareapproachingtheendoftheGPRACGPTriennium(December2013),GPsareremindedofourCat1activitiesavailabletoallmedicalpractitioners.ToregisterforanyofourongoingAudits,pleasecontactyourlocalMedicalLiaisonOfficerorQMLPathologyMarketing.
SURGICAL SKIN AUDITDiagnosticAccuracy(wheretheprovisionaldiagnosismadebythereferringdoctorequalledthehistologicaldiagnosisforcomparison)hasremainedataveryhighstandardandsomeverypleasingresultsoverallisevident.
CYTOLOGY PAP SMEAR AUDITOnceagainwehaveverypleasingresultsforthePapSmearAudit.Manycliniciansarecontinuingtotakeparteachmonthoncecompletingtheiraudit.GraphicalstatisticsandpositiveHPVnumbershavebeengreatlybeneficial,accordingtofeedbackreceived.
Thankyoutoallparticipants,welookforwardtoanotherbusyyearin2013fortheendoftheGPTriennium.
QML PathoLogy NewsLetter // Issue 4, 2012 // Page 6
Management of Women with Abnormal Cytology Dr Jason Stone, Cytopathologist
ThecurrentmanagementofwomenwithabnormalcervicalcytologyisbasedontheNHMRCapprovedguidelines2005.Alothasdevelopedsincethe2005guidelinesincludingourincreasedunderstandingofHPVbiology,theintroductionoftheHPVvaccine,roleofHPVtestingandtheincreaseduptakeofliquid-basedcytology.
Thisguidanceiscurrentlyunderreview(the‘NationalCervicalScreeningProgramRenewal’).ThereviewwillensurethatallAustralianwomenhaveaccesstoascreeningprogrambased onthelatestevidenceandbestpractice.ThefirstmeetingsoftheRenewalwereinNovember2011andtheprocessisexpectedto becompletedbymid2014.
Thisisasummaryofthecurrentmanagementguidelines.
Low-grade squamous abnormalitiesThiscategoryincorporatesthesubgroupsofCIN1,HPVinfectionandatypicalsquamouschangesthatfallshortofCIN1.Theriskfordiseaseprogressionisthesameforallofthesesubgroupshenceallaremanagedthesame.
MostofthesefindingsareduetoatransientHPVinfectionwhichislikelytospontaneouslyregresswithin8to16months.TheaimoftheguidelinesaretodetectthesmallproportionwhichdonotregressandgoontobecomepersistentHPVinfection,whilstsimultaneouslynotovertreatingthevastmajoritynotneedinganymedicalintervention.
Women with a smear report of low-grade squamous abnormality should have a repeat smear at 12 months.
If the repeat smear at 12 months again shows low-grade squamous abnormality, the woman should be referred for colposcopy.
If the 12 month repeat smear is normal, the woman should have a further smear in 12 months, i.e., 24 months after the index smear. If this second repeat is normal, she can return to the routine screening interval.
Fluctuatinglow-gradesquamousabnormalities mayindicatepersistentHPVinfection,hencethe nextmanagementguideline:
Referral for colposcopy should be considered for a woman with fluctuating low-grade squamous reports, i.e., two in a three year timeframe, regardless of intervening normal cytology reports.
Mostwomenover30haveclearedtheirHPVinfection. Thisagegroupalsohasahigherincidenceofsquamouscervicalcarcinoma.Thereforeanindexsmearreportoflow-gradesquamousabnormality,especiallywithoutthereassuringhistoryofanegativesmearintheprecedingtwotothreeyears,mayportendeitherapersistentHPVinfectionorahighergradelesion.
Women over 30 years who have not had a negative Pap smear within the preceding 2-3 years, may be offered immediate colposcopy or a repeat smear in 6 months.
Interestingly,20-25%ofpatientswithaPapsmearreportoflow-gradesquamousabnormalityhaveaconcurrenthistologicaldiagnosisofahigh-gradesquamouslesion.Thisostensibly
concerningfigureisreproducedaroundtheworldregardlessofthequalityofthesmeartakerorreportinglaboratory.IntheAustraliancontext,theriskofinvasivecancerdevelopingintheoneyearintervalbeforerepeattestingisexceptionallylowandinsufficienttowarrantdifferentmanagement.ThecurrentreviewofthescreeningprogramwillbeassessingthepotentialroleofHPVtestingoflow-gradesmearsasameansoftriagingwhichhavehighriskHPVinfectionandmayrequiredifferentmanagement.
