Two Days of Case Study Excellence

Our New Frontiers in Pathology conference was established in 2007 as a largely case-based conference in which short, 30-minute case presentations were complemented by daily plenary lectures and breakout sessions that emulated the experience of sitting with colleagues at a multiheaded scope. Excluding a two-year break due to COVID, members of the Department of Pathology and guest pathologists have continued to bring a variety of challenging cases focusing on practical problems common in daily practice and lectures on timely topics of more general interest to our attendees. This year’s 15^th Annual New Frontiers in Pathology pegged another milestone as Dr. Jeffrey Myers, conference founder, presented for the last time in anticipation of his retirement in January 2025. This year’s conference, held both in person at The Graduate Hotel in Ann Arbor, Michigan and via Zoom, was well attended with participants from across the United States, including trainees, community pathologists, and academic pathologists.

This year’s conference opened with a warm welcome from Dr. Sara Abbott, conference co-chair, who then introduced the first of three speakers focused on female health. Dr. Julia Dahl, director of MLabs and assistant professor of pathology, reviewed a placental pathology a high-grade basal variant case of chronic villitis. Dr. Ellen Chapel, assistant professor of breast pathology, discussed the evolution of neoadjuvant therapy and standardization of the evaluation of breast specimens following therapy. She went on to discuss the residual cancer burden calculator, which provides a score to evaluate specimens and uses data on the size of the tumor, the tumor bed changes, and lymph node treatment effect. The final speaker in this conference segment was Dr. Richard Lieberman, professor of gynecologic pathology and obstetrics and gynecology. He discussed the recent change in guidelines for cervical cancer screening to HPV testing without cytology and the impact this will have on women with non-HPV cervical cancers who may experience increased numbers of high-grade carcinomas. He then described his research findings of increasing numbers of post-menopausal women being diagnosed with cervical cancer, when this is typically considered a pre-menopausal disease. He hypothesized that some women who have HPV that clears on its own experience a reactivation of HPV in their system as their immune system weakens with age. Once reactivated, HPV never clears again and leads to cervical cancers in post-menopausal women.

The next segment in the conference focused on gastrointestinal pathology. Dr Nora Joseph, assistant professor of gastrointestinal and hepatobiliary pathology, and program director for the molecular genetic fellowship program, discussed specimen identity testing in the molecular diagnostic laboratory. She described the molecular testing done when specimens from multiple patients become mixed, how the results indicate which specimen belongs to which patient, and how the correct diagnoses are finally attributable to the proper individuals. Dr. Margaret Fang, a gastrointestinal pathologist from the Veterans Affairs Ann Arbor Healthcare System, followed Dr. Joseph. She presented on differentiation between ulcerative colitis, irritable bowel syndrome, and Crohn’s disease.

Fang’s presentation was followed by our plenary speaker, Dr. Annette Kim, who spoke on “Beyond ‘Leukemia Cutis’ – Cutaneous Manifestations of Myeloid Neoplasms.” She discussed molecular patterns in myeloid neoplasms, patterns of cutaneous involvement by myeloid neoplasms with a variety of cases of AML, CMML, and histiocytic and dendritic cell neoplasms, among others. She went on to discuss mutations relevant to various leukemias and the skin conditions that may be associated with them. The term “leukemia cutis” is a catchphrase that covers all types of skin conditions related to leukemia but is not specific. She recommends that this term not be used as there are multiple types of leukemia and many different causes of these skin conditions. The diagnosis should be as specific as possible.

A welcome lunch break was followed by breakout sessions. Dr. Kamran Mirza, assistant chair of education, director of educational programs and communications, and professor of hematopathology, and Dr. Maria Westerhoff, assistant chair of well-being and professor of gastrointestinal and hepatobiliary pathology, each led a breakout session focused on their subspecialty expertise, reviewing several cases with attendees.

The afternoon case presentations continued covering three additional subspecialties. Dr. Kyle Perry, associate professor and director of bone and soft tissue pathology, presented on cases of soft tissue tumors with inflammatory cells. Soft tissue tumors can be difficult to diagnose as tumor cells are outnumbered by inflammatory cells, reactive fibrosis, or reactive vascular changes. He then reviewed three cases, one of a well-differentiated liposarcoma, followed by an angiomatoid fibrous histiocytoma and an inflammatory myofibroblastic tumor. Dr. Mark Girton, assistant professor of chemical pathology, hematopathology, and immunopathology and the technical supervisor of the hematology section of the clinical core laboratory, presented a case on an Epstein Barr Virus positive mucocutaneous ulcer which turned out to be an EBV+ B-cell lymphoproliferative disorder. The day wrapped up with Dr. Sean Ferris, assistant professor of neuropathology, presenting a case of necrotizing myopathy, consistent with immune-mediated necrotizing myopathy, which is an autoimmune muscle disease that presents with progressive muscle weakness, myalgias, arthritis and skin rashes or lesions. As the day ended, participants were invited to attend an evening reception at a local restaurant. It was a full, and informative day of learning and the room was filled with conversations relating to various cases of interest. All were eager to hear the cases to be presented on day 2.

