The Laboratory Report Winter 2012

The

Winter 2012

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

Methodist Pathology and Pharmacy Partner to Reduce Length of Stay

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he Methodist Hoseffective therapy as pital System Dequickly as possible is partment of Patholcritical.” ogy and Genomic MediThe collaborating team cine is once again leading conducted a clinical study medicine with the impleat Methodist to assess the mentation of a new internew intervention, and vention that significantly confirmed that it signifireduces the length of hoscantly improved the time pitalization for patients to optimal therapy and with Gram-negative decreased hospital lengthStudy investigators pose with the Bruker mass spectrometer. From left, Dr. William bloodstream infections. The of-stay and costs. The reMusick, Dr. James Musser, Dr. Katherine Perez, Pat Cernoch, Dr. James Davis, new process combines rapid sults of the study were Dr. Geoffrey Land, Dr. Leif Peterson, and Dr. Randall Olsen. identification of bacteria published in an early using matrix-assisted laser desorption online release in Archives of Pathology and Department, and the Center for Biostatisionization-time of flight (MALDI-TOF) Laboratory Medicine. tics at The Methodist Hospital Research mass spectrometry and streamlined anFor more information on the intervenInstitute. timicrobial susceptibility testing, in contion, contact Pat Cernoch in the Clinical “This new method is as accurate as the junction with near-real-time antimicrobial Microbiology Laboratory at 713-441-0333. old method, and takes less than half the stewardship practices.

For more information on the Express time,” said Dr. James Musser, chair of the This novel intervention was developed Blood Culture Service offered by Department of Pathology and Genomic here at Methodist by Dr. Katherine Perez, Methodist Diagnostic Laboratories or to Medicine for the system and a coa clinical specialist in the Pharmacy Desubscribe to the service for your noninvestigator on the study. “Time is espepartment, and members of the Clinical Methodist hospital, contact Phuong cially important when infections become Microbiology Laboratory, Pharmacy Nguyen at ptnguyen@tmhs.org.  systemic. Getting patients on the most

Table of Contents

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

To register, visit uscap.org. The abstract submission deadline has passed.

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Dr. Alberto Ayala Receives Award from MD Anderson Dr. Suyang Hao Joins Department Faculty

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Dr. Youli Zu Receives Grant from National Cancer Institute New Diagnostic Test Offerings

To register, visit texpath.org. The abstract submission deadline has passed.

View archive issues at methodisthealth.com/TheLaboratoryReport

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In Focus: The Renal Pathology Team Lab Stats: Methodist West Houston Hospital Dr. Muthiah Kumaraswami Receives Grant From American Heart Association

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Trainee Spotlight

Laboratory Report

Office of Academic Development to Hold Additional Seminars

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Dr. Alberto Ayala Receives Award from MD Anderson

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r. Alberto Ayala, deputy chief of pathology for the Department, has received the Distinguished Alumnus Award from The University of Texas MD Anderson Cancer Center. He was presented with the prestigious award at a ceremony and lecture at MD Anderson on December 6th.

“The Department and the Hospital System congratulate Dr. Ayala,” said Dr. James Musser, chair of the Department of Pathology and Genomic Medicine for the System. “This level of recognition is remarkable and a testament to his immense career accomplishments.”

The Distinguished Alumnus Award was established at MD Anderson in 1980 to recognize a prominent individual who had trained at the Center and made

distinguished contributions to their respective field.

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 joined the pathology department at Methodist in 2004.

For more information on Dr. Ayala, visit methodisthealth.com/ayala. 

Alberto G. Ayala, M.D.

Dr. Suyang Hao Joins Department Faculty

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he Department’s Hematopathology service added its newest faculty member on October 1st. Dr. Suyang Hao comes to Methodist from the Department of Pathology at the University of Massachusetts Medical School and the UMass Memorial Medical Center in Worcester, Massachusetts, where she was an associate professor and director of the Flow Cytometry Laboratory and Hematopathology Fellowship Program.

“Dr. Hao brings an impressive range and depth of experience to the Department,” said Dr. James Musser, chair of the Department of Pathology and Genomic Medicine for The Methodist Hospital System. “Her contributions to our patients and our academic programs will be greatly appreciated.”

