The Laboratory Report Spring 2013

The

Spring 2013

Laboratory Report A Publication of the Department of Pathology and Genomic Medicine

Dr. Alberto Ayala Receives Highest Honor From Academy

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r. Alberto Ayala, deputy chief of pathology for the Department, has received the Distinguished Pathologist Award from the United States and Canadian Academy of Pathology (USCAP), the highest honor bestowed by the Academy. He was presented with the award in a ceremony at the Arthur Purdy Stout Society of Surgical Pathologists Meeting during the 102nd annual meeting of the USCAP in Baltimore, Maryland on March 3rd.

“Alberto is a living legend in pathology,” said Dr. James Musser, chair of the Department of Pathology and Genomic Medicine for the Hospital System. “The Department, the System, and our patients are very fortunate to have him here at Methodist.”

The Distinguished Pathologist Award was established by the Council of the

USCAP for recognition of distinguished service in the development of the discipline of pathology. This award is presented to an individual who is recognized as making major contributions to pathology over the years.

Dr. Ayala received his M.D. degree from the University of Nuevo Leon School of Medicine in Monterrey, Mexico in 1960. He completed pathology residency at The University of Texas Medical Branch at Galveston, and a fellowship at MD Anderson where he joined the faculty in 1968. Dr. Ayala served as the deputy chairman and ad-interim chairman of the department there before joining Methodist in 2004.

For more information on Dr. Ayala, visit methodisthealth.com/Ayala. For more information on the USCAP, visit uscap.org. 

Alberto G. Ayala, M.D.

Table of Contents

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Dr. Dina Mody to Present at International Congress of Cytology Dr. Suzanne Powell Helps Build Training Infrastructure Abroad

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Dr. Pulin Kothari Joins Department Faculty New Diagnostic Test Offerings

To register or submit an abstract, visit cap.org. Abstract deadline is April 1st.

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In Focus: The Clinical Microbiology Team

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Department Hosts International Symposium Sugar Land Lab Staff Lead Continuing Education Effort Trainee Spotlight

Register now at houstonpathologists.org.

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2013 Residency Match

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Dr. Dina Mody to Present at International Congress of Cytology

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r. Dina Mody, medical director of cytopathology and director of the Cytopathology Fellowship Program for the Department, will chair two seminars at the 18th International Congress of Cytology on May 27th, in Paris, France.

“I am genuinely grateful just to be asked,” said Dr. Mody. “This is an incredible occasion to meet with the great cytopathologists of our time, and share our immense wealth of knowledge and expertise with each other, and the younger doctors in attendance.”

The International Congress of Cytology is held every three years by the International Academy of Cytology and a host country academy partner. The Congress offers a comprehensive overview of

current practices and future developments in the field of clinical cytology, covering morphology, molecular testing, newly targeted therapy strategies, and up-to-date Codes of Good Practices.

Dr. Mody received her M.D. degree in 1979 from the Seth G.S. Medical College at Bombay University. She completed her pathology residency at the Baylor College of Medicine. Dr. Mody was the recipient of the Lifetime Achievement Award from the College of American Pathologists in 2009.

For more information on Dr. Mody, visit methodisthealth.com/Mody. For more information on the International Congress of Cytology in Paris, visit cytologyparis2013.com. 

Dina R. Mody, M.D.

Dr. Suzanne Powell Helps Build Training Infrastructure Abroad

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r. Suzanne Powell, vice chair of education for the Department, recently visited several institutions in Singapore as part of a group of specialty-specific site visitors from the Accreditation Council for Graduate Medical Education International (ACGME-I).

“Singapore is a wonderful country with some great graduate medical education programs,” said Dr. Powell. “The ACGME-I can assist with efforts to establish more uniform standards across programs in Singapore, and the rest of the international community.”

The ACGME-I is a non-governmental organization that accredits graduate medical education programs outside of

the United States. Its mission is to improve health care by assessing and advancing the quality of resident physician education through accreditation to benefit the public, protect the interests of residents, and improve the quality of teaching, learning, research, and professional practice.

