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1.
Lab Med ; 50(4): 331-332, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31599961
2.
Am J Clin Pathol ; 152(5): 542-543, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31589749
3.
Am J Clin Pathol ; 151(6): 539-541, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-30918966
4.
Int J Lab Hematol ; 2018 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-30216684

RESUMO

INTRODUCTION: Carcinocythemia is a rare phenomenon defined as morphologically identifiable, circulating tumor cells in the peripheral blood. No modern case series of carcinocythemia exists in the literature. METHODS: Blood smears from carcinocythemia patients were reviewed and associated clinicopathologic findings described and compared to the literature. When available, bone marrows were examined. RESULTS: We identified 7 carcinocythemia cases over 3 years at our institution in 5 females and 2 males with a median age of 57 and compare them to 26 case reports in the literature (19 females, 10 males; median age 57). The primary neoplasms were carcinomas of breast (3 cases), lung, non-small cell (2 cases), prostate (1), and 1 case of unknown primary. Circulating tumor cells were associated with fragmentation hemolysis (2 cases), asplenic RBC changes (3 cases), and myeloid antigen expression by flow cytometry (2 cases) and were most commonly found at the feathered edge of the slide (6 cases) as single cells or in clusters. CONCLUSIONS: This represents the largest series of carcinocythemia reported. The identification of 7 cases at one institution over a 3-year period suggests carcinocythemia may becoming more common. Raising awareness of this entity and its associated clinicopathologic findings may help avoid diagnostic pitfalls in blood smear examinations and may guide timely clinical management.

5.
Am J Clin Pathol ; 2018 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-30165557
6.
Am J Clin Pathol ; 148(6): 485-493, 2017 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-29126177

RESUMO

Objectives: CD30 is a protein thought to promote cell proliferation/survival and downregulate the immune response. Twenty percent to 40% of de novo diffuse large B-cell lymphomas (DLBCLs) express CD30, and some patients have been treated with the anti-CD30 agent brentuximab. In the solid organ transplant setting, allograft regulatory T cells (Tregs) have been shown to be modulated via CD30 signaling. Methods: Posttransplant lymphoproliferative disorders (PTLDs) constitute a heterogeneous group of lymphomas, and since CD30 expression has been rarely formally assessed in PTLDs, we analyzed a cohort of PTLDs. Results: We found that 26 (79%) of 33 PTLDs were CD30+. Of these, 17 (77%) of 22 DLBCL monomorphic PTLDs were CD30+ compared with 56 (38%) of 148 de novo DLBCLs (P = .009). The median FoxP3+ Treg count was higher in CD30+ than in CD30- PTLDs, 3.0 vs 0 (P = .012). Conclusions: These findings suggest a pathophysiologic link between CD30 activity and Tregs and may indicate differential expression of CD30 in B-cell lymphomas arising in the setting of immune dysregulation.


Assuntos
Antígeno Ki-1/metabolismo , Linfoma Difuso de Grandes Células B/patologia , Transtornos Linfoproliferativos/metabolismo , Linfócitos T Reguladores/metabolismo , Adulto , Idoso , Infecções por Vírus Epstein-Barr/patologia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/terapia , Transtornos Linfoproliferativos/terapia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/metabolismo , Segunda Neoplasia Primária/patologia , Linfócitos T Reguladores/patologia , Adulto Jovem
7.
Clin Lab Med ; 37(4): 697-723, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29128065

RESUMO

Flow cytometric evaluation is considered a standard ancillary study for the diagnosis of most B-cell lymphoproliferative disorders. Establishing a neoplastic B-cell population depends on identification of light chain restriction or lack of light chain expression in mature neoplasms and demonstration of aberrant antigen expression in both immature and mature neoplasms, as compared with normal counterparts. The immunophenotypes of the most common B-cell neoplasms are herein described, with an emphasis on their immunophenotypic differential diagnosis and prognostic and therapeutic implications.


