Pathology & Laboratory Medicine

It was another productive and busy year for the Department of Pathology and Laboratory Medicine. There was a 21 percent increase in testing volume from 2019 to 2020. The most significant changes were seen in Microbiology as well as Molecular Pathology and Chemistry. The Covid pandemic is the main reason for the increases in Microbiology and Chemistry whereas the Molecular Pathology increase can be attributed to newly developed tests.

In Anatomic Pathology, we continue to recruit for pathologists with subspecialty training. In 2020, the focus was to interview in breast and gastrointestinal pathology. Dr. Robert Vasquez, a fellow in breast pathology at Mt. Sinai Hospital, NYC, will join us in July 2021. Recruitments in the recent past also have been successful, and Krzysztof Glomski, MD, Ronald Araneta, MD, and Thomas Mezzetti, MD, have all been integrated into the department.

As in years past, the department provided on-site assessment and tissue triage for 25 Connecticut Children’s renal biopsy procedures. This total is down from previous years (37 were received in 2019). All but one of these specimens were FedEx’ed to Columbia University pathologists the same day they were received.

We continue to expand the laboratory offerings in immunohistochemistry and molecular pathology, expanding markers used for diagnostic pathology and also ones that have therapeutic implications.

NEW PROGRAMS

Anatomic Pathology We are participating in a new research study collaborating with a vendor (Cytoveris) and the HHC Breast Surgery Division to use spectroscopy in evaluation of gross margins intraoperatively. Informatics A lot of background work got put into implementation of expanding the scope and capability of whole slide digital scanning. Various vendors were evaluated, information technology leadership was engaged, and a large capacity scanner purchased. This will be implemented in 2021, allowing us to begin digitization of glass slides, which will have significant positive impact on the work-flow.

LABORATORY MEDICINE

Microbiology Over the course of 2020, the HHC Ancillary Microbiology Laboratory at Newington implemented the following instruments and/or assays to provide in-house SARS-CoV-2 NAA (molecular) testing. a. By Dec. 30, 2020, HHC had performed 91,038 in-house tests for the system. i. Abbott m2000 assay onto the current m2000 instrument by way of routing standard viral loads to a reference laboratory ii. Biofire torch additional modules and a base for HH: implemented the SARS-CoV-2 single assay when it was available and validated the RP2.1 assay, which will be available to order in January 2021 iii. Addition of a Panther Plus instrument and a Panther fusion module for SARS-CoV-2

NAA testing iv. Luminex Aries instrument added for SARS-

CoV-2 testing v. Addition of Genexperts at the affiliate hospitals across the system and SARS-

CoV-2 NAA as well as the multiplex for influenza A/B, RSV, and SARS-CoV-2 at each affiliate

b. Added the GI panel to the Biofire Torch to reduce staffing needs on the stool culture and other infectious disease stool assays. This was also implemented due to supply chain shortages for routine microbiology diagnostic supplies. c. The Luminex Aries also provides backup for C. difficile testing and MRSA screening testing due to supply chain shortages. d.Over the course of 2020, the clinical laboratory expanded specimen processing specific to SARS-

CoV-2 testing. e.Various reference laboratories were engaged to ensure and facilitate testing of the community, surgical (procedure) screening, expanded inpatient/ED testing, and also colleague testing for SARS-CoV-2. Negotiations took place with the Jackson Laboratory for Genomic Medicine in

Farmington, CT, and Sema4 to ensure optimal test pricing as well as <48 hour result turnaround time.

DEPARTMENT GOALS

Plans to renovate the frozen section room to meet demand got underway as planned but were delayed due to the Covid-19 pandemic. The renovation and move to the new frozen section room is expected to be completed in 2021.

The centralized microbiology laboratory in Newington continues along the objective of integrating work from other HHC sites. In 2020, the work from Charlotte Hungerford Hospital in Torrington, CT, and St. Vincent’s Hospital in Bridgeport, CT, was added.

In Anatomic Pathology, some of the goals include: procedures to improve adequacy of specimen material submitted for molecular studies in tumor cases, updating of gross manuals, and work to rectify the processing of Epic orders for cytology specimens.

Covid/Flu Testing initiatives include: New tests (molecular and antibody), new instrument platforms (Revogene, Roche 8800, Trax), referral laboratory services (Sema4), and interface development. In Molecular Pathology, the sequencing panel for solid tumors will be expanded to include tumor mutational burden testing. The validation for the expanded panel for hematologic malignancies will be finalized.

STAFF CHANGES AND PLANNED RECRUITMENT

We successfully recruited Robert Vasquez, MD, a surgical pathologist with subspecialty training and expertise in breast pathology. Pertinent subspecialization 1.There is a wide range of subspecialization in the department broadly as Anatomic and Clinical Pathology. Within Anatomic Pathology there is subspecialization as follows: neuropathology (3), cytopathology (6), pediatric pathology (1), molecular pathology (1), and dermatopathology (1). Additional members within AP have specialty skills in organ systems for which there is no board certification. These include breast pathology, GI pathology, GU pathology, gynecologic pathology, pulmonary pathology, head and neck pathology and soft tissue/bone tumor pathology. Additionally four members of the department are boardcertified in hematopathology to provide support in Hematology and Hematopathology. 2.In other areas of Clinical Pathology, two staff members provide support in transfusion medicine. One is board-certified in transfusion medicine and the other has specialty expertise in coagulation. There is one PhD board-certified member in each of the following disciplines: microbiology, chemistry, molecular pathology/cytogenetics, and immunopathology.

