American journal of clinical pathology最新文献

{"title":"Response to Comment on \"Reflex somatic testing for the detection of FGFR alterations in urinary tract carcinomas: a dual-institutional experience\".","authors":"Ngoc-Nhu Jennifer Nguyen, Ekaterina Olkhov-Mitsel, Kenneth J Craddock, Trevor A Flood, Michelle R Downes","doi":"10.1093/ajcp/aqaf151","DOIUrl":"10.1093/ajcp/aqaf151","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147621617","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: PRAME immunohistochemistry distinguishes breast secondary angiosarcoma from benign and atypical vascular lesions of the breast.","authors":"Simonetta Piana, Giacomo Santandrea","doi":"10.1093/ajcp/aqag035","DOIUrl":"10.1093/ajcp/aqag035","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147669832","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":"Telepathology expert consultation platform-implementation and lessons from a tertiary hospital in Tanzania.","authors":"Aisha Mohamed, Kenneth Landgraf, Gilbert Nkya, Jeremia Pyuza, Patrick Amsi, Angela Pallangyo, Alex Mremi","doi":"10.1093/ajcp/aqag024","DOIUrl":"10.1093/ajcp/aqag024","url":null,"abstract":"<p><strong>Objectives: </strong>Cancer is a leading cause of mortality worldwide, yet access to specialized pathology services remains limited in many low- and middle-income countries, including Tanzania. Telepathology offers a practical means to expand diagnostic capacity and improve timely cancer care. Through a partnership with the American Society for Clinical Pathology (ASCP) and Duke University, Kilimanjaro Christian Medical Centre (KCMC) implemented a telepathology consultation platform to provide expert review for diagnostically challenging cases.</p><p><strong>Methods: </strong>This cross-sectional observational study analyzed challenging pathology cases submitted for teleconsultation between September 2018 and March 2025. Whole-slide images were reviewed by pathologists from Duke University, Radboud University Medical Centre, Princess Máxima Center, ASCP-Tanzania, and the Medical College of Wisconsin. Diagnostic concordance between local and expert interpretations was measured. Turnaround time (TAT) and subspecialty variation were analyzed using descriptive statistics and χ2 testing.</p><p><strong>Results: </strong>A total of 1266 cases were reviewed, representing 16 different subspecialties. Hematopathology (28.4%), head and neck pathology (17.1%), and soft tissue pathology (9.9%) were the most frequently consulted. The overall concordance rate was 44.79% (567/1266), with a partial concordance rate of 19.75% (250/1266) and a discordance rate of 32.78% (415/1266). Concordance varied significantly across subspecialties (χ2(15) = 31.90, P = .0066). The mean TAT was 18.3 days, with a downward trend from 2018 to 2025.</p><p><strong>Conclusions: </strong>Implementation of telepathology at KCMC is feasible and provides a sustainable model for expanding access to expert pathology consultation in resource-limited settings. Despite modest concordance rates, telepathology enhanced diagnostic accuracy, education, and quality assurance, while TATs improved over the study period. Continued investment is needed in digital infrastructure.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 4","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632204","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":"Not all errors are created equal: assessment of amended diagnoses at a major academic center.","authors":"Stanislav Fridland, Vikas Mehta, Lucy Jager, Luis Z Blanco, Borislav A Alexiev, Christopher Felicelli","doi":"10.1093/ajcp/aqag005","DOIUrl":"10.1093/ajcp/aqag005","url":null,"abstract":"<p><strong>Objective: </strong>We sought to characterize amendment rates, patterns, and turnaround times in surgical pathology and to identify subspecialty and error-specific opportunities for quality improvement.</p><p><strong>Methods: </strong>All amended surgical pathology and fine-needle aspiration reports from quarter 3 of 2021 to quarter 2 2025 were retrieved through our in-house Epic Beaker system. Amendments were allocated to 1 of 7 predefined error categories and analyzed by year and subspecialty. Amendment rates, odds ratios, and 95% CIs were calculated, and time-to-amend metrics were compared using nonparametric tests with false-discovery-rate correction.