Cardiovascular specimens are commonly encountered in clinical practice, but there is a lack of formal (uniform) specimen handling, training, and reporting. These modules will address the value and limitations of new ancillary diagnostic techniques.

Released: June 13, 2016
Expires: June 13, 2018

Target Audience

This module is appropriate for general pathologists, surgical pathologists, autopsy pathologists, cardiovascular pathologists, forensic pathologists, molecular pathologists, pathology residents, and pathology fellows.

Estimated time to complete this educational activity:  Maximum of 1 hour each.

Format: This is a self-paced module that contains no video or audio elements.


 

Module 1: Myocardial Disease

Overview

Cardiovascular specimens are commonly encountered in clinical practice, but formal training on how to handle them is lacking. Both the Society for Cardiovascular Pathologists (SCVP) and the Association for European Cardiovascular Pathology (AECVP) have recognized the need for a uniform approach to the handling and reporting of cardiovascular specimens. Pathologists and clinicians alike must also be aware of the value and limitations of newer ancillary diagnostic techniques such as genetics and proteomics. This module aims to familiarize participants with the fundamentals of handling surgery- and biopsy-derived myocardial specimens. Specifically, the course will address information that is relevant and actionable for clinicians. It also seeks to inform participants about the emerging technologies available to help inform diagnoses and clinical practice.

Objectives

After completing this module, participants should be able to:

  • Describe the fundamental approaches to handling cardiovascular specimens (both surgery- and biopsy-derived).
  • Explain the impact of emerging ancillary tools such as molecular genetics (including molecular microbiology methods), proteomics, and 3D printing on specimen handling and result reporting.
  • Synthesize clinically actionable information that is essential to convey to care providers and, ultimately, the patient and/or the patient’s family.

Module

Handout

References

  1. Thiene G, et al. AECVP and SCVP 2009 recommendations for training in cardiovascular pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2010;19:129-35.
  2. Stone JR, et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2012;21:2-16.
  3. Leone O, et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology. 2012;21:245-74.
  4. Brinkman CL, et al. PCR-electrospray ionization mass spectrometry for direct detection of pathogens and antimicrobial resistance from heart valves in patients with infective endocarditis. Journal of clinical microbiology. 2013;51:2040-6.
  5. Castonguay MC, et al. Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985-2004). Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2013;22:19-27.
  6. Castonguay MC, et al. Surgical pathology of atrial appendages removed during the cox-maze procedure: a review of 86 cases (2004 to 2005) with implications for prognosis. The American journal of surgical pathology. 2013;37:890-7.
  7. Larsen BT, et al. Surgical pathology of hypothenar hammer syndrome with new pathogenetic insights: A 25-year institutional experience with clinical and pathologic review of 67 cases. The American journal of surgical pathology. 2013;37:1700-8.
  8. Loporcaro CG, et al. Confirmation of cause and manner of death via a comprehensive cardiac autopsy including whole exome next-generation sequencing. Archives of pathology & laboratory medicine. 2014;138:1083-9.
  9. Maleszewski JJ, et al. PRKAR1A in the development of cardiac myxoma: a study of 110 cases including isolated and syndromic tumors. The American journal of surgical pathology. 2014;38:1079-87.
  10. Neuville A, et al. Intimal sarcoma is the most frequent primary cardiac sarcoma: clinicopathologic and molecular retrospective analysis of 100 primary cardiac sarcomas. The American journal of surgical pathology. 2014;38:461-9.

Module 2: Aortic Disease

Overview

Aortic specimens are commonly encountered in clinical practice, but formal training on how to handle them is lacking. Both the Society for Cardiovascular Pathologists (SCVP) and the Association for European Cardiovascular Pathology (AECVP) have recognized the need for a uniform approach to the handling of these specimens. Pathologists and clinicians alike must also be aware of the value and limitations of newer ancillary diagnostic techniques such as genetics and proteomics. This module aims to familiarize participants with the fundamentals of handling surgical aortic specimens. Specifically, the course will address information that is relevant and actionable for clinicians. It also seeks to inform participants about the emerging technologies available to help inform diagnoses and clinical practice.

Objectives

After completing this module, participants should be able to:

  • Describe the fundamental approaches to handling aortic specimens (both surgery- and biopsy-derived).
  • Explain the impact of emerging ancillary tools such as molecular genetics on specimen handling and result reporting.
  • Synthesize clinically actionable information that is essential to convey to care providers and, ultimately, the patient and/or the patient’s family.