High-grade squamous abnormalities A woman with a Pap smear report of possible high-grade squamous lesion or high-grade squamous lesion should be referred for colposcopy.
If there is a report of a definite or a possible invasive component, the woman should be referred to a specialist gynaecologist, ideally within two weeks.
Glandular lesionsAllglandularabnormalitiesarerecommendedtohavecolposcopicassessment:
A woman with a Pap smear report of possible high-grade glandular lesion or endocervical adenocarcinoma in situ (AIS) should be referred to a specialist gynaecologist
A woman with a Pap smear report of adenocarcinoma (of any origin) should be referred to a specialist gynaecologist.
Follow up of women previously treated for high-grade diseaseFollowupoftreatedhighgradediseaserequirescolposcopyandrepeatsmearat4-6monthsaftertreatment.
At12months,afurtherrepeatsmearandHPVtestingiscarriedout.
Once a woman has tested negative to both HPV testing and cervical cytology on two consecutive occasions, i.e., 12 months apart, she can return to the normal screening interval rather than continuing annual Pap smears.
ThisistheonlyuseofHPVtestingthatiscurrently Medicarerebatable.
ConclusionItisimportanttorememberthatthecervicalsmearisonlyascreeningtest,andpatientsshouldbeawarethatithasasmall,unpreventable,incidenceoffalsepositivesandfalsenegatives.ThebestwayforawomantoreduceheroddsofgettingcervicalcancerisregularPapsmearsandtoattendanyprescribedfollowupsmears.
Dr Jason Stone MBChB FRCPath FRCPA
Consultant Histopathologist & CytopathologistPhone: (07) 3121 4426 Email: DrJason.Stone@qml.com.au
Dr Bryan Knight BSc (anatomy) MB ChB MMed (anatomical pathology) FIAC ACAP PhD
We would like to take this opportunity to thank Dr Knight for his contribution as the Head of Department of Cytopathology, Dr Knight will be continuing on with QML Pathology as a cytopathologist.
Congratulations Dr Jason Stone, our new Head of Department of Cytopathology.
Real-Time Results...Anytime, Anywhere.Path-Way and Path-Way Mobile, the new web-based application by QML Pathology, provide you with access to pathology results in real-time, at anytime, from anywhere.
To register, visit www.path-way.com.au
After graduating with a Bachelor of Medicine and Bachelor of Surgery in 1997 from the University of Cape Town, South Africa, where he received multiple academic prizes, Dr Jason Stone continued his internship and clinical rotations at Greys Hospital Pietermaritzburg, South Africa.
In 2000, Dr Stone went to the UK and worked in the Department of Physiology and Histology at Bristol University. He commenced his histopathology training in Sheffield where he handled a wide range of general surgical specimens, including non-gynaecological cytopathology.
Dr Stone joined Doncaster and Bassetlaw Hospital as a Consulting Pathologist in 2006, and in 2010 moved to Australia and joined the QML Pathology Brisbane histology and cytology team.
In addition to his work at the Brisbane Laboratory, Dr Stone also oversees histology and cytology for the Mackay region.
Special Interests: Breast and gynaecological pathology, and cytopathology.
QML PathoLogy NewsLetter // Issue 4, 2012 // PAGE8
Cytopathology training programmeManydoctorsarenotawarethattheQMLPathologyCytopathologyDepartmenthasaverysuccessfulin-housetrainingprogrammethathasbeenrunningsince1995. Theprogrammeincludesscreeningofgynaecologicspecimens(papsmears)andnon-gynaecologicspecimens.Since1995wehavetrained54graduatestoscreengynaecologicandnon-gynaecologicspecimens.
Ittakesapproximately6to8monthstofullytrainacandidatetoscreencervicalpapsmears,andmostscreenerstakeovertwoyearstobecomecompetentinscreeningallofthevariousnon-gynaecologicspecimens,suchasurines,sputa,FineNeedleAspiratesetc.Thetrainingprogrammeinvolvesaformalisedseriesoflectures,multi-headermicroscopesessions,theoryquestions,slidescreeningsetsandsupervisedscreening.TraineesaresupervisedbyagroupofseniorscientistsknownasMentors, whoareintegraltothesuccessofourtrainingprogram.