Assuntos
Citometria de Fluxo , Linfoma de Células B , Humanos , Imunofenotipagem , Linfoma de Células B/classificação , Linfoma de Células B/diagnóstico
8.
Ann Diagn Pathol ; 29: 23-27, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28807337

RESUMO

OBJECTIVES: CD43 is normally expressed only on the surface of leukocytes, and is considered a sensitive and specific marker for hematologic malignancies. As such, it may have diagnostic utility in confirming hematolymphoid lineage in cases that are negative for CD45. Aberrant CD43 expression has been described in non-hematopoietic tumors, although literature data on this topic is variable and sometimes contradictory. To clarify and expand on existing literature findings, we evaluated CD43 expression by immunohistochemistry (IHC) in a large cohort (307) of non-hematopoietic neoplasms, including poorly differentiated malignancies. METHODS: 17 tissue microarrays and sections from 19 individual cases were stained with CD43 (clone DF-T1) monoclonal antibody. The proportion of positive cells, stain localization (nuclear, cytoplasmic or membranous), and intensity (compared to internal leukocyte controls) were recorded in all cases. RESULTS: There were 98/307 (32%) positive cases, that showed focal weak nuclear staining in 1-25% of cells, including 23/25 (92%) pancreatic ductal adenocarcinomas; 31/34 (91%) breast invasive ductal carcinomas; 13/15 (87%) papillary thyroid carcinomas; 3/4 (75%) follicular thyroid carcinomas; 6/15 (40%) renal cell carcinomas; 9/28 (32%) lung adenocarcinomas; 1/13 (8%) lung squamous cell carcinomas (SCCs); 2/8 (25%) prostate adenocarcinomas; 8/62 (13%) colon adenocarcinomas; and 2/21 (10%) neuroendocrine neoplasms. None of the positive cases demonstrated strong, membranous CD43 expression comparable to that seen in background mature lymphocytes or segmented neutrophils. Negative cases included 11 cervical SCCs, 12 cervical adenocarcinomas, 19 urothelial carcinomas, 10 lung small cell carcinomas, 11 sarcomas, and 19 poorly differentiated carcinomas from various tissue sites. CONCLUSIONS: In our cohort, most non-hematopoietic neoplasms are negative for CD43 expression, with a subset showing focal, weak nuclear positivity. This data indicates that uniform and strong membranous staining appears to be specific to hematopoietic neoplasms.


Assuntos
Biomarcadores Tumorais/metabolismo , Leucossialina/metabolismo , Neoplasias/metabolismo , Feminino , Neoplasias Hematológicas/metabolismo , Neoplasias Hematológicas/patologia , Humanos , Imuno-Histoquímica/métodos , Masculino
9.
Ann Diagn Pathol ; 25: 15-19, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27806839

RESUMO

OBJECTIVES: Proliferation centers (PCs) are a characteristic finding in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) lymph nodes, and their presence and extent in this site are not currently felt to be related to clinical course. In contrast, detailed clinicopathologic analyses of bone marrow (BM) PCs have not been previously reported. METHODS: The PCs in 88 CLL/SLL BMs from 45 patients (pts) were graded (0-4) and were correlated with other morphologic, immunophenotypic, cytogenetic, and laboratory features. RESULTS: Proliferation centers were present in 69 BMs (78%) from 32 pts (71%) and were distinct/prominent (grades 2-4) in 21 pts (47%), with the latter more commonly found in follow-up BMs (1/7 diagnostic BMs vs 49/81 follow-up BMs; P=.04). When present, PCs were most commonly graded as distinct nodules easily visible on ×10. No relationships were identified between PCs and any complete blood count parameter, serum lactate dehydrogenase or IgG levels, degree or pattern of BM involvement, blood morphology, CD38 and FMC7 expression by flow cytometry, or fluorescence in situ hybridization results, when the first encountered BM was considered for each patient. CONCLUSIONS: This represents the first detailed analysis of PCs in CLL/SLL BMs. In our tertiary center, PCs were seen frequently, in approximately three-fourths of cases. There were no statistical associations identified between PCs and cytogenetic, immunophenotypic, or other laboratory and morphologic findings.