Module

Handout

References

  1. Thiene G, et al. AECVP and SCVP 2009 recommendations for training in cardiovascular pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2010;19:129-35.
  2. Stone JR, et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2012;21:2-16.
  3. Neuville A, et al. Intimal sarcoma is the most frequent primary cardiac sarcoma: clinicopathologic and molecular retrospective analysis of 100 primary cardiac sarcomas. The American journal of surgical pathology. 2014;38:461-9.
  4. Stone JR, Bruneval P, Angelini A, Bartoloni G, Basso C, Batoroeva L, Buja LM, Butany J, d'Amati G, Fallon JT, Gittenberger-de Groot AC, Gouveia RH, Halushka MK, Kelly KL, Kholova I, Leone O, Litovsky SH, Maleszewski JJ, Miller DV, Mitchell RN, Preston SD, Pucci A, Radio SJ, Rodriguez ER, Sheppard MN, Suvarna SK, Tan CD, Thiene G, van der Wal AC, Veinot JP. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol. 2015 Sep-Oct;24(5):267-78.
  5. Maleszewski JJ. Inflammatory ascending aortic disease: perspectives from pathology. J Thorac Cardiovasc Surg. 2015 Feb;149(2 Suppl):S176-83.
  6. Maleszewski JJ, Miller DV, Lu J, Dietz HC, Halushka MK. Histopathologic findings in ascending aortas from individuals with Loeys-Dietz syndrome (LDS). Am J Surg Pathol. 2009 Feb;33(2):194-201.
  7. Eleid MF, Forde I, Edwards WD, Maleszewski JJ, Suri RM, Schaff HV, Enriquez-Sarano M, Michelena HI. Type A aortic dissection in patients with bicuspid aortic valves: clinical and pathological comparison with tricuspid aortic valves. Heart. 2013 Nov;99(22):1668-74.
  8. Maleszewski JJ, Tazelaar HD, Horcher HM, Hinkamp TJ, Conte JV, Porterfield JK, Halushka MK. IgG4-related disease of the aortic valve: a report of two cases and review of the literature. Cardiovasc Pathol. 2015 Jan-Feb;24(1):56-9.

Module 3: Cardiac Transplant

Overview

Transplant endomyocardial biopsies are commonly encountered in clinical practice at centers that actively perform heart transplants, but formal training on how to handle them is lacking. The International Society for Heart and Lung Transplantation (ISHLT) has long advocated for a standardized approach to the handling and reporting of these biopsies. Pathologists and clinicians alike must also be aware of the value and limitations of newer ancillary diagnostic techniques such as those that aid in the diagnosis of antibody-mediated rejection. This module aims to familiarize participants with the fundamentals of handling and reporting of endomyocardial biopsy specimens. Specifically, the course will address information that is relevant and actionable for clinicians.

Objectives

After completing this module, participants should be able to:

  • Review the fundamental approaches to handling endomyocardial biopsy specimens.
  • Explain the reporting structure and recommendations of the International Society for Heart and Lung Transplantation.
  • Describe the current trends in cardiac allotransplantation.

Module

Handout

References

  1. Thiene G, et al. AECVP and SCVP 2009 recommendations for training in cardiovascular pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2010;19:129-35.
  2. Stone JR, et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2012;21:2-16.
  3. Leone O, et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology. 2012;21:245-74.
  4. Maleszewski JJ, Kucirka LM, Segev DL, Halushka MK. Survey of current practice related to grading of rejection in cardiac transplant recipients in North America. Cardiovasc Pathol. 2011 Sep-Oct;20(5):261-5.
  5. Kucirka LM, Maleszewski JJ, Segev DL, Halushka MK. Survey of North American pathologist practices regarding antibody-mediated rejection in cardiac transplant biopsies. Cardiovasc Pathol. 2011 May-Jun;20(3):132-8.
  6. From AM, Maleszewski JJ, Rihal CS. Current status of endomyocardial biopsy. Mayo Clin Proc. 2011 Nov;86(11):1095-102.

Module 4: Pericardial Disease

Overview

Cardiovascular specimens are commonly encountered in clinical practice, but formal training on how to handle them is lacking. Both the Society for Cardiovascular Pathologists (SCVP) and the Association for European Cardiovascular Pathology (AECVP) have recognized the need for a uniform approach to the handling and reporting of cardiovascular specimens. Pathologists and clinicians alike must also be aware of the value and limitations of newer ancillary diagnostic techniques such as genetics and proteomics. This module aims to familiarize participants with the fundamentals of handling surgery- and biopsy-derived pericardial specimens. Specifically, the course will address information that is relevant and actionable for clinicians. It also seeks to inform participants about the emerging technologies available to help inform diagnoses and clinical practice.