In addition to her leadership roles in the residency programs at Methodist, Dr. Powell is the immediate past chair of the Residency Program Directors of Pathology (PRODS) Council and the Residency Review Committee for Pathology of the ACGME, where she has also served on the Executive Council of Review Committee Chairs as the representative of hospital-based specialties.

For more information on Dr. Powell, visit methodisthealth.com/Powell. For more information on the ACGME-I, visit acgme-i.org. 

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Dr. Pulin Kothari Joins Department Faculty

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r. Pulin Kothari has joined the Department faculty as of March 1st. He comes to Methodist from Christus St. Catherine Hospital in Katy, where he was chief of pathology and laboratory medical director.

“Dr. Kothari has a remarkable breadth of experience in pathology and laboratory management,” said Dr. James Musser, chair of the Department of Pathology and Genomic Medicine for the System. “His services are much needed at many of our outlying system hospitals where community growth continues at a rapid pace. We are glad to have him with us.”

Dr. Kothari will serve at Methodist West Houston Hospital, Methodist Willowbrook, and Methodist Sugar Land Hospitals.

Dr. Kothari received his medical degree from the medical school at The University of Texas Health Science Center at San Antonio. He completed his pathology residency at The University of Texas Health Science Center at Houston, and fellowships in surgical pathology and cytopathology at the Baylor College of Medicine.

For more information on Dr. Kothari, visit methodisthealth.com/Kothari.  Pulin S. Kothari, M.D.

New Diagnostic Test Offerings: West Nile Virus PCR Test West Nile virus (WNV) is transmitted to humans by infected mosquitos and causes seasonal epidemics in the summer through autumn. The CDC reports that more than 30,000 people have become sick from WNV since it was first identified in the US in 1999. Last year, nearly half of all US cases occurred in Texas.

Approximately 80% of infected people remain asymptomatic; however, a subset of patients develops overt clinical disease. Immunocompromised, elderly, and pregnant individuals are particularly susceptible to severe infections. Most commonly, patients develop West Nile fever, which is characterized by fever, headache, rash, and malaise. Less than

Schema of Common Intraocular Pathogen Assay.

1% of patients will develop a potentially life threatening neuroinvasive disease, such as encephalitis, meningitis, or poliomyelitis. Early diagnosis and treatment is crucial for best outcomes.

In March 2013, the Molecular Diagnostics Laboratory at TMH validated a realtime reverse transcriptase PCR-based assay to detect West Nile virus. The test is run daily and can be performed on peripheral blood or cerebrospinal fluid.

For more information, please contact Dr. Randall Olsen at rjolsen@tmhs.org or Ms. Heather Hendrickson at hlhendrickson@tmhs.org.

Common Intraocular Pathogen Assay Ocular pathology poses many challenges, most notably, the very small quantity of specimen available for diagnostic evaluation. In cases of suspected infectious anterior or posterior uveitis, all laboratory testing must be performed using only a few hundred microliters of vitreous fluid or aqueous humor. To maximize our testing capacity, the Molecular Diagnostics Laboratory at TMH has validated a multiplex real-time PCR assay to detect the five most common intraocular pathogens.

The test panel includes cytomegalovirus (CMV), herpes simplex virus 1 and 2 (HSV1 and HSV2), Toxoplasma gondii, and varicella-zoster virus (VZV). This novel multiplex strategy further strengthens our existing expertise in ophthalmic and infectious disease pathology at TMH. The validation study was supported, in part, by a department microgrant.

The new molecular diagnostic panel will be introduced in-house in April.

For more information, please contact Dr. Randall Olsen at rjolsen@tmhs.org, Dr. Patricia Chevez-Barrios at pchevezbarrios@tmhs.org, or Ms. Heather Hendrickson at hlhendrickson@tmhs.org. 

