Pathology Service

Target population

All populations.
What is the service about?

The Pathology Service has as an aim the study of anatomic and physiologic disorders caused by a disease through the analysis of samples of tissue, organ and body fluids.

Pathologists use different morphologic, molecular, microbiologic and immunologic techniques in order to define the biochemical, structural, genetic and functional changes occurring within cells, tissues and organs in response to aggressions.

The objective of the Pathology Service is, therefore, to explain the effects and the course of a disease, providing a precise and timely diagnosis which provides physicians with a well-founded base for establishing treatment and prognosis factors, as well as the evaluation of a patient’s response to pre-established therapies.

 

 

Test Portfolio

A wide portfolio of special techniques is available at the Service, in order to provide high level coverage for the analysis of medical and surgical cases of high complexity using cutting-edge technology for studies of:

  • General pathology.
  • Specialized pathology.
  • Molecular pathology.
  • Cytopathology.
  • Flow cytometry.

Services offered are:

  • First medical diagnosis.
  • Second medical diagnostic.
  • Biopsy, cytology, fine needle aspiration cytology, intra-operative studies.
  • Histochemical, immunohistochemical and in-situ hybridization studies.
  • Molecular markers analysis and cytofluorographic analysis.

 

Fundación Valle del Lili’s Pathology Service works in association with the Clinical Laboratory and the Blood Bank constituting a single department. It supports our university hospital, an institution of reference and high complexity, with a full team of medical and healthcare professionals specialized and subspecialized, who provide an excellent service.

Subdivisions in specialized work groups defined by type of pathology allow pathologist deepening their knowledge in a specific area; as a result, they are constantly updating their skills in accordance with the complexity of the cases managed by our institution.

Our Service has automatized all processes, from sample reception to results delivery; this allows for verification and traceability, migrating reports in real time to the general information system, in order to grant immediate availability for treating physicians.

The Pathology Service has internal (real time verifications) and external (comparative review against international benchmarks) quality control programs, duly standardized and documented to ensure adherence to best practices and compliance with all national and international standards.

The Service has groups specialized in different areas; this makes possible to increase knowledge in such areas, transforming the service in a national referent, which is why many students from different universities of the country in their first or second specialty training come to our clinic to complete their residency.

Work groups

  • Cytopathology
  • Dermatopathology.
  • Hematopathology.
  • Renal Pathology.
  • Neuropathology.
  • Endocrine pathology and head and neck pathology.
  • Gastrointestinal Pathology and Pancreatobiliary Pathology.
  • Genitourinary pathology.
  • Mammary pathology.
  • Bone and soft tissue pathology.
  • Pediatric and Perinatal pathology.
  • Pulmonary pathology.
  • Transplant pathology
  • Liver Pathology and Cardiovascular Pathology.

Provides diagnostic services for all types of cytology samples, including:

–Gynecological cytology (conventional cytology and systems for HPV detection).

–Non-gynecological cytology, such as bronchoalveolar lavage, cerebrospinal fluid, pleural fluid, ascites and pericardial fluid (liquid-based cytology).

–Fine needle aspiration cytology of superficial and deep tissues.

Aspiration cytology

As a pioneer institution in the country, Fundación Valle del Lili implements the ROSE (Rapid On-Site Evaluation) technique, which consists of real-time microscopic evaluation of the material collected during ultrasound control, computed tomography (CT), EBUS (Endobronchial Ultrasound) or endoscopic ultrasound. This technique provides immediate feedback on the quality of the material collected, minimizing second interventions and enhancing diagnosis timeliness.

Also, advanced adjuvant techniques, such as immunocytochemistry and molecular techniques to detect diagnostic and prognostic markers in cancer patients are being developed in this area.

6 cyto-histotechnologists and a team of pathologists are part of the cytopathology group, which is coordinated by Dr. Juliana Escobar Stein, MD PhD.

 

      

The Dermatopathology team has specialists with advanced training, following processes and using technologies clinically validated for the diagnosis of skin, hair and nail diseases. Our team supports treating dermatologists in order to solve clinical cases rendering an adequate clinical-pathological correlation as well as providing teaching support to future specialists.

The Dermatopathology Service offers:

  • Frozen section biopsy (Mohs technique): Diagnostic support in oncologic resection.
  • Biopsy analysis:  Study of tissues and skin surgical specimens using routine staining.
  • Histochemistry and immunohistochemistry: Tests additional to routine staining (haematoxylin and eosin) performed on biopsy samples to identify lesions.
  • Immunofluorescence: used for the diagnosis of autoimmune diseases, where your immune system loses control and attacks your body organs. This technique is performed after obtaining a skin or mucosa biopsy.
  • Referrals to specialized care and revisions: Second opinions for microscopic diagnosis in complex cases, both for the general and clinical pathologist.

