Small gland proliferations of the breast are a common source of diagnostic difficulty in breast pathology. Benign proliferations such as adenosis and radial scars can be mistaken for invasive carcinoma, and vice versa. Rare lesions such as low-grade adenosquamous carcinoma, microglandular adenosis, and adenomyoepithelioma are also predominately or entirely composed of small glands and may be mistaken for more common benign or malignant entities, with attendant differences in clinical management.  In this presentation, we will review the features of these challenging small gland proliferations, with an emphasis on key histologic findings, diagnostic pearls and pitfalls, and appropriate ancillary diagnostic studies. 

Endometrial biopsies, including pipelles and dilation and curettage, are essential in gynaecological histopathology for diagnosing causes of infertility, abnormal uterine bleeding and malignancies. This session will focus on practical diagnostic challenges, highlighting key "do not miss" diagnoses such as metaplasia, hyperplasia and endometrial carcinoma subtypes. We will explore how these diagnoses directly influence clinical follow-up and treatment, providing valuable insights to enhance your diagnostic skills and guide clinical decision-making. Whether you are a seasoned histopathologist or a trainee, this talk will sharpen your ability to navigate routine cases with confidence and precision.

Rosemary Balleine¹, Lyndal Anderson², Spinder Samra³, Raghwa Sharma³, King Tan⁴, Pamela Provan¹, Cristina Mapagu^1,5, Natalie Bouantoun¹, Nikilyn Nevins¹, Sivatharsny Srirangan¹, Catherine Kennedy⁶, Jessica Boros⁶, Eunice Lee¹, Anna DeFazio^1,6,7 for the INOVATe Investigators. 

¹The Westmead Institute for Medical Research, Faculty of Medicine and Health, The University of Sydney; ²NSW Health Pathology, Royal Prince Alfred Hospital, ³NSW Health Pathology, ICPMR Westmead, ⁴Douglass Hany Moir Pathology, ⁵Department of Medical Oncology, Nepean Hospital, Nepean Blue Mountains Local Health District, ⁶Department of Gynaecological Oncology, Westmead Hospital, Western Sydney Local Health District, ⁷The Daffodil Centre, a joint venture of the Cancer Council NSW and University of Sydney

 

INOVATe is a precision oncology program for ovarian cancer that has enrolled over 800 women in NSW since 2016. All patients with Epithelial Ovarian Cancer (arising from fallopian tube, ovary or peritoneum) were eligible. Participants were preferentially enrolled at diagnosis but could also be enrolled at relapse or disease progression. The objective was to use molecular testing of cancer tissues to align patients with clinical trials at relapse. 

INOVATe conducted around 4000 tissue-based molecular tests including Next Generation Sequencing panel testing to identify relevant mutations, and whole genome DNA copy number analysis to assess homologous recombination DNA repair deficiency (HRD). HRD in high-grade serous ovarian cancer (HGSC), and Mitogen Activated Protein Kinase (MAPK) pathway mutations in non-HGSC were major genomic findings that supported clinical trial recommendations. Molecular results also contributed to genetic testing for inherited variants and provided a useful adjunct to routine histopathology and immunohistochemistry in diagnostic assessment of some cases.

Pathologists have been key contributors to INOVATe. Their role has included expert histopathology review, selecting tissues for testing and participation in multi-disciplinary case discussions. Our experience demonstrates the benefit of a partnership between Pathologists, Oncologists and Researchers in progressing an evidence-based implementation of molecular testing for ovarian cancer.