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In Focus: The Clinical Microbiology Team

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linical microbiology, or medical microbiology, is both a field of medicine and a branch of microbiology. It involves the study of microorganisms, including bacteria, viruses, fungi, and parasites, that have medical importance because they can cause infections in humans.

The Department of Pathology and Genomic Medicine has a team of three clinicians with specialty training and expertise in clinical microbiology. This team

provides invaluable support to the entire medical staff throughout The Methodist Hospital System, and at institutions served by Methodist Diagnostic Laboratories.

James R. Davis, Ph.D. Medical Director, Clinical Microbiology Dr. Davis received his Ph.D. in microbiology from the University of Houston in 1965. He has held faculty appointments at The University of Texas Dental Branch in Houston and the Baylor College of Medicine. Dr. Davis is particularly interested in the training of the next generation of clinical microbiologists. His research aims to improve patient care by reducing test turnaround time while maintaining accuracy.

In addition to being the medical director of clinical microbiology, he is also the associate director of all clinical laboratories in the Department of Pathology and Genomic Medicine.

For more information on Dr. Davis, visit methodisthealth.com/Davis.

Geoffrey A. Land, Ph.D., D(ABB) Co-Director, Clinical Microbiology Dr. Land received his Ph.D. in microbiology from the Tulane University Medical Center in New Orleans, Louisiana in 1973. He completed an NIH-sponsored research fellowship in microbiology at the Duke University Medical Center in Durham, North Carolina, before holding faculty appointments at several institutions, including The University of Texas Southwestern Medical Center and Baylor College of Medicine.

Dr. Land is an active laboratory inspector and has served on the American Society for Histocompatibility and Immunogenetics (ASHI) Accreditation Review Board as commissioner, co-chair, program director, and as president of the society.

For more information on Dr. Land, visit methodisthealth.com/Land.

The clinical microbiology team: from left, Drs. Randall Olsen, James Davis, and Geoffrey Land.

Dr. Davis (right) mentoring PGY1 resident, Dr. Eric Salazar.

Randall J. Olsen, M.D., Ph.D. Associate Medical Director, Clinical Microbiology Dr. Olsen received his M.D. and Ph.D. (pathology and microbiology) degrees from the University of Nebraska in 2003.

He completed clinical pathology residency training at the Baylor College of Medicine and a hematopathology fellowship at The Methodist Hospital.

Dr. Olsen’s research focuses on the molecular pathogenesis of severe invasive group A Streptococcus infections, such as is seen with necrotizing fasciitis or “flesh eating disease.”

For more information on Dr. Olsen, visit methodisthealth.com/Olsen.

For more information on the clinical microbiology service at Methodist, please contact Pat Cernoch at 713-441-0333. 

Dr. Olsen inspecting a mass spectrometry target with Laboratory Manager Pat Cernoch.

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Department Hosts International Symposium

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arlier this month (March 4-5), Dr. James Musser and The Methodist Hospital hosted the third Nordic-North American Symposium on Antimicrobial Resistance and Molecular Epidemiology. Investigators from Denmark, Finland, Norway, Canada, Iceland, and the United States participated in the 2-day event.

Antimicrobial resistance has been a serious medical and public health concern for over a decade, especially with regards to resistant strains of tuberculosis, Staphylococcus aureus, and Klebsiella pneumoniae. According to the World Health Organization, approximately 440,000 new cases of multidrug-resistant tuberculosis emerge annually, resulting in more than 150,000 deaths.

Sugar Land Lab Staff Lead Continuing Education Effort

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onna Hermis, M.H.A., MT(ASCP), the laboratory director at Methodist Sugar Land Hospital, and two of her staff, have developed continuing education modules for the American Society for Clinical Pathology (ASCP).

These modules are part of the ASCP LabQ program to earn credits towards the maintenance of ASCP certification.

“ASCP certification is very important in the clinical pathology laboratory,” said Ms. Hermis.

