The Laboratory Report Fall 2012

The

Fall 2012

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

Methodist Laboratories Receive Reaccreditation

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he laboratories in The Methodist Hospital, Methodist Sugar Land Hospital, Methodist West Houston Hospital, and the Kirby ER have again retained their accreditation with the College of American Pathologists (CAP). A 19-member inspection team from the CAP accreditation program conducted its unannounced biennial inspection on September 12th and 13th.

“The inspection team provided a very thorough evaluation of all aspects of our laboratories,” said Dr. James Musser, chair of the Department of Pathology and Genomic Medicine. “I am extremely proud of the superb global performance of our outstanding technical staff and faculty. Our patients and medical staff colleagues can be assured that the quality of our pathology services is second to none nationally.”

“These are very important inspections,” said Manuel Hinojosa, director of laboratory

services for the hospital. “This accreditation validates that our laboratories consistently meet the highest standards of excellence. This is essential to all of us in the Department, as it directly affects the quality of care we provide our patients here, and at other institutions served by our reference laboratory.”

The CAP Laboratory Accreditation Program is internationally recognized and approved by the Centers for Medicare and Medicaid Services as an accrediting organization. The program is intended to improve patient safety by advancing the quality of pathology and laboratory services through education, standard setting, and ensuring that laboratories meet or exceed regulatory requirements.

The Blood Bank at The Methodist Hospital also received reaccreditation from the American Association of Blood Banks (AABB) following an inspection that took

place September 11th and 12th. The AABB has developed voluntary standards for blood bank blood component collection, processing, and transfusion and assessed compliance with these standards through its accreditation program since 1957. The program strives to improve the safety of collecting, processing, testing, distributing, and administering blood and blood products.

For more information on the CAP Laboratory Accreditation Program, visit cap.org. For more information on AABB standards and accreditation, visit aabb.org. 

Table of Contents

102nd Annual Meeting Baltimore Convention Center Baltimore, Maryland March 2-8, 2013

To register or submit an abstract, visit uscap.org. Abstract submission deadline is October 7th.

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Dr. Dina Mody to Receive Papanicolaou Award Drs. Jian Chen and Christopher Leveque Receive Fenwal Award

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Dr. Alberto Ayala Receives Award for Professional Excellence Trainee Spotlight New Diagnostic Test Offerings

To register or submit an abstract, visit texpath.org. Abstract submission deadline is November 1st.

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In Focus: The Neuropathology Team Lab Stats: San Jacinto Methodist Hospital

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Dr. Dina Mody to Receive Papanicolaou Award

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r. Dina Mody, medical director of cytopathology for the Department, will receive the prestigious Papanicolaou Award from the American Society of Cytopathology (ASC) at the society’s annual meeting on November 3rd in Las Vegas, Nevada.

“This is a humbling experience,” said Dr. Mody. “The recognition that this award represents is immense, and I am grateful that my peers have bestowed this honor upon me.”

“Receipt of the Papanicolaou Award is the pinnacle of achievement in cytopathology,” said Dr. James Musser, chair of the Department of Pathology and Genomic Medicine for the System. “We are extremely proud that the society has recognized the many contributions that Dr. Mody has made to the field.”

The Papanicolaou Award was established

in 1958 and is the highest award given by the ASC. The bronze medal is presented annually to a member of the society in recognition of meritorious contributions in the field of cytopathology. Past recipients of the award include Drs. Ibrahim Ramzy, Leopold Koss, and George Papanicolaou himself (posthumously).

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

For more information on the ASC, visit cytopathology.org. For more information on Dr. Mody, visit methodisthealth.com/ Mody. 

Dina R. Mody, M.D.

Drs. Jian Chen and Christopher Leveque Receive Fenwal Award

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r. Christopher The AABB is an international Leveque, medical association representing indidirector of the Blood viduals and institutions involved Bank, and Dr. Jian Chen, PGY4 in the field of transfusion mediresident, were the recipients of cine and cellular therapies. The the Fenwal Scholarship from association is committed to imthe American Association of proving health by developing Blood Banks (AABB) for their and delivering standards, acabstract entitled: “Body Mass creditation, and educational proIndex Affects Stem Cell Yield.” grams that focus on optimizing The award will be formally patient and donor care and presented during the AABB safety. annual meeting in October.

For more information on Dr. Drs. Chen (left) and Leveque (right) with a stem cell donor in the Blood Bank.

