The Need for Education in Molecular Immunohematology: A Survey of Specialists in Blood Banking.

BACKGROUND: Within transfusion medicine, the education of molecular technologies lacks standardization. OBJECTIVE: To address this problem, we surveyed specialist in blood bank technology (SBBT) programs, immunohematology reference laboratories, and SBBT graduates to define its current state. METHODS: An anonymous online survey (SurveyMonkey) was emailed to the 15 American Association of Blood Banks (AABB) SBBT programs, 59 AABB IRLs, and 82 SBBT graduates. RESULTS: In the didactic portion of the SBBT curriculum, all programs incorporate knowledge base of blood groups, 13 incorporate molecular techniques, and 5 include case studies. Thirteen programs have intentions of expanding the knowledge base in molecular topics. Most IRLs (97%) think SBBT programs should continue to expand molecular knowledge base. Most graduates (94%) believe more molecular topics should be included in the SBBT curriculum; however, only 50% believe they currently apply their molecular knowledge in their post-graduate employment. CONCLUSION: We propose a more descriptive molecular diagnostics curriculum for SBBT programs to help standardize the education of molecular topics.

Metanephric adenoma: the utility of immunohistochemical and cytogenetic analyses in differential diagnosis, including solid variant papillary renal cell carcinoma and epithelial-predominant nephroblastoma.

Metanephric adenoma is a benign renal neoplasm that overlaps in morphology with the solid variant of papillary renal cell carcinoma and epithelial-predominant nephroblastoma. To aid in resolving this differential diagnosis, we investigated the utility of immunohistochemical and molecular analyses in distinguishing between these entities; the first study, to our knowledge, to use a combined approach in analyzing all three tumors. We analyzed 37 tumors originally diagnosed as metanephric adenomas (2 of which we reclassified as papillary renal cell carcinomas), 13 solid variant papillary renal cell carcinomas, and 20 epithelial-predominant nephroblastomas using a combination of immunohistochemistry and fluorescence in situ hybridization (FISH) assessing for trisomy of chromosomes 7 and 17 and loss of Y. Immunohistochemical staining was performed for CK7, AMACR, WT1, and CD57. The combination of CK7-, AMACR-, WT1+, and CD57+ was considered characteristic of metanephric adenoma. Most of the tumors originally diagnosed as metanephric adenomas (31/37) showed the expected staining pattern of metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+). Of the six tumors with discordant immunophenotype, two tumors were reclassified as papillary renal cell carcinoma after cytogenetic workup. It is recommended that all adult cases histologically resembling metanephric adenoma have WT1, CD57, CK7, and AMACR immunohistochemical staining performed. If the staining pattern is characteristic for metanephric adenoma (CK7-, AMACR-, WT1+, and CD57+, including membranous staining), then no other diagnostic tests are indicated. However, if there is a different immunostaining pattern, then we recommend FISH analysis.