After2years,thetraineesareeligibletositfortheAustralianSocietyofCytologycertificate-anationalexaminationwhichtestscompetencyinallaspectsofCytologyscreeninginAustralia.Onseveraloccasions,aQMLPathologycandidatehasgainedthehighestmarkinthisexam,andmanyofourcandidateshavepassedwithdistinction.
SpecialistRegistrarsinHistopathologyalsomakeuseoftheexcellentteachingresourcesavailableintheCytopathologyDepartment.
QMLPathologyCytopathologyisveryproudofthequalityofitsgraduatesandthecultureofongoingeducationinthedepartment.Thiscommitmenttotrainingformsoneaspect oftheongoinggoaltomaintainthehighqualitycytologyservice thatQMLPathologyDepartmentofCytopathologyoffers.
WearepleasedtointroduceourtwonewestgraduatesAmyHassum(picturedleft)andKerrynBuchanski(right)whograduatedinSeptember2012.
Since1995,fourtrainingco-ordinatorshaveoverseenthetrainingprogramme.Ourcurrentco-ordinator,TereseBoost(picturedcentre),hasheldthepositionforfiveyears.TereseisherselfagraduateoftheoriginalQMLPathologytrainingprogrammein1995,gainingherASCcertificatein1998and aMaster’sdegreeinCytologyin2006.
QML PathoLogy NewsLetter // Issue 4, 2012 // PAGE9
Collection Centre Updates
NEW cOllEcTION cENTrES
BALDHILLS.....................................................................(07)32611486 11BaldHillsRoad OpeningHours: Mon-Fri: 7.00am–12.00pm
BUDERIM........................................................................(07)54410200 16-18KingStreet OpeningHours: Mon-Fri: 8.00am–12.00pm
CANUNGRA.....................................................................(07)55434800 49ChristieStreet OpeningHours: Mon-Fri: 8.00am–11.00am
COLLINGWOODPARK..................................................... (07)38143377 RedbankPlazaMedicalCentre,Level1RedbankPlaza 1CollingwoodParkDrive OpeningHours: Mon-Fri: 8.00am–1.00pm
MACKAY–CANELANDDENTAL.....................................(07)49512999 CanelandDental,CanelandCentralShoppingCentre CnrMangroveRoad&VictoriaStreet OpeningHours: Mon-Fri:9.00am–1.00pm
REDLANDBAY.................................................................(07)38292903 Shop4,100DonaldRoad OpeningHours: Mon-Fri: 7.00am–12.00pm
suMNer......................................................................... (07)33765051 1/50SumnersRoad OpeningHours: Mon-Fri:7.30am–11.30am,12.00pm–1.30pm
rElOcATED cOllEcTION cENTrES
PIALBA............................................................................. (07)41248645 14LiuzziStreet OpeningHours: Mon-Fri: 7.00am–12.00pm
THE FOLLOWING COLLECTION CENTRES ARE NOW BY APPOINTMENT ONLY
CAIRNSCITY.................................................................. (07)40312668 BarrierReefMedicalCentre,377SheridanStreet
COOROYEAST................................................................ (07)54410200 CnrPearlandElmStreets
IBUKI.............................................................................. (07)54410200 IbukiHealthandWellness,6QuambyPlace,NoosaHeads
IMBIL.............................................................................. (07)54410200 6ImbilIslandRoad
PeregIaN sPrINgs...................................................... (07)54410200 PeregianSpringsShoppingCentre,HavanaRoadWest
rossLea.........................................................................(07)47289193 112BowenRoad
SPRINGWOOD................................................................ (07)32901501 DennisRoadMedicalCentre,18DennisRoad
TOWNSVILLECITY..........................................................(07)47242794 UrbanQuarters-Townsville Room4,MyFamilyDoctors,StanleyStreet
QML PathoLogy NewsLetter // Issue 4, 2012 // Page 10
Doctor’s Noticeboard
TheDoctor’sNoticeboardisafreeserviceforpractitionerstoadvisechangestotheirpractice. Ifyouwouldliketoplaceanotice,pleaseemaildetailstoinfo@qml.com.au.