The Fenwal Awards are preLeveque, visit methodsented annually by the AABB isthealth.com/Leveque. For more as distinguished candidates are identinational recognition for exceptional acainformation on the AABB, visit aabb.org.  fied. demic work.” In addition to his medical “Advances in patient care are a result of director responsibilities in the Blood superior academic inquiry,” said Dr. Bank, Dr. Leveque is also the director of Leveque. “Scholarships such as this one the Blood Banking/Transfusion Medicine greatly assist our trainees by providing Fellowship Program.

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Dr. Alberto Ayala Receives Award for Professional Excellence

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r. Alberto Ayala, elected deputy chief of pathology, received the Award for Professional Excellence from his alma mater, Universidad Autonoma de Nuevo Leon, in Monterrey, Mexico. He was presented with the award in a ceremony at the university on September 20th.

“This is a great honor,” said Dr. Ayala. “The university has always been important to me, and I am grateful to receive such an award from it.”

The Award of Excellence was established in 2004 to recognize alumni with distinguished academic and professional

accomplishments.

Dr. Ayala received his medical degree from the School of Medicine at Universidad Autonoma de Nuevo Leon in 1960.

The university is the third largest in Mexico and the oldest institution of higher education in that country.

For more information on Dr. Ayala, visit methodisthealth.com/Ayala. For more information on Universidad Autonoma de Nuevo Leon, visit uanl.mx/universidad. 

Alberto G. Ayala, M.D.

Trainee Spotlight: Irene Shu, Ph.D. Clinical Chemistry Fellow

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r. Irene Shu, clinical chemistry fellow, is one of three recipients of the Department’s Trainee Leadership and Innovation Award for the third quarter of 2012.

She received the award with residents, Dr. Gabriela Quiroga-Garza (PGY4) and Dr. Sergio Pina-Oviedo (PGY3), for developing and validating a vitamin D assay. The test was previously done as a send-out to a reference laboratory.

Dr. Shu received her Ph.D. in chemistry from the University of Washington in Seattle in 2011. She began the Clinical Chemistry Fellowship under the direction of Dr. Ping Wang last year.

Irene Shu, Ph.D.

New Diagnostic Test Offerings: Thyroid Gene Mutation Panel Thyroid cancer is the most common endocrine malignancy, with an incidence that has steadily grown in the United States over the past 10 years. Most thyroid lesions are readily diagnosed by cytopathological examination of fine needle aspirate (FNA) material. However, in a small proportion of cases, the cytomorphology reveals indeterminate features that result in a diagnosis of atypical cells of undetermined significance (ACUS) or follicular lesion of uncertain significance (FLUS).

Although the rate of ACUS/ FLUS diagnoses at TMH are much lower than the national average (2.1% compared to 9.9%, Bethesda recommendation under 7%), these cases remain an unsolved diagnostic dilemma. Recently published

studies have demonstrated that the malignant potential of these indeterminate thyroid lesions can be predicted by molecular testing. That is, if gene mutations characteristic of malignant tumors are identified, then surgical excision may be recommended over conservative approaches.

Dr. Dina Mody has been an advocate for applying molecular tests to better inform the management of patients with indeterminate thyroid FNA diagnoses. To support this strategy, the Molecular Diagnostics Laboratory has validated a gene mutation panel to identify alterations commonly encountered in malignant thyroid tumors, including mutations in the genes encoding BRAF, HRAS, KRAS, and NRAS. These gene mutations may also

Diff-Quik stain of thyroid FNA aspirate with ACUS diagnosis.

predict the metastatic behavior of overtly malignant thyroid carcinomas. The gene mutation test is available now and can be performed on fresh tissue, FNA specimens preserved in fixative or RPMI, and formalin-fixed, paraffin-embedded tissue.

For more information, please contact Dr. Randall Olsen at rjolsen@tmhs.org or Dr. Dina Mody at dmody@tmhs.org. 

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In Focus: The Neuropathology Team

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europathology is the subspecialty of anatomic pathology that focuses specifically on the study of diseases of nervous system tissue. These studies are usually conducted through the examination of small surgical biopsies or whole brains obtained from autopsies.

The Department of Pathology and Genomic Medicine has a team of three board-certified neuropathologists. This team provides vital support to the busy patient care activities conducted at the

Methodist Neurological Institute, and excellent training experiences to the residents and fellows in the Department of Pathology and Genomic Medicine.