Another bright and sunny Ann Arbor day greeted New Frontiers in Pathology attendees on Day 2 as they gathered at the Graduate Hotel for breakfast and a day of engaging case presentations. The morning began with a focus on endocrine pathology. Dr. Aaron Udager, associate professor of genitourinary, head and neck, and surgical pathology and the co-director of our physician-scientist training pathway residency program, kicked off the day with a session on hyperaldosteronism. Bilateral primary aldosteronism is idiopathic (unknown cause) in 70% of the cases and many remain undiagnosed. It results in patients experiencing hypertension, increased cardiovascular morbidity and mortality, including strokes, heart attacks, and AFIB, decreased kidney function and glomerular filtration rates, and increased creatinine levels and urine protein excretion. A PAC/PRA ratio above 20 is diagnostic. These conditions may not resolve even after treatment, which includes removal of the adrenal glands. Dr. Tom Giordano, the Ronald Nishiyama MD research professor of pathology and professor of endocrine pathology, presented a case on thyroid cancer, which turned out to be a high-grade cribriform-morular thyroid carcinoma, which can be caused by an inherited (germline) mutation. Follow-up germline testing for APC was negative, indicating a sporadic disease.

Next on the docket was Dr. Xiaobing Jin, assistant professor of cytopathology and surgical pathology, who presented on salivary gland neoplasms, which represent 3-10% of all head and neck tumors. Many of these neoplasms are sent for review following fine needle aspiration biopsies (FNA), which have limitations for evaluation and must be correlated with clinical presentations and imaging studies to help avoid misdiagnosis. FNAs cannot provide a specific diagnosis for most benign and malignant salivary gland neoplasms. Jin discussed the types of testing that should be completed and the importance of having the tumor excised for more complete testing to differentiate between carcinomas and pleomorphic adenomas.

Dr. Jaclyn Plotzke, assistant professor of dermatopathology, presented a case of a patient with metastatic esophageal carcinoma being treated with Pembrolizumab. His physician then added Carboplatin to his regimen which resulted in a maculopapular rash. Steroid treatment resulted in the rash worsening. A skin biopsy and evaluation revealed the rash was Stevens-Johnson Syndrome, a toxic epidermal necrolysis caused by the drug.

Following these case presentations were breakout sessions on thoracic pathology led by Drs. Jeffrey Myers and Heather Chen and genitourinary pathology led by Drs. Eman Abdulfatah and Angela Wu. Each session presented several case studies and discussed them with attendees.

The highlight of the day followed with our A. James French Lecture by Dr. Lynette Sholl, chief of thoracic pathology from Brigham and Women’s Hospital, associate professor of pathology at Harvard Medical School. Sholl’s lecture, “Advances in Cancer Biomarker Testing: An Anatomic Pathologist’s Perspective,” provided a historical context for genomic biomarker-driven therapy for lung cancers and other solid tumors, and examined immunotherapy and tumor agnostic biomarkers and circulating tumor DNA testing.

Following a break, Dr. Tao Huang, associate professor of gynecologic pathology and co-director of the surgical pathology fellowship program, presented a case on differentiating between squamous cell carcinoma and squamoid lesions. Granulomatous Lung Disease was the topic for Dr. Will Perry’s case study. Perry, assistant professor of head and neck, pulmonary, and surgical pathology, presented case studies on necrotizing and non-necrotizing granulomatous inflammation representing varying diseases. He described the quality and distribution of granulomas, associated histological features, and correlated clinical findings for determining diagnoses. Dr. Kristine Konopka, associate professor and director of thoracic pathology and director of the thoracic pathology fellowship program, was the final speaker for the conference and presented her case study on usual interstitial pneumonia (UIP). She emphasized that pathologists can and should make this diagnosis. She then proceeded to discuss differential diagnoses with other conditions resembling UIP.

This concluded day 2 of New Frontiers in Pathology. The slides for the case studies are available for review on our website. We encourage you to join us next year for NFP 2026! To be added to the email list for our Save the Date announcements, please contact Brent Temple.