DR NAEEM KHAN,MBBS,FRCS,FRACS
GeneralSurgeonand GastrointestinalEndoscopist
DrNaeemKhanisaGeneralSurgeonandGastrointestinalEndoscopistwithaspecialinterestinLaparoscopicBreast,ColorectalandHerniasurgery.DrNaeemKhansuccessfullycompleted5yearsof
advancedsurgicaltrainingatPrincessAlexandraHospitalinBrisbanewhichisacentreofexcellenceforsurgicaltraininginAustralia,andcompletedhispostgraduatetraininginQueenslandin2011.
PriortothisDrKhanobtainedhisEnglishfellowshipfromtheRoyalCollegeofSurgeonsandPhysiciansin2000,hasworkedasasurgeoninSouthAfricaandhasacquiredaverybroadsurgicalexperience.
Inaddition,DrKhanisaseniorlecturer(UniversityofQueensland)andisaregulartutorofjuniordoctorsandinternationalmedicalgraduates.Hetakesprideinprovidingthebestprofessionaladviceandpersonableservicetowhichhispatientscanrelate.
BasedatCaboolturePublicHospital,healsooperatesandconsultsatCaboolturePrivateHospital.
AppointmentsforDrKhancanbemadeon:(07)54959440.
DR DAVID PHILLIPS,ConsultantPhysician,Diabetes,ThyroidandEndocrinehasrelocatedto:
118AshmoreRoad BenowaQLD4215
Phone:(07)55975976
Fax:(07)55970459
GraduatedUniversityofQueenslandMBBS,MRCP(UK),FRACP.PostgraduatetrainingUnitedKingdomandRoyalBrisbaneHospital(clinicallecturerinendocrinology).
Officeconsultationsrestrictedtodiabetes,thyroid andendocrinology.
Comfortableroomsandampleoffstreetparking.
PROF. PAMELA MCCOMBEwouldliketoadvisethat shehasasessionalroomavailableat:
Suite286,GroundFloor StAndrew’sPlace,33NorthStreet SpringHillQ4000(Opp.StAndrew’sHospital)
Sessionsareavailableatthefollowingtimes: WednesdaysAM/PM ThursdaysPM FridaysAM
Pleasecall(07)32369960or emailreception@pmccombe.com.auforfurtherinformation.
DR SHAFIq YASIN,MBBS,DPM,MRCPsych,FRANZCP
Director&ConsultantPsychiatrist
ASSESSMENT&MANAGEMENT
•Depression •Anxiety •SelfHarmBehaviourandSuicideRisk •Schizophrenia •BipolarIllness •PersonalityDisorders •EatingDisorders •SleepDisorders •ADHD
E:shafiqyasin1970@yahoo.com www.yasinpsychiatricservice.com.au
Forappointmentspleasephone:0477017070 orfaxGPreferrallettersto:(07)32457898.
Suite2 TheHubSpecialistCentre CnrLoraine&RickeyStreets,Capalaba
ErrOrS & OmISSIONSInthelastissueoftheQMLPathologyDoctorsnewsletter,wementionedthediscontinuationofthefaecalreducingsubstancetest.TheentrywastitledFatReducingSubstances,whenitshouldhavebeentitledFaecal ReducingSubstances.
Dr ANDrEW DAvIDSON
FertilitySpecialistandGynaecologist
Asof5thNovember2012,DrDavidson’snewBrisbanePracticeaddresswillbe:
Level10,WatkinsMedicalCentre 225WickhamTceBRISBANE4000
PleaseuseourexistingRobinacontacts: Phone:(07)56677711 Fax:(07)56677733 Email:reception@adavidson.com.au
QML PathoLogy NewsLetter // Issue 4, 2012 // Page 11
EvE HEAlTH pIONEErS TElEHEAlTH
EveHealthisproudtoannounceTelehealth,anewinitiativeinpatientaccessibilityandcare.Telehealthoffersthepotentialforsignificantpatientbenefits,particularlyinremote,regionalandoutermetropolitanareas.Telehealthconsultationaimstoprovideimmediateaccesstospecialistswithoutthetimeandexpenseoftraveltoourmetropolitancentre.