Work group

 Liliana Muñoz MD.
Bladimir Pérez MD.

Carlos Jiménez MD.

 

Hematological neoplasms are a group of diseases that arise from the malignant behavior of hematopoietic cells (which generate blood) whose characteristics differ according to the state of cellular maturity, including acute and chronic myeloid neoplasms, mature and immature lymphoid neoplasms and histiocytic proliferations.

The Hematopathology Service is a department for clinical diagnosis with a team of qualified professionals whose objective is offering comprehensive diagnosis for patients with suspected hematolymphoid neoplasms.

Different types of samples are analyzed, from body fluids to fresh tissues, fixed in formaldehyde or sent from other institutions in viable media, using different advanced and high-complexity techniques such as immunohistochemistry, flow cytometry, molecular genetics, cytogenetics and FISH (Fluorescence In-situ Hybridization), to establish a specific diagnosis.

In order to study this type of pathologies, the Service performs the following:

-Hematoxylin and Eosin, Immunohistochemistry: Protocols for adequate sample monitoring and handling are followed, as well as a wide range of immunohistochemical antibodies for diagnosis, classification and prognosis in these neoplasms. We perform In situ Hybridization for Epstein Barr, Kappa and Lambda viruses identification.

-Flow cytometry: In order to study peripheral blood samples, 2 flow cytometers with 3 lasers are used, which analyze fluorescent signals in 10 colors or wavelengths, complemented by a wide range of antibodies for diagnosis, classification and monitoring of hematolymphoid neoplasms.

Standardized studies available:

  • Immunophenotype for leukemias and lymphomas.
  • Paroxysmal nocturnal hemoglobinuria.
  • B-, T- and NK- cell subpopulations.
  • HLA B27.
  • Stem Cell count.

-Karyotypes in peripheral blood and bone marrow.

Chimerism: bone marrow transplant and B- and T- cell populations

FISH: Fluorescent In-situ Hybridization studies are performed in acute leukemia, myelodysplastic, myeloproliferative and lymphoma syndromes..

– t(9;22).
– MLL.
– t(15;17).
– BCL-2.
– BCL-6.
– MYC.

PCR:
– FLT3.
– BCR/ABL p210 y p190, 210, 230.
– PML/RARα.
– NMP1.
– JAK 2.

Pathologists in this team are trained in hematopathology and flow cytometry at the Hospital Clínic of Barcelona and are members of national and international scientific societies, such as the Colombian Association of Pathology (ASOCOLPAT), the Latin American Society of Hematopathology and the European Association for Hematopathology.

Work Team

 Nhora María Silva Pérez, MD.
Juan Carlos Bravo Ocaña, MD.

The Renal Pathology Service performs specialized studies of renal diseases, such as glomerulopathy, as well as native renal biopsies and post-transplant biopsies.

It provides a customized service and immediate reporting of results and diagnoses within the first 24-48 hours:

  • Preliminary results and important observations are immediately communicated by telephone, in order to allow the treating physician to take prompt therapeutic decisions.
  • Final reports are sent by email to the treating physician.

Clinical-pathological correlation is performed for all renal biopsies in alignment with pediatric and adult nephrology groups through a teamwork approach.

Pathologists of this discipline have received training abroad: University of North Carolina at Chapel Hill and John Hopkins Hospital. Physicians develop their research interests through the Nephrology research team of Fundación Valle del Lili; they have participated in national and international congresses, such as ASN (American Society of Nephrology), CAP (College of Ameican Pathologists), RPS, and have authored and co-authored indexed articles.

In addition to conventional histology and histochemistry technologies, conventional immunofluorescence (IgG, IgM, IgA, C3, Ciq, kappa and lambda light chains, and fibrinogen) and electron microscopy, our laboratory offers an extensive antibodies panel for immunohistochemistry and special immunofluorescence.

  • Immunofluorescence study for Alport Syndrome and phospholipase A2 study for primary membranous nephropathy.
  • Immunohistochemistry studies for myoglobin, hemoglobin A, amyloid AA.

 Work Team

Carlos Andrés Jiménez, MD .
Ana Maria Arrunategui, MD.

    

 

 

Neuropathologists are responsible of studying diseases of the central nervous system (tumoral and non-tumoral), and muscle and peripheral-nerve pathologies. Pathologists of the department use new generation techniques for a comprehensive study of their cases.

Fundación Valle del Lili’s Neuropathology Service works on several research lines of great interest to the community and currently focuses on academic concerns such as: high-grade glioma lesions, neurodegenerative diseases, a variety of muscle pathologies, among others. Specialists in this department participate in national and international academic activities and have authored articles in international and highly recognized indexed journals.