Dr. Hao received her M.D. degree in 1983 from the Tianjin Medical University in Tianjin, China. She completed her pathology residency at the University of Kansas Medical Center in Kansas City, Kansas, and a hematopathology fellowship at the William Beaumont Hospital in Royal Oak, Michigan. Dr. Hao joined the Department of Pathology at the University of Massachusetts Medical School in 2003.

For more information on Dr. Hao, visit methodisthealth.com/hao. 

Suyang Hao, M.D.

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Dr. Youli Zu Receives Grant from National Cancer Institute

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r. Youli Zu, co-director of Hematopathology for the Department, has received a $1 million R33 grant from the National Cancer Institute (NCI) to develop and validate an assay for the detection of circulating tumor cells.

“Early detection of cancer and realtime assessment of response to treatment are critical in improving patient outcomes,” said Dr. Zu. “This test will be a great advance over the existing test, and will allow for earlier detection and more accurate results.”

The proposed assay will allow physicians to detect circulating tumor cells in one drop of patient blood and provide results in seconds. The “one-drop, one-step”

Dr. Zu at The Methodist Hospital Research Institute

assay will use unique aptamer probes, developed with Dr. Zu’s previous R43 grant from the NCI, that carry a reporter

system that is only activated in the presence of tumor cells. The current assay is both time and labor intensive, requiring significantly more blood and several preparation steps to isolate and stain the tumor cells. Tumor cells can be lost during these steps, reducing the accuracy of the assay.

In addition to his responsibilities as codirector of Hematopathology for the Department, Dr. Zu is also the director of the Cancer Pathology Laboratory at The Methodist Hospital Research Institute where the R33 grant is based.

For more information on Dr. Zu, visit methodisthealth.com/Zu. 

New Diagnostic Test Offerings:

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on Willebrand disease is the most common hereditary coagulation disorder. It is caused by a deficiency and/or malfunctioning of von Willebrand factor, a protein required for platelet adhesion and hemostasis. The Department of Pathology and Genomic Medicine has recently brought three new assays in-house to test for von Willebrand disease.

Von Willebrand Factor Collagen Binding Assay When tissue is damaged or wounded, collagen is exposed to blood, and the von Willebrand factor in blood adheres to the collagen and pulls platelets from the blood to start the hemostasis process.

This assay mimics this wound process to determine the amount of and collagen binding ability of von Willebrand factor.

In can be used to help differentiate type 1 from type 2 von Willebrand disease.

Von Willebrand Factor Immunofunctional Activity Assay The GP1b binding domain is responsible for facilitating the proper binding of

platelets with von Willebrand factor. This assay uses a monoclonal antibody to determine if the GP1b binding domain is functioning properly. This assay measures the amount of and GP1 binding site function of von Willebrand factor in blood.

Von Willebrand Factor Multimer Assay Normal von Willebrand factor is composed of large protein polymers with high molecular weight. This test is a Western blot assay that evaluates whether the patient is making these normal, large polymers.

The Methodist Hospital is the only provider of the multimer assay in Texas.

Combined, these assays establish Methodist as having the most comprehensive von Willebrand disease panel available in the state.

For more information regarding von Willebrand disease testing at Methodist, contact Dr. Wayne Chandler at wlchandler@tmhs.org. To subscribe to the von Willebrand testing services for your nonMethodist hospital, please contact Phuong Nguyen at Methodist Diagnostic Laboratories at ptnguyen@tmhs.org.

Western blot multimer assay results showing absence of normal von Willebrand polymers.

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In Focus: The Renal Pathology Team enal pathology, or nephropathology, is the subspecialty of anatomic pathology that focuses specifically on the study of diseases of kidney tissue, including conditions related to kidney transplant. These studies are usually conducted on tissues obtained through percutaneous renal biopsy. In addition to light microscopy, renal pathologists also use transmission electron microscopy and immunofluorescence to render a diagnosis.

