American journal of clinical pathology最新文献

{"title":"Correspondence: from incident reporting to predictive safety surveillance: the role of laboratory quality indicators.","authors":"Hala Ahmed Adam Elnour, Andrés Pérez-López, Mohammed Suleiman","doi":"10.1093/ajcp/aqag109","DOIUrl":"https://doi.org/10.1093/ajcp/aqag109","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide-induced pneumatosis intestinalis: a rare but clinically significant gastrointestinal adverse effect.","authors":"Ari Kassardjian, Nafis Shafizadeh","doi":"10.1093/ajcp/aqag108","DOIUrl":"https://doi.org/10.1093/ajcp/aqag108","url":null,"abstract":"<p><strong>Objectives: </strong>Glucagon-like peptide 1 receptor agonists such as tirzepatide are increasingly prescribed to treat type 2 diabetes mellitus and obesity because they improve glycemic control and promote weight loss. Although gastrointestinal adverse effects such as nausea, vomiting, constipation, and delayed gastric emptying are well recognized, very rare cases of pneumatosis intestinalis have also been reported in association with this class of medications. We report the first documented histologic diagnosis of a possible tirzepatide-associated pneumatosis intestinalis.</p><p><strong>Methods: </strong>A 55-year-old man with obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea underwent colonoscopy for evaluation of abdominal pain, constipation, and anal fissures. He had been receiving tirzepatide therapy for approximately 1 year and experienced a 49-pound weight loss. Colonoscopy demonstrated mucosal edema of the cecum and ascending colon.</p><p><strong>Results: </strong>Biopsy specimens of the colon revealed mucosal and submucosal air-filled spaces associated with foreign body-type giant cell reactions and mixed inflammatory infiltrates, including eosinophils and neutrophils, consistent with pneumatosis intestinalis. The patient lacked other recognized risk factors for pneumatosis intestinalis, and his symptoms improved following discontinuation of tirzepatide.</p><p><strong>Conclusions: </strong>As the use of tirzepatide and related glucagon-like peptide 1 receptor agonists continues to increase, awareness of this rare side effect and its characteristic histologic features should facilitate prompt recognition and accurate diagnosis. Reporting these rare events remains essential to refine the safety profile of these increasingly used medications and improve our understanding of their long-term gastrointestinal effects in broader patient populations.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intentionality, audience, and production time: reconsidering TikTok's role in pathology education.","authors":"Muhammad Abu Bakar Moin","doi":"10.1093/ajcp/aqag110","DOIUrl":"https://doi.org/10.1093/ajcp/aqag110","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 4","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and molecular spectrum of VEXAS with multiple UBA1 variants: case study and literature review.","authors":"Riku Das, Ion Prisneac, Emilia Calvaresi, Frank Mularo, Jonathan Pohl, Christine Wensel, Richard D Press, David S Bosler","doi":"10.1093/ajcp/aqag097","DOIUrl":"10.1093/ajcp/aqag097","url":null,"abstract":"<p><strong>Objectives: </strong>VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a rare adult-onset autoinflammatory disorder, caused by a single somatic UBA1 mutation. We report a novel case with 3 independent UBA1-mutated clones and compare its clinical, hematologic, and laboratory features with those of the only 3 previously reported cases harboring multiple UBA1 mutations.</p><p><strong>Methods: </strong>Droplet digital polymerase chain reaction (PCR) and targeted next-generation sequencing of peripheral blood DNA were performed to assess UBA1 variants. Bone marrow specimens were evaluated for morphologic, immunophenotypic, and cytogenetic abnormalities.</p><p><strong>Results: </strong>Clinical and hematologic features included neck swelling, headache, elevated inflammatory markers, leukopenia, macrocytic anemia, and thrombocytopenia. Bone marrow biopsy specimens showed no dysplasia, increased blasts, or cytoplasmic vacuolization. Droplet digital PCR detected atypical positive signals across multiple targets, and next-generation sequencing identified 3 presumed independent UBA1 variants: p.M41V, p.M41L, and c.118-2A > T. Comparison with 3 previously reported VEXAS cases carrying multiple UBA1 variants revealed diverse clinical manifestations, including systemic inflammation, polychondritis, venous thromboembolism, arthritis, and arthralgia, with variable hematologic findings ranging from no neoplasm to myelodysplastic syndrome or multiple myeloma, as well as co-occurring clonal hematopoietic variants.</p><p><strong>Conclusions: </strong>This report describes a novel VEXAS case with multiple UBA1 variants and highlights the clinical and hematologic heterogeneity among patients harboring multiple UBA1 mutations. It also emphasizes the technical challenges in detecting these variants and the importance of sequencing studies for definitive diagnosis in complex or equivocal cases, supporting early identification of UBA1 mutations and closer hematologic surveillance in patients with inflammatory symptoms and cytopenias.