The Neuropathology team conducted its training at the University Hospital of Bellvitge Institute of Neuropathology of the University of Barcelona. They also have participated as a members of the International Neuropathology Medical Consultation Team and permanently receive cases to be discussed and reviewed at a national and international level.

In addition to histology, cytology and histochemistry conventional technologies, the laboratory offers an extensive antibodies panel for immunohistochemistry, electron microscopy and molecular pathology studies.

Work Team

Luis Alberto Escobar Florez. MD, MEd.
Luz Fernanda Sua MD, PhD.

 

This group of specialist physicians assess benign and neoplastic lesions, diagnosing common and complex cases of oral cavity, oropharynx, larynx and traquea, sinonasal tract, salivary gland and thyroid pathologies.

Pathologists of this discipline have been trained in Head and Neck and Endocrine Pathology at Yale University – New Haven Hospital, Connecticut (United States) and at the University Hospital 12 de octubre, Madrid (Spain).

Diagnostic services specialized in the management of these pathologies include:

  • Morphological interpretation of tissue biopsies and surgical specimens.
  • Immunohistochemical assessment with an extensive antibodies panel.
  • In-situ Hybridization of HPV (Human Papillomavirus) and EBV (Epstein-Barr virus).
  • Detection of ETV6 gene rearrangements by Fluorescent In Situ Hybridization (FISH).
  • Molecular analysis of thyroid tumors, including detection of BRAF V600E.
  • Consultation / second opinion on complex cases.

Work Team

Juliana Escobar Stein, MD PhD. 
Bladimir Pérez, MD, MSc (c).
Ana María Arrunátegui, MD, MSc.

This group of specialists offer specialized diagnostic and testing services for a large number of biopsies and complex surgical resection gastrointestinal and pancreatic samples. They assess a wide variety of neoplastic and non-neoplastic conditions.

Additionally, specialized laboratory tests are performed, including Her2/neu by IHC and FISH, as well as immunohistochemical studies of virus and DNA repair proteins in order to determine microsatellite instability, EGFR mutation, KRAS mutation and BRAF mutation, for diagnosis, prognosis and treatment of patients with gastrointestinal diseases.

Work Team

Juan Carlos Bravo, MD. 
Juliana Escobar Stein, MD PhD. 
Nancy Vargas, MD. 
Luisa Valencia, MD. 
Marcela Botero, MD. 

 

 

 

 

This group studies neoplasic and non-neoplasic disorders of the prostate, bladder, testicles and adnexa, ureter and urethra and penis. They play an active role in the Prostate Center of Excellence, which has the participation of a genitourinary pathologist trained in The Johns Hopkins Hospital.

Second opinions for genitourinary malignancies are issued for defining clinical-surgical management.

Work Team

Carlos Andrés Jiménez, MD.
Luis Alberto Escobar Florez, MD, MEd.
Clara Campos, MD.

 

 

The mammary pathology group evaluates benign and malignant breast tissue samples coming from thick needle biopsies, quadrantectomies and mastectomies, in addition to the examination of sentinel lymph nodes for adequate staging and prognosis of breast cancer.

Additional to the conventional histologic and cytologic evaluation of anatomic specimens, pathologists use cutting-edge diagnosis and prognosis tools, such as such as

Molecular Pathology

  • Fluorescence In-Situ Hybridization  (FISH) or studying HER2 gene amplification
  • Tumor selection for the 21-gene assay
  • Immunohistochemistry tests: Hormone receptors, HER2 and Ki-67. Multiple markers are used for myoepithelial cells evaluation and the study of benign and malignant mammary gland tumors.
  • Digital Pathology: Cutting-edge equipment for a safe molecular characterization approved by the US Food and Drug Administration  (FDA).

Members of the team develop their interest in research through the mammary pathology multidisciplinary research line of the Breast Cancer group of excellence. Our pathologists have specialized in oncological and mammary pathology at international centers including Hospital Clinic of Barcelona, San Carlos Clinical Hospital of Madrid, Fundación Jiménez Díaz of Madrid and at National centers, such as the National Institute of Cancerology

Work Team

Carmenza Macías Mejía. MD.
Luz Fernanda Sua MD, PhD. 
Luisa Valencia,  MD.
Nancy Vargas MD.
Marcela Botero MD.

 

 

 

The team of Bone and Soft Tissue Pathology provides a comprehensive evaluation of neoplastic and non-neoplastic diseases of the musculoskeletal system in patients of all ages by correlating clinical, radiological information and morphological findings.

The laboratory offers the following tests for these pathologies: conventional cytology and ROSE (Rapid On Site Evaluation)-lead cytological study, conventional optical studies with Hematoxylin and Eosin staining, immunohistochemistry, electron microscopy and molecular pathology.