Suzanne Z. Powell, M.D. Chief, Neuropathology Dr. Powell received her M.D. degree from the West Virginia University College of Medicine in Morgantown, West Virginia in 1988. She completed her residency training at the University of Florida Health Science Center in Jacksonville, and a fellowship in neuropathology at the University of Florida College of Medicine in Gainesville.

In addition to providing excellent clinical services, Dr. Powell is especially involved with the mentoring of trainees and holds numerous education leadership positions, both in the Department and at the national level in several societies. She has chaired both the Residency Program Directors of Pathology Council and the Residency Review Committee for Pathology of the Accreditation Council for Graduate Medical Education.

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

Hidehiro Takei, M.D. Associate Medical Director, Neuropathology Dr. Takei received his medical degree from the National Defense Medical College in Saitama, Japan in 1990. He holds subspecialty certification in cytopathology, neuropathology, and molecular genetic pathology. Dr. Takei is also the medical director of autopsy pathology for the Department.

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

Dr. Powell in conference with Department trainees.

The neuropathology team: from left, Drs. Andreana Rivera, Suzanne Powell, and Hidehiro Takei.

Andreana L. Rivera, M.D. Staff Pathologist, Neuropathology Dr. Rivera received her M.D. degree from the Baylor College of Medicine in Houston, Texas in 2004. She completed her pathology residency at Baylor and fellowships in neuropathology and molecular neuropathology at The University of Texas MD Anderson Cancer Center.

Dr. Rivera is also the director of the Research Pathology Core for The Methodist Hospital Research Institute.

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

For more information on the neuropathology service at Methodist, please contact Dr. Suzanne Powell at spowell@tmhs.org. ď Ž

Dr. Takei (right) mentors resident, Dr. Miguelina De la Garza.

Dr. Rivera (right) mentors resident, Dr. Nathan Lee.

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Lab Stats: San Jacinto Methodist Hospital Medical Director: Joyce Maldonado, M.D. Dr. Maldonado received her M.D. degree from the University of Oklahoma College of Medicine in 1983, and completed pathology residency at the Baylor College of Medicine. Dr. Maldonado became the medical director of the laboratories at San Jacinto Methodist Hospital in 2008, where she also currently chairs the Patient Safety Council and serves on other hospital committees.

Faculty: Claudia P. Molina, M.D. Dr. Molina received her M.D. degree from the Francisco Marroquin University School of Medicine in 1994. She completed pathology residency and a medical microbiology and infectious disease pathology fellowship at The University of Texas Medical Branch in Galveston, Texas, and a surgical pathology fellowship at The Methodist Hospital.

Faculty: Enrique M. Gomez, M.D. Dr. Gomez received his medical degree from the Ponce School of Medicine in 2003. He completed pathology residency at The University of Texas Medical School in Houston, and a surgical pathology fellowship at The University of Texas MD Anderson Cancer Center.

Director: Gail Lumus, BS, MT Ms. Lumus received her Bachelor of Science in 1970 from Baylor University in Waco, Texas. She has been the laboratory director at the San Jacinto Methodist Hospital since 1987.

Manager: Karen Simon, BS, MT Ms. Simon received her Bachelor of Science in Medical Technology from the University of Louisiana at Lafayette. In addition to managing the staff, she also oversees the Quality Improvement (QI) program for the laboratory.

Staff: The laboratory currently employs 78 staff members that include technical supervisors, medical technologists, phlebotomists, histology assistants, processors, and technicians. A successful laboratory requires a group effort, and these employees work as a unified group to ensure the highest quality of care at San Jacinto Methodist Hospital. 

“We all work hard to support our medical staff in providing the best possible care to our patients, and it shows: our hospital is ranked higher than any other in Houston outside of the Texas Medical Center.”

Joyce Maldonado, M.D.

“I enjoy serving the people of Baytown and Pasadena every day. This is a wonderful and diverse community.”

Claudia P. Molina, M.D.

“We have strong leadership, quality facilities, and a supportive staff; it is a great environment for a pathologist.”

Enrique M. Gomez, M.D.

“Our laboratory is exceptional, and we are very proud to be part of such a highlyranked hospital.”

Gail Lumus, BS, MT

“A good team is built on mutual respect and open communication, and we have a great team here.”

Karen Simon, BS, MT

“Teamwork is the key.”