Assuntos
Medula Óssea/patologia , Proliferação de Células/fisiologia , Leucemia Linfocítica Crônica de Células B/patologia , Linfonodos/patologia , Linfoma de Células B/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Citometria de Fluxo/métodos , Humanos , Imunofenotipagem , Hibridização in Situ Fluorescente/métodos , Linfoma de Células B/diagnóstico , Masculino , Pessoa de Meia-Idade
10.
11.
Am J Clin Pathol ; 146(2): 170-81, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27413139

RESUMO

OBJECTIVES: We sought to immunophenotype blasts, monocytes, and granulocytes in chronic myelomonocytic leukemias (CMMLs) and compare CMML subtypes, to identify if significant antigen expression differences existed. METHODS: Bone marrow blasts, monocytes, and granulocytes from CMML subgroups (n = 30; World Health Organization types 1/2, proliferative/dysplastic, therapy related/de novo, and low/intermediate/high cytogenetic risk) were immunophenotypically compared by flow cytometry with 10 nonneoplastic control marrows. RESULTS: Aberrancies were present in blasts of 26 (87%) of 30 CMMLs (26 diagnostic; four follow-up) and six (60%) of 10 controls (P = .089), monocytes of 28 (93%) of 30 CMMLs and six (60%) of 10 controls (P = .026), and granulocytes of eight (28%) of 29 CMMLs and zero of 10 controls (P = .166). Underexpression of CD14 and CD15 on monocytes was more common in CMMLs compared with controls (P = .008 and P = .043). Statistical analysis showed no significant difference in antigen expression between the CMML subgroups on blasts or monocytes; granulocytes demonstrated more common HLA-DR expression in CMML-2 vs CMML-1. CONCLUSIONS: These findings confirm heterogeneity within CMML subgroups and find no specific qualitative or quantitative findings characteristic of a subgroup.


Assuntos
Imunofenotipagem/métodos , Leucemia Mielomonocítica Crônica/patologia , Idoso , Idoso de 80 Anos ou mais , Antígenos CD/análise , Biomarcadores Tumorais/análise , Feminino , Citometria de Fluxo , Humanos , Leucemia Mielomonocítica Crônica/classificação , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Am J Clin Pathol ; 145(4): 538-51, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27124944

RESUMO

OBJECTIVES: Pure erythroid leukemia (PEL) is an extremely rare entity that may, even more rarely, evolve from a preexisting chronic myeloid neoplasm (CMN); there is minimal literature regarding this latter phenomenon. METHODS: We describe 14 patients with PEL that represented progression from a preexisting myelodysplastic syndrome (MDS, n = 8) or myeloproliferative neoplasm (MPN, n = 6), three of which manifested as erythroblastic sarcoma (EBS), a rare entity. These patients had a highly complex karyotype with prominent clonal evolution and a very aggressive clinical course. RESULTS: Patients with PEL from MDS showed a more rapid progression time to PEL and had lower platelet counts compared with PEL from MPN. No other significant differences were found between the two groups. CONCLUSIONS: These data represent the largest cohort of patients with PEL and an antecedent CMN, as well as the largest series of EBS reported to date, and underscore the unique morphologic, cytogenetic, immunophenotypic, and clinical features of this uncommon entity.


Assuntos
Leucemia Eritroblástica Aguda/patologia , Transtornos Mieloproliferativos/patologia , Adulto , Idoso , Progressão da Doença , Feminino , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade
15.
Am J Clin Pathol ; 138(6): 867-76, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23161721

RESUMO

The majority of plasma cell myelomas (PCMs) are positive for CD200, a membrane protein with immunosuppressive function. There are no flow cytometry data in the literature on plasma cell CD200 expression in other immunoproliferative disorders. Therefore we used flow cytometry to study the expression of CD200 on plasma cells in diagnostic bone marrow aspirates from 61 patients with monoclonal gammopathy of undetermined significance (MGUS) and 10 patients with lymphoplasmacytic lymphoma (LPL). For comparison, we evaluated CD200 expression in 74 PCM bone marrow biopsies. Thirty-three (54.1%) of 61 MGUS cases and 2 (20.0%) of 10 LPL cases were CD200+. Comparative clinicopathologic parameters for MGUS cases, based on CD200 expression status, showed no differences between the 2 groups. The proportion of CD200+ PCMs (73.0%) in our series was significantly higher than that of CD200+ MGUS (P = .030) and CD200+ LPL (P = .002) cases.