The Department of Pathology and Genomic Medicine has a team of three anatomic pathologists with special training and expertise in renal pathology. This team

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provides invaluable support to the nephrology service and transplant center at Methodist, and at other institutions served by Methodist Diagnostic Laboratories. The renal pathology team also The renal pathology team: from left, Drs. Roberto Barrios, Luan Truong, provides outstanding and Lillian Gaber. mentoring opportunities for the residents and fellows in the Department of Pathology and Genomic Medicine.

Luan D. Truong, M.D. Medical Director, Renal Pathology Dr. Truong received his M.D. degree from the Pennsylvania State University College of Medicine in 1979. He completed pathology residency at Baylor College of Medicine in Houston, and a renal pathology fellowship at Columbia University in New York. His research aims to better understand chronic tubulointerstitial injury using models of chronic obstructive nephropathy and ischemiareperfusion injury.

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

Roberto Barrios, M.D. Associate Medical Director, Renal Pathology Dr. Barrios received his M.D. degree from the Facultad de Medicina, Universidad Nacional Autonoma de Mexico in Mexico City in 1969. He then completed pathology residency at the University Hospitals of Cleveland and a renal pathology fellowship at the Children’s Hospital and National Heart Institute in Mexico City. Dr. Barrios also completed a pulmonary pathology fellowship at the Lyman Duff Laboratory of McGill University and Royal Victoria Hospital in Montreal, Quebec, Canada.

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

For more information on the renal pathology service at Methodist, please contact Dr. Luan Truong at ltruong@tmhs.org. 

Dr. Truong (right), and technologist Claire Haueter, review a kidney biopsy using the transmission electron microscope.

Dr. Barrios (left) mentors resident, Dr. Jordan Roberts.

Lillian W. Gaber, M.D. Associate Medical Director, Renal Pathology Dr. Gaber received her medical degree from the Ain Shams University School of Medicine in Cairo, Egypt in 1976. She completed residencies in anatomic and clinical pathology at the New England Deaconess Hospital in Boston, and a fellowship in perinatal obstetrics and gynecology pathology at the Brigham and Women’s Hospital, also in Boston. Her research investigates donor kidney biopsies at the cellular and molecular level to determine suitability for transplantation, changes following organ reperfusion, and efficacy of immunosuppressive therapies.

For more information on Dr. Gaber, visit methodisthealth.com/LillianWGaber.

Dr. Gaber (center) consults on a kidney transplant patient with Dr. A. Osama Gaber (left) and Dr. Samir Patel.

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Lab Stats: Methodist West Houston Hospital Medical Director: Thu Ngo, M.D. Dr. Ngo received his M.D. degree from the Baylor College of Medicine in Houston in 1995. He completed a pathology residency and fellowships in cytopathology, hematopathology, and transfusion medicine there as well. Dr. Ngo became the medical director of Laboratory Services at Methodist West Houston Hospital when the hospital opened in 2010.

Faculty: Lauri B. Campagna, M.D. Dr. Campagna received her M.D. degree in 1991 from the University of Colorado School of Medicine in Denver. She completed a residency in anatomic and clinical pathology and a fellowship in cytopathology at the Baylor College of Medicine in Houston.

Dr. Campagna spent ten years in community hospital pathology, including as the hospital chief of staff at the Medical Center of Mckinney in McKinney, Texas.

She then held the appointment of assistant professor of surgical pathology at The University of Texas Southwestern Medical Center in Dallas before joining the laboratory at Methodist West Houston Hospital in 2011.

Director: Melody Peeples, B.S., M.Ed. Ms. Peeples received her master of education (higher education administration and supervision) from the University of Houston and her bachelor of science (medical technology) from Eastern Illinois University. In addition to being the director of laboratory services at Methodist West Houston Hospital, she is also the director of respiratory care.

Staff: The laboratory currently employs 22 staff members that include laboratory technicians, medical technologists, histology assistants, and laboratory service center representatives. These employees work together to adapt to the fastgrowing environment of Methodist West Houston Hospital. They are the A-team of West Houston. 

“West Houston is growing fast and so is our hospital. Our team works hard to meet the challenges that new and growing service lines bring. We like those challenges; they energize us.”