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to comment on \"Impact of tumor budding on recurrence risk prediction in stage I-III colorectal cancer: a Swedish cohort study\".","authors":"Shabane Barot, Mikael Andersson-Franko, Sam Ghazi, Ulrik Lindforss, Petri Rantanen, Johannes Blom, Annika Lindblom, Annelie Liljegren","doi":"10.1093/ajcp/aqag105","DOIUrl":"https://doi.org/10.1093/ajcp/aqag105","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a 15-minute incubation on citrated TEG (thromboelastography) results in adult surgical patients-a prospective observational study.","authors":"Hong Hong, Andrew Hasenzahl, Mohamed Abdel-Fattah, Shivani Dobhal, Vladimir Volel, Tylis Chang","doi":"10.1093/ajcp/aqag096","DOIUrl":"10.1093/ajcp/aqag096","url":null,"abstract":"<p><strong>Objectives: </strong>The thromboelastography (TEG) 6s Global Hemostasis Cartridge package insert recommends a 15-minute incubation of citrated blood prior to testing; however, most centers run samples immediately. Limited data are available to evaluate how incubation affects results and thus influences hemostatic transfusion decisions.</p><p><strong>Methods: </strong>In this single-center prospective study, 35 adult surgical and critical care patients were enrolled. Paired citrated samples were tested immediately upon laboratory arrival vs after a 15-minute benchtop incubation at room temperature. Primary endpoints included changes in citrated kaolin-reaction time (CK-R), kaolin with heparinase-reaction time (CKH-R), citrated kaolin-maximum amplitude (CK-MA), Citrated Rapid Thromboelastography Maximum Amplitude (CRT-MA), and citrated functional fibrinogen-maximum amplitude (CFF-MA) (fibrin-fibrinogen contribution). Paired t tests were used for analysis, and percent differences were calculated as [(Incubated - Immediate) / Incubated] × 100%. Categorical interpretation shifts (low/normal/high) were also assessed.</p><p><strong>Results: </strong>A 15-minute incubation significantly shortened CK-R (8.5 ± 3.4 vs 7.4 ± 3.1 minutes; P < .01) and CKH-R (7.2 ± 2.7 vs 6.9 ± 2.5 minutes; P < .01), with mean percent changes of -17% and -12%, respectively. CK-MA decreased marginally (57.0 ± 16.0 vs 56.2 ± 12.4 mm; P < .01), while CFF-MA remained unchanged (P = .976). Notably, 23% of CK-R results shifted interpretation categories after incubation, whereas no CFF-MA categories changed.</p><p><strong>Conclusions: </strong>A 15-minute incubation significantly shortens CK-R/CKH-R and marginally decreases CK-MA, potentially normalizing hyper- or hypocoagulable readings. Omitting incubation risks misclassification and inappropriate plasma/prothrombin complex concentrate administration. Strict adherence to the manufacturer's incubation protocol is recommended except in emergencies, and local transfusion algorithms should specify whether \"immediate\" or \"incubated\" TEG cutoffs apply.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MGA::NUTM1 fusion sarcoma: expanding the spectrum of NUT-rearranged sarcomas with extensive review of the literature.","authors":"Bhagat S Lali, Paromita Roy, Mayur Parihar, Reghu K Sukumaran, Anirban Mukherjee","doi":"10.1093/ajcp/aqag101","DOIUrl":"https://doi.org/10.1093/ajcp/aqag101","url":null,"abstract":"<p><strong>Objectives: </strong>We sought to present a rare case of MGA::NUTM1 fusion sarcoma, with a discussion of the differential diagnoses and approach to diagnosing these ultra-rare cases, which represent an emerging subset of NUTM1-rearranged mesenchymal neoplasms characterized by varied clinical behavior. Our review of the literature (17 cases) indicated bimodal age distribution, variable anatomical distribution, and frequent metastasis in these cases. Differential diagnosis has included synovial sarcoma and BCOR-associated sarcoma. The reported survival rates vary widely, from 1 month to 15 years.</p><p><strong>Methods: </strong>Here we report the case of a 16-year-old girl who presented with a large pelvic-abdominal mass and metastatic disease on a positron emission tomography/computed tomography scan. Based on TLE-1 positivity, the mass was initially diagnosed as synovial sarcoma at an outside center.</p><p><strong>Results: </strong>Histologically, the patient's tumor showed monomorphic spindle to epithelioid cells within dense hyalinized stroma. Immunohistochemistry demonstrated diffuse nuclear NUT positivity along with TLE-1 and BCOR expression. Next-generation sequencing confirmed MGA::NUTM1 fusion, with additional alterations in TP53, CCND2, and PIK3CD. Despite chemotherapy, the patient's disease progressed, highlighting poor therapeutic response in these cases.