Terry Gibson, MT

Pictures from top: Dr. Maldonado at the autostainer; Dr. Molina at the chemistry analyzer; Dr. Gomez in the Histology Laboratory; Ms. Lumus in her office; and Ms. Simon (left) with Medical Technologist Terry Gibson in the Core Laboratory.

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RECENT PUBLICATIONS Cagle PT, Zhai QJ, Murphy L, Low PS. Folate Receptor in Adenocarcinoma and Squamous Cell Carcinoma of the Lung: Potential Target for Folate-Linked Therapeutic Agents. Arch Pathol Lab Med. 2012 Sep 14. [Epub ahead of print] Chen WC, Rodriguez-Waitkus PM, Barroso A, Balsaver A, McKechnie JC. A Rare Case of Gastric Fundic Gland Adenocarcinoma (Chief Cell Predominant Type). J Gastrointest Cancer. 2012 Jul 12. [Epub ahead of print] Cunningham MT, Olson JD, Chandler WL, Van Cott EM, Eby CS, Teruya J, Hollensead SC, Adcock DM, Allison PM, KottkeMarchant KK, Smith MD. External quality assurance of fibrinogen assays using normal plasma: results of the 2008 College of American Pathologists proficiency testing program in coagulation. Arch Pathol Lab Med. 2012 Jul;136(7):789-95.

Dhingra S, Ayala A, Chai H, Moreno V, Zhao B. Renal myopericytoma: case report and review of literature. Arch Pathol Lab Med. 2012 May;136(5):563-6.

Duan X, Sneige N, Gullett AE, Prieto VG, Resetkova E, Andino LM, Wu Y, Gilcrease MZ, Bedrosian I, Dawood S, Arun B, Albarracin CT. Invasive paget disease of the breast: clinicopathologic study of an underrecognized entity in the breast. Am J Surg Pathol. 2012 Sep;36(9):1353-8.

Gao L, Hammoudi AA, Li F, Thrall MJ, Cagle PT, Chen Y, Yang J, Xia X, Fan Y, Massoud Y, Wang Z, Wong ST. Differential diagnosis of lung carcinoma with three-dimensional quantitative molecular vibrational imaging. J Biomed Opt. 2012 Jun;17(6):066017.

Ghodsizad A, Fahy BN, Waclawczyk S, Liedtke S, Gonzalez Berjon JM, Barrios R, Mehrabi A, Karck M, Ruhparwar A, Kรถgler G. Portal application of human unrestricted somatic stem cells to support hepatic regeneration after portal embolization and tumor surgery.

ASAIO J. 2012 May-Jun;58(3):255-61.

Grilley-Olson JE, Hayes DN, Moore DT, Leslie KO, Wilkerson MD, Qaqish BF, Hayward MC, Cabanski CR, Yin X, Socinski MA, Stinchcombe TE, Thorne LB, Allen TC, Banks PM, Beasley MB, Borczuk AC, Cagle PT, Christensen R, Colby TV, Deblois GG, Elmberger G, Graziano P, Hart CF, Jones KD, Maia DM, Miller CR, Nance KV, Travis WD, Funkhouser WK. Validation of Interobserver Agreement in Lung Cancer Assessment Hematoxylin-Eosin Diagnostic Reproducibility for Non-Small Cell Lung Cancer-The 2004 World Health Organization Classification and Therapeutically Relevant Subsets. Arch Pathol Lab Med. 2012 May 14. [Epub ahead of print] Gupta A, Pacha O, Skaria R, Huynh T, Truong L, Abdellatif A. Retroperitoneal sarcoma presenting as acute renal failure, secondary to bilateral renal artery invasion. Clin Nephrol. 2012 Aug;78(2):164-8.

Hammadah M, Gaber L, Raghavan R. Renal cortical necrosis following a colonoscopy. Clin Nephrol. 2011 Dec 16. [Epub ahead of print] Harvey AM, Truong LD, Mody DR. Diagnostic Pitfalls of Hashimoto's/Lymphocytic Thyroiditis on Fine-Needle Aspirations and Strategies to Avoid Overdiagnosis. Acta Cytol. 2012;56(4):352-60.