Thu Ngo, M.D.

“It‟s been wonderful to return to Houston and The Methodist Hospital System.

The Katy area is vibrant and growing; it‟s a great place to be.”

Lauri B. Campagna, M.D.

“With expansion of our cardiovascular surgery program, opening of another medical/surgical unit, and the addition of beds in our Family Birthing Center and NICU, the belief of „build it and they will come‟ is being fulfilled. Our team has successfully met each challenge with enthusiasm and demonstration of our ICARE values.”

Melody Peeples, B.S., M.Ed.

“This is a nice place to work. We all work well together.”

Ericka Bonnee Laboratory Service Center Representative

“It‟s always changing, but that is good; it keeps you on your toes.”

Joy Nunez, MT Q.A. Specialist and ICARE Award Recipient

Pictures from top: Dr. Ngo in the Core Laboratory; Dr. Campagna in the Histology Laboratory; Melody Peeples processing hematopathology specimens; Ericka Bonnee logging in specimens; and Joy Nunez loading the coagulation analyzer.

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Dr. Muthiah Kumaraswami Receives Grant from American Heart Association

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mild pharyngitis and impetigo to r. Muthiah Kumaraslife threatening flesh-eating diswami, an investigator ease and toxic shock syndrome. in the Department’s Post-infection sequelae can also Center for Molecular and Transinclude acute rheumatic heart lational Human Infectious Disdisease, the leading cause of eases Research, has received a 4cardiovascular morbidity and year Scientist Development mortality in young people in Grant from the American Heart developing countries.

Association to study the effect of In the proposed studies, Dr. gene regulation on virulence in Kumaraswami will use genetic, group A Streptococcus. biochemical, biophysical, and “These bacteria cause a wide crystallographic methods to range of infections, and some elucidate the role of growthcan be very serious,” said Dr. phase-specific secreted small Kumaraswami. “Understanding Dr. Kumaraswami (right), with Senior Research Technician Nishanth peptides as potential intercelluwhy some Streptococcus infecMakthal, in their laboratory at The Methodist Hospital Research Institute. lar signals in the gene regulation tions are more severe than others of Streptococcus virulence. is important, and will help us For more information on Dr. Kumarasdevelop more effective treatments.” wami, visit methodisthealth.com/ Group A Streptococcus causes a broad Kumaraswami.  range of clinical manifestations, from

Trainee Spotlight: Jian Chen, M.D., Ph.D. PGY4 Resident

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r. Jian Chen, PGY4 clinical pathology resident, is the recipient of the Department’s Trainee Leadership and Innovation Award for the 4th quarter of 2012. He received the award for initiating and conducting a stem cell donation study with Dr. Christopher Leveque that resulted in a Fenwal Award from the American Association of Blood Banks. Dr. Chen will also be presenting a poster on partial e antibody at the Texas Society of Pathologists’ 92nd Annual Meeting in Austin in January.

Dr. Chen received his medical degree from the Shandong Medical University in China and his Ph.D. in molecular and cellular pathology from the University of Alabama at Birmingham. He completed a blood banking/transfusion medicine fellowship at Methodist last year.

Jian Chen, M.D., Ph.D.

Office of Academic Development to Hold Additional Seminars

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he Office of Academic Development (OAD) in the Department of Pathology and Genomic Medicine has scheduled its seminars and workshops for 2013.

“These seminars can be very helpful to trainees and junior faculty,” said Dr. Kathryn Stockbauer, manager of the OAD. “It gives them the information they need to „jump start‟ their academic development and really get moving with their projects.”

The OAD will hold 2 one-hour seminars

Dr. Stockbauer leading a scientific writing seminar with trainees in 2011.

in the first quarter of 2013. These seminars will cover research credentialing, ARAF/IRB submissions, and study design (Jan. 15), and scientific writing and presentations (Mar. 12).

A more interactive workshop on manuscript development will be held in April. That workshop will last approximately 2 hours, and attendees will bring actual manuscripts in preparation to further develop with the instructor.

For more information on the OAD, visit methodisthealth.com/OAD. 