“The designation indicates a high level of professional training and continuing education.”

The three learning modules cover important laboratory topics, such as how to ensure accurate handling and testing of patient specimens, how phlebotomists can improve patient satisfaction among

the modules. “These continuing education modules and certifications help keep us at this high level of performance.”

Outpatient Phlebotomist Catherine Mingino also authored one of the modules which focused on achieving a positive patient experience.

The ASCP LabQ program modules focus on technical problems in the clinical pathology laboratory and provide From left, Sugar Land Laboratory Director Donna Hermis, CME and CMLE credits in areas Phlebotomist Catherine Mingino, and Laboratory that include transfusion medicine, Manager Rosalie Thornblom. clinical chemistry, clinical immupatients with special needs, and how to nology, hematology, microbiology, and prepare for laboratory accreditation inphlebotomy. spections.

For more information on the ASCP “Our laboratory runs very accurately LabQ program, visit ascp.org/LabQ. For and efficiently,” said Rosalie Thornblom, more information on Methodist Sugar BS, MT(ASCP), manager of the Sugar Land Hospital, visit methodisthealth.com/ Land laboratory and an author of one of SugarLand. 

Trainee Spotlight: Sergio Piña Oviedo, M.D. PGY3 Resident

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r. Sergio Piña Oviedo, PGY3 pathology resident, has published a first-author paper in Modern Pathology, the premiere journal of the United States and Canadian Academy of Pathology and a Nature Publishing Group periodical. The paper, entitled, “Flat pattern of nephrogenic adenoma: previously unrecognized pattern unveiled using PAX2 and PAX8 immunohistochemistry,” was published online in January and identifies a previously undescribed benign flat pattern adenoma, and highlights the importance of the differential diagnosis from flat neoplastic lesion, particularly urothelial carcinoma in-situ.

Dr. Piña Oviedo received his M.D. degree in 2003 from the Universidad Panamericana School of Medicine in Mexico City. He conducted neuroscience research at Temple University in Philadelphia before joining the residency program at Methodist in 2010.

Sergio Piña Oviedo, M.D.

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2013 Residency Match

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he results from the 2013 National Resident Matching Program were posted on March 15, and the following medical school graduates will be PGY1 residents in the Department starting in July:

David A. Cohen, M.D. University of Miami Leonard M. Miller School of Medicine Brandon R. Driver, M.D. The University of Texas Medical Branch at Galveston Nicola E. Dundas, M.D. The University of Texas Medical School at Houston Katherine H. Lohmann, M.D. Tulane University School of Medicine

RECENT PUBLICATIONS Bingham BA, Hatef DA, Chevez-Barrios P, Blackmon SH, Kim MP. Increased FDG Activity in a Dermatofibroma in Esophageal Cancer Patient. Clin Nucl Med. 2013 Mar;38(3):e140-2.

Brown AF, Sirohi D, Fukuoka J, Cagle P, Policarpio-Nicolas M, Tacha D, Jagirdar J. Tissue-Preserving Antibody Cocktails to Differentiate Primary Squamous Cell Carcinoma, Adenocarcinoma, and Small Cell Carcinoma of Lung. Arch Pathol Lab Med. 2013 Jan 4. [Epub ahead of print] Cagle PT. Evolving frontlines in the diagnosis and treatment of pulmonary diseases. Arch Pathol Lab Med. 2012 Dec;136(12):1476-7.

Cagle PT, Allen TC. Lung cancer genotype-based therapy and predictive biomarkers: present and future. Arch Pathol Lab Med. 2012 Dec;136(12):1482-91.