Molecular pathology techniques include:

  • B-RAF gene mutations by PCR
  • EWSR1 gene rearrangements by Fluorescent In Situ Hybridization (FISH).
  • SYT gene rearrangements by Fluorescent In-Situ Hybridization (FISH).
  • CHOP (DDIT3) gene rearrangements by Fluorescent In-Situ Hybridization (FISH).
  • ETV6 gene rearrangements by Fluorescent In Situ Hybridization (FISH).

Research interests focus on the molecular pathology of sarcomas and melanomas. Academic production is made public to the international scientific community, mainly through national and international congresses celebrated by ASOCOLPAT (Colombian Association of Pathology), SEAP (Spanish Society of Anatomical Pathology) and GEIS (Spanish Group for Research on Sarcoma).

Pathologists have received training in this type of pathologies at internationally recognized institutions, including the University Hospital 12 de Octubre in Madrid and the Hospital Clínic of Barcelona, and are part of national and international scientific societies, such as ASOCOLPAT, SLAP, SEAP, GEIS and SPP (Society for Pediatric Pathology).

Work Team

Bladimir Pérez Hurtado, MD.
Nhora María Silva Pérez, MD.
Clara I Campos, MD.

Pediatric and perinatal pathologies have unique clinical, histopathologic and molecular characteristics, which makes them different from adult pathologies, thus requiring a differentiated approach. Fundación Valle del Lili has dedicated a specialized group in this area, directed by a pediatric and perinatal pathologist, who received training at McMaster University in Canada.

By performing perinatal autopsies under the highest quality standards, families are provided answers about adverse outcomes and their possible consequences in a future pregnancy, giving them the necessary tools for informed decision making.

Work Team

Clara Campos, MD.  
Luisa Valencia, MD.  

Bladimir Pérez, MD. MSc. (c)

 

The pulmonary pathology team evaluates non-neoplastic and neoplastic specimens as well as lung transplantation specimens. Pathologists of this service use molecular pathology techniques, immunohistochemistry and ultrastructural study techniques.

The Chest biomedical research line of Fundación Valle del Lili’s clinical research group develops research interests, with their participation at national and international congresses by entities such as ATS (American Thoracic Society), ARS, ALAT(Latin American Association of Thorax), IASLC (International Association for The Study of Lung Cancer), and their authorship and co-authorship in indexed articles.

Our pathology physicians have been trained in pulmonary pathology at international centers in the United States, including the Cleveland Clinic in Ohio, and in Europe, such as the Hospital 12 de Octubre of Madrid, and also they have specialized in lung cancer, pulmonary infectious diseases, interstitial lung diseases and lung transplantation. They are members of academic organizations that study pulmonary diseases, such as the American Thoracic Society and the International Association for the Study of Lung Cancer.

In addition to histology, cytology and histochemistry conventional technologies, the laboratory has an extensive antibodies panel available for immunohistochemistry, electron microscopy and molecular pathology studies.

– Scanning Electron Microscopy for the study of cilia 
– Immunofluorescence study for vasculitis 
Molecular pathology examinations:

  • EGFR gene mutation.
  • ROS1 gene mutation
  • Protein expression: EML4-ALK.
  • Protein expression: PDL-1.

Work Team

Luz Fernanda Sua MD, PhD. 
Bladimir Pérez MD, MSc. (c)

 

Fundación Valle del Lili is a national leader in organ transplantation. The Transplant Pathology Service is available 24 hours a day for evaluating explanted organs by frozen biopsy, in order to provide the necessary support to transplant surgeons and ensure selection of the adequate organs for patients who need them by delivering definite results in only 5 hours.

As clinical pathologists, they are in charge of the Transplant Immunology and Immunogenetics laboratory, ensuring compatibility and optimal clinical outcomes.

The Transplant pathology specialist group participates in longitudinal monitoring of transplant patients, providing to the treating physician fundamental support for managing acute and long-term events.

Our pathologist have been trained at international centers such as King’s College and Mount Vernon Hospital in London, they participate in medical boards to provide comprehensive management to patients and conduct their own collaborative research projects.

 Work Team

Ana María Arrunátegui, MD. MSc.

Carlos Andrés Jiménez, MD. 

  

 

This group is irresponsible for neoplastic and non-neoplastic liver and cardiovascular pathology.r.

For case study, routine techniques are used, as well as complementary histochemical, immunohistochemical and molecular tests, responding promptly to treating physicians’ needs and joining them in medical boards and in collaborative research projects.

Our pathologists have received training in international centers as King’s College and Mount Vernon Hospital in London.

Work Group

Ana María Arrunategui, MD. MSc.
Carlos Andrés Jiménez, MD.

Specialist in Pathology Service