Husain AN, Colby T, Ordonez N, Krausz T, Attanoos R, Beasley MB, Borczuk AC, Butnor K, Cagle PT, Chirieac LR, Churg A, Dacic S, Fraire A, Galateau-Salle F, Gibbs A, Gown A, Hammar S, Litzky L, Marchevsky AM, Nicholson A, Roggli V, Travis WD, Wick M. Guidelines for Pathologic Diagnosis of Malignant Mesothelioma: 2012 Update of the Consensus Statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med. 2012 Aug 28. [Epub ahead of print] Kim K, Ihm H, Ro JY, Cho YM. High-level expression of stem cell marker CD133 in clear cell renal cell carcinoma with favorable prognosis. Oncol Lett. 2011 Nov;2(6):1095-1100.

Kim K, Ro JY, Kim S, Cho YM. Expression of stem-cell markers OCT-4 and CD133: important prognostic factors in papillary renal cell carcinoma. Hum Pathol. 2012 Aug 31. [Epub ahead of print] Kwon BS, Ha CM, Yu S, Lee BC, Ro JY, Hwang S. Microscopic nodes and ducts inside lymphatics and on the surface of internal organs are rich in granulocytes and secretory granules. Cytokine. 2012 Aug 9. [Epub ahead of print] Kobayashi SD, Musser JM, DeLeo FR. Genomic analysis of the emergence of vancomycin-resistant Staphylococcus aureus. MBio. 2012 Jun 26;3(4).

Lee EW, Kim JH, Ahn YH, Seo J, Ko A, Jeong M, Kim SJ, Ro JY, Park KM, Lee HW, Park EJ, Chun KH, Song J. Ubiquitination and degradation of the FADD adaptor protein regulate death receptor-mediated apoptosis and necroptosis. Nat Commun. 2012 Jul 31;3:978.

Lee H, Choi SK, Ro JY. Overexpression of DJ-1 and HSP90ฮฑ, and loss of PTEN associated with invasive urothelial carcinoma of urinary bladder: Possible prognostic markers. Oncol Lett. 2012 Mar;3(3):507-512.

Continued page 7

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RECENT PUBLICATIONS continued Li JY, Lopez JI, Powell SZ, Coons SW, Fuller GN. Giant cell ependymoma-report of three cases and review of the literature. Int J Clin Exp Pathol. 2012;5(5):458-62.

Liu Z, Treviño J, Ramirez-Peña E, Sumby P. The small regulatory RNA FasX controls pilus expression and adherence in the human bacterial pathogen group A Streptococcus. Mol Microbiol. 2012 Aug 6. [Epub ahead of print] Marquez L, Feske ML, Teeter LD, Musser JM, Graviss EA. Pediatric Tuberculosis: The Litmus Test for Tuberculosis Control. Pediatr Infect Dis J. 2012 Jul 3. [Epub ahead of print] Mehta S, Singh C, Plata KB, Chanda PK, Paul A, Riosa S, Rosato RR, Rosato AE. β-lactams increase the antibacterial activity of daptomycin against clinical MRSA strains and prevent selection of DAP-resistant derivatives. Antimicrob Agents Chemother. 2012 Sep 17.

[Epub ahead of print] Ordóñez NG, Shen SS, Zenali M, Deavers MT. Melan A (A103) is not a Marker of Mesothelioma. Appl Immunohistochem Mol Morphol.

2012 Jul 19. [Epub ahead of print] Oviedo SP, Cagle PT. Diffuse malignant mesothelioma. Arch Pathol Lab Med. 2012 Aug;136(8):882-8.

Raparia K, Lin JW, Donovan D, Vrabec JT, Zhai QJ, Ayala AA, Ro JY. Chondroblastoma-like chondroma of soft tissue: report of the first case in the base of skull. Ann Diagn Pathol. 2012 Jun 26. [Epub ahead of print] Shen SS, Truong LD, Ro JY, Ayala AG. Use of frozen section in genitourinary pathology. Pathology. 2012 Aug;44(5):427-33.

Sneige N, Thomison JB, Malpica A, Gong Y, Ensor J, Silva EG. Peritoneal washing cytologic analysis of ovarian serous tumors of low malignant potential to detect peritoneal implants and predict clinical outcome. Cancer Cytopathol. 2012 Aug 25;120(4):238-44.

Wright AM, Smith D, Dhurandhar B, Fairley T, Scheiber-Pacht M, Chakraborty S, Gorman BK, Mody D, Coffey DM. Digital Slide Imaging in Cervicovaginal Cytology: A Pilot Study. Arch Pathol Lab Med. 2012 Sep 12. [Epub ahead of print] 

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.