</p><p><strong>Conclusions: </strong>This case highlights the overlapping and distinguishing features between MGA::NUTM1 fusion sarcomas and other common entities. Because survival in the reported MGA::NUTM1 fusion sarcomas varies widely, we hypothesized that more aggressive cases harbor second-hit alterations in the tumor suppressor genes (eg, our case had TP53 missense mutations). As the true biological nature of MGA::NUTM1 fusion sarcomas is still evolving, exploring this hypothesis by studying the second-hit alterations will be worthwhile in future cases and studies. The current lack of effective targeted therapies underscores the need for further research into novel treatment strategies for this disease.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Impact of tumor budding on recurrence risk prediction in stage I-III colorectal cancer: a Swedish cohort study\".","authors":"Qinyi Li, Lijuan Kang, Zhiqiang Zhang","doi":"10.1093/ajcp/aqag103","DOIUrl":"https://doi.org/10.1093/ajcp/aqag103","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRAF V600E-mutated marginal zone lymphoma may exhibit features that partially overlap with hairy cell leukemia.","authors":"Jason Love, Tanvi Verma, Phil Palmer, Kikkeri N Naresh","doi":"10.1093/ajcp/aqag099","DOIUrl":"10.1093/ajcp/aqag099","url":null,"abstract":"<p><strong>Objectives: </strong>To establish the occurrence of BRAF mutation in marginal zone lymphomas (MZLs) and study its impact on clinical presentation, pathologic features, and disease classification.</p><p><strong>Methods: </strong>Conventional histology, immunohistochemistry, flow cytometry, and molecular methods were used.</p><p><strong>Results: </strong>We identified 2 BRAF‑mutated MZL cases: a nodal MZL (NMZL) with BRAF V600E and partial morphologic/immunophenotypic overlap with hairy cell leukemia (HCL) and an extranodal MZL with a non-V600E BRAF mutation co‑occurring with TET2, KRAS, and TP53 variants. The NMZL case showed strong CD25 and CD123 expression and patchy cyclin D1 expression; together with the presence of a BRAF V600E mutation, these features overlapped with HCL. However, the absence of annexin A1 and CD103 expression, along with the remaining morphologic features in the lymph node, supported accurate classification as NMZL.</p><p><strong>Conclusions: </strong>These 2 cases expand the mutational spectrum of MZL and illustrate important diagnostic pitfalls. These observations underscore that BRAF V600E, while highly specific and clinically useful for HCL in the context of a B‑cell lymphoproliferative process involving blood and marrow, is not entirely pathognomonic and must be interpreted alongside morphology and a full immunophenotypic panel. Integrating BRAF testing into the workup of challenging small B‑cell lymphomas may refine diagnosis and reveal rare, potentially targetable MAPK pathway lesions.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preanalytical variables in surgical pathology: practical sources of diagnostic error before microscopic interpretation.","authors":"Arthur Vaz Alvares Fernandes","doi":"10.1093/ajcp/aqag098","DOIUrl":"https://doi.org/10.1093/ajcp/aqag098","url":null,"abstract":"<p><strong>Objectives: </strong>To review clinically important preanalytical variables in surgical pathology and their effects on diagnostic accuracy, ancillary testing, and patient safety.</p><p><strong>Methods: </strong>A narrative review was developed from selected literature on surgical pathology preanalytics, fixation, specimen handling, histotechnology, immunohistochemistry, molecular testing, tissue contamination, and quality improvement. Emphasis was placed on practical variables that affect routine anatomic pathology workflows.</p><p><strong>Results: </strong>The diagnostic value of a surgical pathology specimen is shaped before microscopic interpretation. Ischemia time, delayed or inadequate fixation, tissue thickness, container and transport problems, labeling discrepancies, poor orientation, grossing variability, histotechnical artifacts, and tissue contamination can compromise morphology, margin assessment, staging, biomarker interpretation, and molecular testing. These effects are especially consequential in small biopsy specimens and precision oncology specimens, in which the same limited tissue may be required for diagnosis, immunohistochemistry, fluorescence in situ hybridization, polymerase chain reaction-based testing, and next-generation sequencing. Gross examination is a particularly important pathology-controlled preanalytical step because block selection determines what can be assessed microscopically.</p><p><strong>Conclusions: </strong>Preanalytical control should be regarded as a diagnostic quality and patient safety process rather than a technical background activity. Standardized fixation, specimen tracking, communication, grossing protocols, histotechnical quality assurance, and tissue stewardship are essential to reliable surgical pathology practice.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"166 3","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}