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RECENT PUBLICATIONS Cagle PT. The transformation of pathology: proceedings of the Houston Lung Symposium. Arch Pathol Lab Med. 2012 Oct;136(10):1184 -5.

Cagle PT, Myers J. Precision medicine for lung cancer: role of the surgical pathologist. Arch Pathol Lab Med. 2012 Oct;136(10):1186-9.

Choi E, Lewis AL, Takei H, Ro JY. Leptomeningeal carcinomatosis as initial presentation in adenocarcinoma of lung with signet ring cell features: an autopsy case report. Int J Clin Exp Pathol. 2012;5(9):972-6.

Chow KK, Naik S, Kakarla S, Brawley VS, Shaffer DR, Yi Z, Rainusso N, Wu MF, Liu H, Kew Y, Grossman RG, Powell S, Lee D, Ahmed N, Gottschalk S. T cells redirected to EphA2 for the immunotherapy of glioblastoma. Mol Ther. 2012 Oct 16. [Epub ahead of print] Crombet O, Lastrapes K, Zieske A, Morales-Arias J. Complete morphologic and molecular remission after introduction of dasatinib in the treatment of a pediatric patient with T-cell acute lymphoblastic leukemia and ABL1 amplification. Pediatr Blood Cancer. 2012 Aug;59(2):333-4.

Eison TM, Hastings MC, Moldoveanu Z, Sanders JT, Gaber L, Walker PD, Lau KK, Julian BA, Novak J, Wyatt RJ. Association of IgG co-deposition with serum levels of galactose-deficient IgA1 in pediatric IgA nephropathy. Clin Nephrol. 2012 Dec;78(6):465-9.

Flores AR, Jewell BE, Fittipaldi N, Beres SB, Musser JM. Human disease isolates of serotype M4 and M22 group A Streptococcus lack genes required for hyaluronic acid capsule biosynthesis. MBio. 2012 Nov 6;3(6).

Gulmann C, Paner GP, Parakh RS, Hansel DE, Shen SS, Ro JY, Annaiah C, Lopez-Beltran A, Rao P, Arora K, Cho Y, HerreraHernandez L, Alsabeh R, Amin MB. Immunohistochemical profile to distinguish urothelial from squamous differentiation in carcinomas of urothelial tract. Hum Pathol. 2012 Sep 17. [Epub ahead of print] Henkel JS, Beers DR, Wen S, Rivera AL, Toennis KM, Appel JE, Zhao W, Moore DH, Powell SZ, Appel SH. Regulatory Tlymphocytes mediate amyotrophic lateral sclerosis progression and survival. EMBO Mol Med. 2012 Nov 9. [Epub ahead of print] Khan KA, Smith DA, Thrall MJ. Only a small fraction of high-grade cervical lesions are discovered after an interpretation of atypical squamous cells of undetermined significance when using imager-assisted, liquid-based Papanicolaou tests and the Bethesda 2001 System. Arch Pathol Lab Med. 2012 Sep 20. [Epub ahead of print] Kim NR, Hyun Yee Cho HY, Piña-Oviedo S, De La Roza G, Lee YD, Ro JY. Follicular adenoma with extensive extracellular mucin deposition: report on two cases. Clin Med Insights Case Rep 2012; 5:155–162.

Kim MJ, Shin HC, Shin KC, Ro JY. Best immunohistochemical panel in distinguishing adenocarcinoma from squamous cell carcinoma of lung: tissue microarray assay in resected lung cancer specimens. Ann Diagn Pathol. 2012 Oct 3. [Epub ahead of print] Li Y, Shaw CA, Sheffer I, Sule N, Powell SZ, Dawson B, Zaidi SN, Bucasas KL, Lupski JR, Wilhelmsen KC, Doody R, Szigeti K. Integrated copy number and gene expression analysis detects a CREB1 association with Alzheimer's disease. Transl Psychiatry. 2012 Nov 20;2:e192.