PUBLICATIONS

Montgomery AB, Dukleska K, Balarezo F, Moote D, Finck C. Cervical thymic cyst: a rare cause of neck mass in a female adolescent. J Pediatr Surg Case Rep. June 2020. https://doi.org/10.1016/j.epsc.2020.101529. PMID: 3197803.

Collins K, Cardinali JL, Mnayer LO, DiGiuseppe JA. CD49f protein expression varies among genetic subgroups of B lymphoblastic leukemia, and is distinctly low in KMT2A-rearranged cases. Cytometry B Clin Cytom. 2020;1-6. https://doi.org/10.1002/ cyto.b.21865.

Collins K, Cartun RW, Ligato S. Utility and limitations of Albumin RNA in situ hybridization in the diagnosis of hepatobiliary lesions and metastatic carcinomas to the liver. Appl Immunohistochem Mol Morphol. Epub ahead of print. 2020 Nov. PMID: 33208670. doi: 10.1097/ PAI.0000000000000885.

Sayej W, Isakoff M, DiGiuseppe J, Moote D, Balarezo F, Finck C, Hyams J. Primary cutaneous follicle center lymphoma in a 16-year-old-male with Crohn’s disease exposed to infliximab and methotrexate. J Pediatr Gastroenterol Nutrit. 2019 Nov. PMID: 31789777.

Moradi S, Castiglione C, Ehrig T. Accessory tragus: report of a case in a rare location on the nasal vestibule. Pediatr Dermatol. 2020 Mar-Apr. https://doi. org/10.1111/pde.14090.

Moradi S, Ricci A, Ehrig T. Digital mucous cyst: altered epidermal mucin as a clue to diagnosis. J Cutan Pathol. 2020 Aug;47(8):705-709. doi: 10.1111/cup.13700. Epub 2020 May 30.

Moradi S, Daoud V, Ricci A, Ehrig T. Mucinous eccrine nevus: case report of a rare entity. Hum Pathol Case Rep. 2020 Jun. doi: 10.1016/j.ehpc.2020.200376.

Moradi S, Morgenstern J, Ehrig T. Verruciform genitalassociated xanthoma with acantholysis: report of a rare case. J Am Acad Dermatol Case Rep. 2020 Jul 1; 6(7);658-660. doi: 10.1016/j.jdcr.2020.05.011.

Siddique A, Siddique O, Einstein M, Urtasun-Sotil E, Ligato S. Drug and herbal/dietary supplementsinduced liver injury: a tertiary care center experience. World J Hepatol. 2020 May 27;12(5): 207–219. Epub 2020 May 27. doi: 10.4254/wjh.v12.i5.207.

Cho WC, Mandavilli S. Intratumoral extramedullary hematopoiesis in solitary fibrous tumor of the breast. Breast J. 2020 Apr; 26(4):755-758. PMID: 31486175.

Hafeez S, Cho WC, Shen P. Leptomeningeal involvement by relapsed follicular lymphoma detected by flow cytometry despite low white blood cell count in cerebrospinal fluid: a case report. Indian J Pathol Microbiol. 2020;63(1):131-133. PMID: 32031143.

Bookland M, Gillan E, Song X, Kolmakova A. Peripheral circulation miRNA expression of pediatric brain tumors and its relation to tumor miRNA expression levels. J Neurosurg Pediatr. 2020 May 8:1-9. PMID: 32384264. doi: 10.3171/2020.2.PEDS19715.

Patel S, Kollar R, Troy P, Song X, Khaled M, Parra A, Pervez M. Malignant cerebral ischemia in a Covid-19 infected patient: case review and histopathological findings. J Stroke Cerebrovasc Dis. 2020 Nov; 29(11): 105231. Epub 2020 Aug 5. doi. 10.1016/j. jstrokecerebrovasdis. 2020.105231.

Nouh A, Mehta T, Hussain M, Song X, Ollenschleger M. Clot composition of embolic strokes of undetermined source: a feasibility study. BMC Neurol. 2020 Oct 22;20:383. doi: 10.1186/s12883-020-01969-w.

STAFF

Srinivas Mandavilli, MD, Division Chief Ronald Araneta, MD Margaret William Assaad, MD Fabiola Balarezo, MD Richard Cartun, MS, PhD Joseph A. DiGiuseppe, MD, PhD Jonathan Earle, MD Torsten Ehrig, MD Mary Fiel-Gan, MD Krzysztof Glomski, MD, PhD Lisa Laird, MD Saverio Ligato, MD Gregory S. Makowski, PhD, DABCC, FACB Thomas Mezzetti, MD Amity Roberts, PhD, D (ABMM) Peter Shen, MD Bradford Sherburne, MD Xianyuan Song, MD, PhD Dean Uphoff, MD