Cagle PT, Olsen RJ. Verifying the Role of Surgical Pathologists in the Precision Medicine of Lung Cancer. Arch Pathol Lab Med. 2012 Dec 31. [Epub ahead of print] Cerny J, Yu H, Ramanathan M, Raffel GD, Walsh WV, Fortier N, Shanahan L, O'Rourke E, Bednarik J, Barton B, Kroll-Desrosiers A, Hao S, Woda B, Hutchinson L, Evens AM, Rosmarin AG, Nath R. Expression of CD25 independently predicts early treatment failure of acute myeloid leukaemia (AML). Br J Haematol. 2013 Jan;160(2):262-6.

Chandler WL. Microparticle counts in platelet-rich and platelet-free plasma, effect of centrifugation and sample-processing protocols.

Blood Coagul Fibrinolysis. 2013 Mar;24(2):125-32.

Chen AC, Paulino AC, Schwartz MR, Rodriguez AA, Bass BL, Chang JC, Teh BS. Prognostic Markers for Invasive Micropapillary Carcinoma of the Breast: A Population-Based Analysis. Clin Breast Cancer. 2012 Dec 12. Epub Crookston KP, Sibbitt WL Jr, Chandler WL, Qualls CR, Roldan CA. Circulating microparticles in neuropsychiatric systemic lupus erythematosus. Int J Rheum Dis. 2013 Feb;16(1):72-80.

Crothers BA, Jones BA, Cahill LA, Moriarty AT, Mody DR, Tench WD, Souers RJ. Quality Improvement Opportunities in Gynecologic Cytologic-Histologic Correlations: Findings From the College of American Pathologists Gynecologic Cytopathology Quality Consensus Conference Working Group 4. Arch Pathol Lab Med. 2013 Feb;137(2):199-213.

Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC; Members of LAST Project Work Groups, including Schwartz MR. The Lower Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. J Low Genit Tract Dis. 2012 Jul;16(3):205-42.

Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC; Members of LAST Project Work Groups, including Schwartz MR. The Lower Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch Pathol Lab Med. 2012 Oct;136(10:1266-97 Divatia M, Kim SA, Ro JY. IgG4-Related Sclerosing Disease, an Emerging Entity: A Review of a Multi-System Disease. Yonsei Med J. 2012;53(1):15-34.

Escalante P, McKean-Cowdin R, Ramaswamy SV, Williams-Bouyer N, Teeter LD, Jones B, Graviss EA. Can mycobacterial katG genetic changes in isoniazid-resistant tuberculosis influence human disease features? Int J Tuberc Lung Dis. 2013 Mar 1. [Epub ahead of print] Continued page 7

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RECENT PUBLICATIONS continued Gao L, Wang Z, Li F, Hammoudi AA, Thrall MJ, Cagle PT, Wong ST. Differential diagnosis of lung carcinoma with coherent antiStokes Raman scattering imaging. Arch Pathol Lab Med. 2012 Dec;136(12):1502-10.

Guo CC, Shen SS, Si Q, Dancer J, Stanton ML, Tamboli P, Ro JY, Czerniak BA Necrosis assessment in renal carcinoma-reply. Hum Pathol. 2012;43(1):151-2.

Guo M, Gong Y, Wang J, Dawlett M, Patel S, Liu P, Bevers TB, Sneige N. The role of human papillomavirus type 16/18 genotyping in predicting high-grade cervical/vaginal intraepithelial neoplasm in women with mildly abnormal Papanicolaou results. Cancer Cytopathol. 2013 Feb;121(2):79-85.

Jung G, Hwang HS, Jang SJ, Ro JY. Are elastic stain and specialty sign out necessary to evaluate pleural invasion in lung cancers? Ann Diagn Pathol. 2012;16(4):250-4 Kibe R, Zhang S, Guo D, Marrero L, Tsien F, Rodriguez P, Khan S, Zieske A, Huang J, Li W, Durum SK, Iwakuma T, Cui Y. IL-7Rα deficiency in p53null mice exacerbates thymocyte telomere erosion and lymphomagenesis. Cell Death Differ. 2012 Jul;19(7):1139-51.