Theparticipationofthepatient’susualhealthcareproviderduringtheconsultationwillprovideappropriate,immediateaccesstoallmanagementoptionsandenhancedcontinuityandqualityofcare.
EveHealth Shop5/199 GreyStreet SouthBankQld4101
Phone:(07)33321999
Email:telehealth@evehealth.com.au
Pleasevisitourwebsitewww.evehealth.com.au formoreinformationonourdoctors.
DR NAVID ADIB,MBBS(Qld),FRACP(PaedRheum),PhD(Manchester)
PaediatricRheumatologist
Childhoodmusculoskeletalandjointpains InflammatoryarthritisandAuto-immunediseases
WesleyRooms:Suite13,Level10 EvanThomsonBuilding 24ChaselyStreet Auchenflower4066
Bookings Ph:(07)38701029 Fax:(07)38710700
pOSITION vAcANTLawntonCountryMarketMedicalCentre
VRandNonVR,MaleandFemaleDoctorsrequired.DWSandAoNavailable.WearelocatedinaverybusyshoppingcentrenextdoortotheChemist.Lookingfordoctorstoworkflexiblehourswithahigherincome,withoutalongerwaitingperiod.Highpercentageguaranteed.ThepracticehasRNsupport,Physiotherapy,ExercisePhysiotherapy,Dietician,Psychologist,Podiatryandplansforonsitepathology.
AllenquiriespleasephoneNeilon0406804559.
GP POSITION AVAILABLE - BRIBIE ISLAND
BellaraFamilyMedicalPractice
OpportunityforF/TVRGPtojoinourlongestablishedGPownedseasidePractice.ThePracticeisfullycomputerised,accreditedandoffersmixedbilling.WehaveanexcellentsupportiveteamofDoctors,RegisteredNurseandAdminstaff.Familyfriendlyhourswithnoon-call.ThePracticeiscoveredbyanafterhoursservice.
PleasecontactTrishJackson(PracticeManager)on Ph:(07)34089077(officehours),or DrRajonPh:0418714183oremail:jraj@ozdoc.com.au.
DR LEN YARED,MBBS,FRANZCOG,FRCOG
Obstetrician&GynaecologistWishestoadvisethatheisstillpracticinginObstetricsandGynaecologyandthathispracticeaddressis:643LoganRoad,Greenslopes,Qld4120Phone:(07)33941071Fax:(07)38471538Email:dryaredsrooms@westnet.com.auAfterHours:(07)33943636
Warfarin Dosing Over ChristmasQMLPathologywishestoadvisethatovertheupcomingChristmasperiod,theQMLPathologyWarfarinCareClinicwillbeclosed. PleasenotethatNONEWREGISTRATIONSwillbetakenfrom2.00pmonFriday,14December2012,withtheregistrationlinere-openingat7.00amonWednesday,2January2013.
Duringthisperiod,itisessentialthatanynewpatientsonWarfarinaresuppliedwithinstructionsand/orreferredtotheirlocaldoctor forsupervision.PatientswhoarecurrentlymonitoredbyQMLPathologyandarebeingdischargedfromhospitalwillbeacceptedover thisperiod.
SpecialistD
iagnosticServicesPtyLtd(ABN
84007190043)t/aQM
LPathologyPUB/MR/001(Nov-12)
ThisnewsletterhasbeenpreparedandpublishedbyQMLPathologyfortheinformationofreferringdoctors.Althougheveryefforthasbeenmadetoensurethatthenewsletterisfreefromerrororomission,readersareadvisedthatthenewsletterisnotasubstitutefordetailedprofessionaladvice.©Copyright2012
FURTHER HISTORICAL CLINICAL DATA CAN BE OBTAINED BY CONTACTING YOUR LOCAL MEDICAL LIAISON OFFICER.