Assuntos
Antígenos CD/metabolismo , Transtornos Imunoproliferativos/imunologia , Mieloma Múltiplo/imunologia , Plasmócitos/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/imunologia , Medula Óssea/metabolismo , Medula Óssea/patologia , Feminino , Citometria de Fluxo , Humanos , Imunofenotipagem , Transtornos Imunoproliferativos/metabolismo , Transtornos Imunoproliferativos/patologia , Masculino , Pessoa de Meia-Idade , Gamopatia Monoclonal de Significância Indeterminada/imunologia , Gamopatia Monoclonal de Significância Indeterminada/metabolismo , Gamopatia Monoclonal de Significância Indeterminada/patologia , Mieloma Múltiplo/metabolismo , Mieloma Múltiplo/patologia , Plasmócitos/metabolismo , Plasmócitos/patologia , Macroglobulinemia de Waldenstrom/imunologia , Macroglobulinemia de Waldenstrom/metabolismo , Macroglobulinemia de Waldenstrom/patologia
16.
Am J Blood Res ; 2(2): 128-35, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22762032

RESUMO

INTRODUCTION: T-cell subset enumeration in HIV patients is routinely performed for monitoring infection stage and response to antiretroviral therapy. Studies have examined the effect of specimen refrigeration and age for single-platform (SP) methods, but there is limited data for time and temperature requirements of dual-platform (DP) methods. METHODS: Using a DP method, we analyzed peripheral blood (PB) from 52 HIV patients at room temperature (RT) at 24, 72, and 96 hours. PBs from 34 HIV patients had baseline RT analysis within 24 hours, and then were refrigerated and analyzed at 24, 48, and 72 hours. The coefficient of variation (CV) and residuals (changes in lymphocyte subsets) were recorded at each time point and compared to assess the precision and bias under the various conditions. Testing performance under different conditions was compared by linear regression. RESULTS: Mean CV was ≤7.3% and median residuals were <30/µl for absolute CD4 and CD8 determinations. There was good correlation between baseline analysis data at RT and at various time points, both at RT and 4°C. CONCLUSIONS: Our results are similar to those published for SP methods for aging or refrigerated specimens. The high level of agreement between measurements supports the robustness of this DP methodology.

18.
Am J Clin Pathol ; 137(5): 800-4, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22523220

RESUMO

CD45/side scatter (SS) gating is widely used for isolating blasts by flow cytometry (FC). However, other cells contaminate the "blast gate" (BG); CD45/SS gating is thus imprecise, particularly when there are few blasts. We studied the BG contents in 21 myelodysplastic syndromes (MDSs), 14 myeloproliferative neoplasms (MPNs), 7 chronic myelomonocytic leukemias (CMMLs), and 40 nonneoplastic control samples using 4-color FC with cluster analysis. There were no significant differences across groups in the median percentage of BG events represented by blasts (14.7%-22%), granulocytes (23.3%-33.2%), lymphocytes (2.1%-3.2%), and erythroids (1.0%-9.8%). Monocytes were a larger percentage of BG events in CMML (24.2%). Basophils averaged 35.4% of the BG in MPNs. The percentage of blasts within the BG averaged 94.2% in control samples vs 88.2% in MDSs and 80.7% in CMMLs. Blasts averaged about 20% of events in the BG. About 10% to 20% of blasts fell outside the BG in CMMLs and MDSs. Our data highlight pitfalls in using a traditional BG for blast analysis in nonacute myeloid disorders.


Assuntos
Citometria de Fluxo/métodos , Imunofenotipagem/métodos , Leucócitos/imunologia , Síndromes Mielodisplásicas/imunologia , Humanos
19.
Am J Clin Pathol ; 137(3): 403-11, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22338052