Objectives

After completing this module, participants should be able to:

  • Describe the fundamental approaches to handling pericardial specimens (both surgery- and biopsy-derived).
  • Explain the impact of emerging ancillary tools such as microbiologic studies (including molecular microbiology methods), and immunohistochemistry.
  • Synthesize clinically actionable information that is essential to convey to care providers and, ultimately, the patient and/or the patient’s family.

Module

Handout

References

  1. Thiene G, et al. AECVP and SCVP 2009 recommendations for training in cardiovascular pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2010;19:129-35.
  2. Stone JR, et al. Recommendations for processing cardiovascular surgical pathology specimens: a consensus statement from the Standards and Definitions Committee of the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology. Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2012;21:2-16.
  3. Leone O, et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology. 2012;21:245-74.
  4. Brinkman CL, et al. PCR-electrospray ionization mass spectrometry for direct detection of pathogens and antimicrobial resistance from heart valves in patients with infective endocarditis. Journal of clinical microbiology. 2013;51:2040-6.
  5. Castonguay MC, et al. Surgical pathology of native valve endocarditis in 310 specimens from 287 patients (1985-2004). Cardiovascular pathology: the official journal of the Society for Cardiovascular Pathology. 2013;22:19-27.
  6. Castonguay MC, et al. Surgical pathology of atrial appendages removed during the cox-maze procedure: a review of 86 cases (2004 to 2005) with implications for prognosis. The American journal of surgical pathology. 2013;37:890-7.
  7. Larsen BT, et al. Surgical pathology of hypothenar hammer syndrome with new pathogenetic insights: A 25-year institutional experience with clinical and pathologic review of 67 cases. The American journal of surgical pathology. 2013;37:1700-8.
  8. Loporcaro CG, et al. Confirmation of cause and manner of death via a comprehensive cardiac autopsy including whole exome next-generation sequencing. Archives of pathology & laboratory medicine. 2014;138:1083-9.
  9. Maleszewski JJ, et al. PRKAR1A in the development of cardiac myxoma: a study of 110 cases including isolated and syndromic tumors. The American journal of surgical pathology. 2014;38:1079-87.
  10. Neuville A, et al. Intimal sarcoma is the most frequent primary cardiac sarcoma: clinicopathologic and molecular retrospective analysis of 100 primary cardiac sarcomas. The American journal of surgical pathology. 2014;38:461-9.

Faculty

Joseph Maleszewski, MD, FCAP, FACC
Joseph Maleszewski, MD, FCAP, FACC
Associate Professor of Laboratory Medicine and Pathology and Medicine
Divisions of Anatomic Pathology, Cardiovascular Diseases, and Molecular Genetics
Mayo Clinic College of Medicine
Mayo Clinic, Rochester, Minnesota

Faculty Disclosure

Course director(s), planning committee, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty members also will disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentations.

Joseph Maleszewski, M.D. has disclosed the following:
Financial relationships with industry - None
References to off-label and/or investigational usage(s) of pharmaceuticals or instruments - None

National Physician Payment Transparency Program

Mayo Medical Laboratories is not an applicable manufacturer or applicable group purchasing organization (GPO). (GPOs, per the Centers for Medicare & Medicaid Services, and this program do not trigger any reporting requirements pursuant to Open Payments [Sunshine Act] legislation.)

Credit

The following types of credit are offered for our Cardiovascular Pathology modules:
AMA PRA Category 1 Credit™
Category 1 CME Self-Assessment credit

To obtain credit:

  1. Complete the learning module.
  2. Complete the post test/evaluation (link provided upon module purchase).
  3. Generate and print your certifcate.

For an instruction sheet that describes the process, see http://www.cme-evaluations.com/instructions.pdf.

Mayo Clinic College of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Mayo Clinic College of Medicine designates this Enduring Material for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Mayo Clinic School of Continuous Professional Development is approved by the American Board of Pathology (ABP) to offer SAMs for meeting ABP requirements for maintenance of certification (MOC). This activity has been approved for Category 1 CME Self-assessment credit per module. In compliance with ABP requirements, physicians must attain a score of 80% or higher on the posttest to obtain a certificate. Participants are allowed two attempts to pass.

Cardiovascular Surgical Pathology provides Category I CME Self-assessment credit toward Part 2 of the ABPath MOC Program.

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