Metcalfe JZ, Cattamanchi A, McCulloch CE, Lew JD, Ha NP, Graviss EA. Test variability of the Quantiferon-TB Gold In-Tube Assay in clinical practice. Am J Respir Crit Care Med. 2012 Oct 26. [Epub ahead of print] Mishra DK, Sakamoto JH, Thrall MJ, Baird BN, Blackmon SH, Ferrari M, Kurie JM, Kim MP. Human lung cancer cells grown in an ex vivo 3D lung model produce matrix metalloproteinases not produced in 2D culture. PLoS One. 2012;7(9):e45308.

Pagano MB, Chandler WL. Bleeding risks and response to therapy in patients with INR higher than 9. Am J Clin Pathol. 2012 Oct;138 (4):546-50.

Panageas KS, Iwamoto FM, Cloughesy TF, Aldape KD, Rivera AL, Eichler AF, Louis DN, Paleologos NA, Fisher BJ, Ashby LS, Cairncross JG, Roldán Urgoiti GB, Wen PY, Ligon KL, Schiff D, Robins HI, Rocque BG, Chamberlain MC, Mason WP, Weaver SA, Green RM, Kamar FG, Abrey LE, Deangelis LM, Jhanwar SC, Rosenblum MK, Lassman AB. Initial treatment patterns over time for anaplastic oligodendroglial tumors. Neuro Oncol. 2012 Jun;14(6):761-7.

Perez KK, Olsen RJ, Musick WL, Cernoch PL, Davis JR, Land GA, Peterson LE, Musser JM. Integrating rapid pathogen identification and antimicrobial stewardship significantly decreases hospital cost. Arch Pathol Lab Med. 2012 Dec 6. [Epub ahead of print] Song JS, Song DE, Kim KR, Ro JY. Cellular pseudosarcomatous fibroepithelial stromal polyp of the vagina during pregnancy: a lesion that is overdiagnosed as a malignant tumor. Korean J Pathol. 2012;46(5):494-8.

Continued page 8

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RECENT PUBLICATIONS continued Treviño J, Liu Z, Cao TN, Ramirez-Peña E, Sumby P. RivR is a negative regulator of virulence factor expression in the group A Streptococcus. Infect Immun. 2012 Nov 12. [Epub ahead of print] Visco C, Tzankov A, Xu-Monette ZY, Miranda RN, Tai YC, Li Y, Liu WM, d'Amore ES, Li Y, Montes-Moreno S, Dybkaer K, Chiu A, Orazi A, Zu Y, Bhagat G, Wang HY, Dunphy CH, O' Neill S, Hsi ED, Zhao XF, Choi WW, Zhao X, van Krieken JH, Huang Q, Ai W, Ponzoni MA, Ferreri AJ, Kahl BS, Winter JN, Go RS, Dirnhofer S, Piris MA, Møller MB, Wu L, Medeiros LJ, Young KH. Patients with diffuse large B cell lymphoma of germinal center origin with BCL2 translocations have poor outcome, irrespective of MYC status: a report from an International DLBCL rituximab-CHOP Consortium Program Study. Haematologica. 2012 Aug 28. [Epub ahead of print] Xiao YL, Kash JC, Beres SB, Sheng ZM, Musser JM, Taubenberger JK. High-throughput RNA sequencing of a formalin-fixed, paraffinembedded autopsy lung tissue sample from the 1918 influenza pandemic. J Pathol. 2012 Nov 26. [Epub ahead of print] Xu-Monette ZY, Wu L, Visco C, Tai YC, Tzankov A, Liu WM, Montes-Moreno S, Dybkær K, Chiu A, Orazi A, Zu Y, Bhagat G, Richards KL, Hsi ED, Zhao XF, Choi WW, Zhao X, van Krieken JH, Huang Q, Huh J, Ai W, Ponzoni M, Ferreri AJ, Zhou F, Kahl BS, Winter JN, Xu W, Li J, Go RS, Li Y, Piris MA, Møller MB, Miranda RN, Abruzzo LV, Medeiros LJ, Young KH. Mutational profile and prognostic significance of TP53 in diffuse large B-cell lymphoma patients treated with R-CHOP: report from an International DLBCL Rituximab-CHOP Consortium Program Study. Blood. 2012 Nov 8;120(19):3986-96. 

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.