Infectious Diseases ReportGEOGRAPHICDISTRIBUTION-SEPTEMBER2012
REGIONS:1Cairns2GoldCoast/NorthernRivers3Ipswich
4Mackay5MountIsa6NewEngland7NorthBrisbaneSuburbs
8NorthernTerritory9Redcliffe10Rockhampton11SouthBrisbaneSuburbs
12SunshineCoast13Toowoomba14Townsville15WideBay/Burnett
orgaNIsM Regions(asperkeybelow) totaL1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 seP aug JUL JUN
Adenovirus(nottyped) 15 3 3 15 14 1 10 5 5 7 78 104 47 38
Adenovirus(typingpending) 6 1 2 3 1 1 1 15 23 19 15
BarmahForestvirus 1 1 2 1 2 2 1 1 2 13 17 9 16
Bordetellapertussis 2 19 18 10 2 14 26 23 52 23 27 5 221 236 206 210
Brucellaspecies 2 1 1 1 1 2 1 9 10 11 4
Campylobacterjejuni 3 3 1 0 0
Chlamydiapneumoniae 0 0 0 0
Chlamydiatrachomatis,nottyped 84 119 43 33 6 88 45 53 145 34 18 46 17 731 754 554 684
Coxiellaburnetii 3 1 4 6 3 14
Cryptococcusspecies 1 1 3 3 2
Cytomegalovirus(CMV) 2 11 7 1 12 13 2 8 5 4 65 82 36 58
Entamoebahistolytica 0 1 2 0
Enterovirus-nottyped 0 1 0 0
Epstein-Barrvirus(EBV) 5 7 8 3 23 7 1 26 10 2 11 5 108 137 112 95
Flavivirusunspecified 2 3 1 1 1 1 3 12 14 8 19
HepatitisAvirus 1 1 6 3 2
HepatitisBvirus 7 7 10 4 5 41 3 2 2 81 100 92 65
HepatitisCvirus 15 60 30 2 1 31 26 5 82 22 13 13 9 309 288 262 297
HepatitisDvirus 1 1 0 0 0
HepatitisEvirus 0 0 0 0
HerpessimplexType1 20 49 14 8 2 44 24 9 73 22 4 18 5 292 354 245 302
HerpessimplexType2 13 34 6 9 1 21 12 4 33 15 2 6 3 159 183 151 187
Herpessimplexvirus-nottyped 0 0 0 1
HIV-1 2 1 3 13 10 11
HTLV-1 0 0 0 0
HumanMetapneumovirus 4 20 13 24 21 8 37 19 2 6 154 185 46 31
InfluenzaAvirus 8 21 15 7 3 58 45 19 68 67 18 23 8 360 2219 1145 333
InfluenzaBvirus 15 42 26 4 2 65 72 19 111 37 33 7 5 438 685 180 122
Legionellapneumophila(allserogroups) 0 1 0 2
Legionellaspecies 1 1 1 3 3 2 5
Leptospiraspecies 1 1 1 3 4 2 3
Measlesvirus 1 1 0 0 0
Mumpsvirus 0 1 1 0
Mycoplasmapneumoniae 19 142 72 42 9 2 110 130 41 215 98 28 33 20 961 1337 848 221
Neisseriagonorrhoeae 9 5 1 9 1 1 5 1 2 1 35 38 41 43
Parainfluenzavirus 2 18 4 4 1 15 16 3 25 8 2 6 1 105 100 41 48
Parvovirus 1 2 4 4 1 4 2 6 4 2 2 32 25 31 28
Pneumocystiscarinii 1 1 0 1 2
RespiratorySyncytialvirus 2 20 13 2 1 1 12 16 13 16 13 8 5 4 126 190 159 130
Rhinovirus(alltypes) 7 23 9 3 1 23 1 17 5 46 13 9 12 2 171 270 241 317
Rickettsia-SpottedFeverGroup 4 4 3 6 3
RossRivervirus 2 5 2 1 3 3 3 6 2 5 32 20 21 23
Rubellavirus 0 1 1 2
SalmonellaparatyphiA 0 0 0
SalmonellaparatyphiB 0 0 0
Salmonellatyphi 0 1 2
StreptococcusGroupA 6 12 7 1 5 12 6 18 7 1 7 2 84 90 52 64
Toxoplasmagondii 0 1 1 2
Treponemapallidum 24 10 4 2 8 23 7 7 28 3 4 22 1 143 164 105 119
Trichomonasvaginalis 21 1 5 2 1 5 35 28 24 27
VaricellaZostervirus 8 37 15 3 39 22 4 64 15 2 6 3 218 235 175 222
TOTAl 273 671 323 141 39 9 640 2 527 235 1115 425 153 271 95 4919 7933 4897 3769
top related