Long SW, Williams D, Valson C, Cantu CC, Cernoch P, Musser JM, Olsen RJ. A Genomic Day In The Life of a Clinical Microbiology Laboratory. J Clin Microbiol. 2013 Jan 23. [Epub ahead of print] Musser JM. S. Burt Wolbach, Rocky Mountain Spotted Fever, and Blood-sucking Arthropods: Triumph of an Early Investigative Pathologist. Am J Pathol. 2013 Feb;182(2):291-3.

Nguyen DT, Nguyen HQ, Beasley RP, Ford CE, Hwang LY, Graviss EA. Performance of Clinical Algorithms for Smear-Negative Tuberculosis in HIV-Infected Persons in Ho Chi Minh City, Vietnam. Tuberc Res Treat. 2012;2012:360852.

Oh SY, Maier H, Schroeder J, Richter GS, Elli D, Musser JM, Quenee LE, Missiakas DM, Schneewind O. Vaccine Protection against Bacillus cereus-Mediated Respiratory Anthrax-Like Disease in Mice. Infect Immun. 2013 Mar;81(3):1008-17.

Ozcan A, de la Roza G, Ro JY, Shen SS, Truong LD. PAX2 and PAX8 expression in primary and metastatic renal tumors: a comprehensive comparison. Arch Pathol Lab Med. 2012 Dec;136(12):1541-51.

Piña-Oviedo S, Shen SS, Truong LD, Ayala AG, Ro JY. Flat pattern of nephrogenic adenoma: previously unrecognized pattern unveiled using PAX2 and PAX8 immunohistochemistry. Mod Pathol. 2013 Jan 18. [Epub ahead of print] Quiroga-Garza G, Zhou H, Mody DR, Schwartz MR, Ge Y. Unexpected High Prevalence of HPV 90 Infection in an Underserved Population: Is It Really a Low-Risk Genotype? Arch Pathol Lab Med. 2013 Feb 20. [Epub ahead of print] Ramkumar C, Kong Y, Cui H, Hao S, Jones SN, Gerstein RM, Zhang H. Smurf2 regulates the senescence response and suppresses tumorigenesis in mice. Cancer Res. 2012 Jun 1;72(11):2714-9.

Song Y, Zhang Y, Bernard PE, Reuben JM, Ueno NT, Arlinghaus RB, Zu Y, Qin L. Multiplexed volumetric bar-chart chip for point-ofcare diagnostics. Nat Commun. 2012;3:1283.

Stamatakis L, Cheng PJ, Ho PL, Thrall MJ, Mayer WA, Miles BJ, Link RE. A 60-year-old woman with an incidentally discovered right renal mass. Urology. 2012 Dec;80(6):1183-6.

Wang M, Tang D, Shu B, Wang B, Jin H, Hao S, Dresser KA, Shen J, Im HJ, Sampson ER, Rubery PT, Zuscik MJ, Schwarz EM, O'Keefe RJ, Wang Y, Chen D. Conditional activation of b- catenin signaling in mice leads to severe defects of intervertibral disc tissue. Arthritis Rheum. 2012 Aug;64(8):2611-23.

Wu X, Amrikachi M, Shah SK. Embedding topic discovery in conditional random fields model for segmenting nuclei using multispectral data. IEEE Trans Biomed Eng. 2012 Jun;59(6):1539-49. 

The Laboratory Report The Laboratory Report is a publication of The Methodist Hospital System Department of Pathology and Genomic Medicine.

Editor-in-Chief April A. Ewton, M.D.

Claudia P. Molina, M.D. Seema Mullick, M.D. Editorial Committee Thu Ngo, M.D. Hazel L. Awalt, M.D. Steven Shen, M.D., Ph.D. Christopher Leveque, M.D. Paul Sumby, Ph.D.

Ping Wang, Ph.D. Editorial Coordinator Philip Randall

The Methodist Hospital Clare Rose, M.B.A. Manuel Hinojosa, M.H.A.

Department Chair James M. Musser, M.D., Ph.D.