RESUMO

Flow cytometry (FC) is frequently used to detect aberrant peripheral blood (PB) T cells ("Sézary cells") in patients with mycosis fungoides (MF) and Sézary syndrome (SS). However, immunophenotypic stability of MF/SS over time is not well characterized. We analyzed 141 PB samples from 9 cases (2 SS, 7 MF). At diagnosis, there were 3 to 5 immunophenotypic aberrancies per case (median, 4), including dim or absent CD2, CD3, CD4, CD5, CD7, or CD26 and bright CD45RO. Of 9 patients, 7 had a subsequent change in immunophenotype. All patients retained multiple aberrancies at follow-up (median, 3 per analysis; range, 2-6), of which 22.0% (81/369) were new. In 5 patients, a more than 99% decrease in absolute Sézary cell (ASC) counts by FC after alemtuzumab therapy or total skin electron beam radiation was associated with clinical improvement. We observed minor immunophenotypic changes over time in most patients with MF/SS; however, the Sézary clones maintain persistently aberrant immunophenotypes and seem amenable to follow-up with limited FC panels. ASC counts by FC correlated well with clinical response.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Antineoplásicos/uso terapêutico , Antineoplásicos/uso terapêutico , Citometria de Fluxo/métodos , Micose Fungoide/diagnóstico , Síndrome de Sézary/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Alemtuzumab , Biomarcadores Tumorais/metabolismo , Contagem de Células Sanguíneas , Monitoramento de Medicamentos , Feminino , Humanos , Imunofenotipagem , Masculino , Pessoa de Meia-Idade , Micose Fungoide/tratamento farmacológico , Micose Fungoide/metabolismo , Síndrome de Sézary/tratamento farmacológico , Síndrome de Sézary/metabolismo
20.
Am J Surg Pathol ; 36(4): 534-43, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22301495

RESUMO

Gamma heavy-chain disease (gHCD) is defined as a lymphoplasmacytic neoplasm that produces an abnormally truncated immunoglobulin gamma heavy-chain protein that lacks associated light chains. There is scant information in the literature regarding the morphologic findings in this rare disorder, but cases have often been reported to resemble lymphoplasmacytic lymphoma (LPL). To clarify the spectrum of lymphoproliferative disorders that may be associated with gHCD, this study reports the clinical, morphologic, and phenotypic findings in 13 cases of gHCD involving lymph nodes (n=7), spleen (n=2), bone marrow (n=8), or other extranodal tissue biopsies (n=3). Clinically, patients showed a female predominance (85%) with frequent occurrence of autoimmune disease (69%). Histologically, 8 cases (61%) contained a morphologically similar neoplasm of small lymphocytes, plasmacytoid lymphocytes, and plasma cells that was difficult to classify with certainty, whereas the remaining 5 cases (39%) showed the typical features of one of several other well-defined entities in the 2008 WHO classification. This report demonstrates that gHCD is associated with a variety of underlying lymphoproliferative disorders but most often shows features that overlap with cases previously reported as "vaguely nodular, polymorphous" LPL. These findings also provide practical guidance for the routine evaluation of small B-cell neoplasms with plasmacytic differentiation that could represent a heavy-chain disease and give suggestions for an improved approach to the WHO classification of gHCD.


Assuntos
Doenças Autoimunes/diagnóstico , Doença das Cadeias Pesadas/diagnóstico , Cadeias gama de Imunoglobulina/sangue , Tecido Linfoide/patologia , Linfoma de Células B/diagnóstico , Macroglobulinemia de Waldenstrom/diagnóstico , Adulto , Idoso , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/genética , Doenças Autoimunes/metabolismo , Biomarcadores Tumorais/metabolismo , Células Clonais , Comorbidade , Análise Citogenética , Feminino , Doença das Cadeias Pesadas/sangue , Doença das Cadeias Pesadas/epidemiologia , Doença das Cadeias Pesadas/genética , Humanos , Cadeias gama de Imunoglobulina/genética , Imunofenotipagem , Hibridização in Situ Fluorescente , Linfócitos/metabolismo , Linfócitos/patologia , Tecido Linfoide/metabolismo , Linfoma de Células B/epidemiologia , Linfoma de Células B/genética , Linfoma de Células B/metabolismo , Masculino , Pessoa de Meia-Idade , Plasmócitos/metabolismo , Plasmócitos/patologia , Fatores Sexuais , Reino Unido/epidemiologia , Estados Unidos/epidemiologia , Macroglobulinemia de Waldenstrom/epidemiologia , Macroglobulinemia de Waldenstrom/genética , Macroglobulinemia de Waldenstrom/metabolismo
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