</p><p><strong>Results: </strong>Over 5 years, 0.33% of finalized surgical pathology reports were amended (95% CI, 0.31-0.35), within national College of American Pathologists Q-Probes and Q-Tracks program benchmarks, and stable over time (P = .64). Typographical errors predominated (20%-30%), followed by minor diagnostic changes and additional diagnostic information (12%-20%). Major diagnostic amendments declined from 30% (95% CI, 21.5%-40.6%) in 2021 to 15% (95% CI, 9.9%-22.8%) in 2025. Breast pathology showed enrichment of laterality errors (16.1%; odds ratio, 4.68 [95% CI, 2.65-8.27]; q = 8.26 ×10-6), gastrointestinal cases were enriched for anatomic-site errors (15.4%; odds ratio, 2.80 [95% CI, 1.71-4.56]; q = 9.28 ×10-4). Median amendment turnaround time was 1 to 3 days overall, with the longest for laterality and major diagnostic changes. Among major diagnostic changes, benign to malignant reclassification and vice versa made up roughly half. Cytology fine-needle aspiration amendments were rare (0.19%), with similar times to amend across all error categories.</p><p><strong>Conclusions: </strong>Amendments in surgical pathology are uncommon, timely, and stable. Subspecialty-specific amendment patterns highlight discrete areas for targeted quality improvement and focused secondary review.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147430100","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":"Enhanced detection of high-risk human papillomavirus by in situ hybridization with expansion from 7 to 18 genotypes in anal biopsies.","authors":"Mahzad Azimpouran, Xiaomo Li, Maha Guindi, Michael Kozak, Keith Lai, Danielle A Hutchings, Brent K Larson, Kevin M Waters","doi":"10.1093/ajcp/aqag014","DOIUrl":"10.1093/ajcp/aqag014","url":null,"abstract":"<p><strong>Objectives: </strong>High-risk human papillomavirus (HPV) plays a central role in the pathogenesis of anal high-grade squamous intraepithelial lesions (HSILs). In situ hybridization (ISH) is commonly used for high-risk HPV detection in surgical specimens. Recently, ISH panels with expanded HPV genotype cocktails have become available. This study evaluated the detection rate of an expanded ISH probe cocktail targeting 18 high-risk HPV genotypes (HR18) compared with a 7-HPV genotype panel (HR7) in anal tissue microarray samples.</p><p><strong>Methods: </strong>A retrospective study was performed on 245 patients with anal biopsy samples collected from 2017 to 2023 at a tertiary-care medical center. Tissue microarrays were constructed with 1 to 3 cores per case. In situ hybridization was performed with an HR18 probe for comparison with the reported HR7 result. The detection rate of high-risk HPV was assessed.</p><p><strong>Results: </strong>Among 55 patients with HSIL, HR18 demonstrated a positivity rate of 93% (51/55) compared with 73% (40/55) for HR7 (P = 2.6 × 10-3). The HR18 panel detected high-risk HPV in 3 patients with histologically low-grade and 1 previously ungraded SIL. No high-risk HPV was detected in patients without SIL by HR18.</p><p><strong>Conclusions: </strong>Expansion of the ISH panel from 7 to 18 genotypes improved detection for high-risk HPV in anal HSIL and identified high-risk HPV in additional patients without HSIL.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147346916","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":"High titer anti-U in pregnancy with absent hemolysis in a U-positive neonate: a case report and literature review.","authors":"Charlotte N Nawor, Timothy C Carll, Fatima A Aldarweesh, Noah J Dearth, Rahaf Alkhateb","doi":"10.1093/ajcp/aqag020","DOIUrl":"10.1093/ajcp/aqag020","url":null,"abstract":"<p><strong>Objectives: </strong>The high-prevalence U antigen is part of the MNS blood group system and is carried on glycophorin B along with the S and s antigens. Approximately 1.5% of the Black population has U-negative or U-variant phenotypes and can potentially develop IgG antibodies against the U antigen. Anti-U antibodies are clinically significant and associated with both transfusion reactions and hemolytic disease of the fetus and newborn (HDFN).</p><p><strong>Methods: </strong>A 24-year-old G4P3003 woman with a history of anti-U alloimmunization had an anti-U titer of 1:16 identified during a second-trimester antibody screen at an outside hospital. Upon repeat testing during the third trimester, the titer had increased to 1:1024. The patient was transferred to our institution for further management, where a middle cerebral artery (MCA) Doppler ultrasound was performed, revealing a normal MCA peak systolic velocity for gestational age.</p><p><strong>Results: </strong>A healthy female neonate, delivered at 37 weeks and 0 days, had a strongly positive direct antiglobulin test with anti-U identified in the eluate. The neonate did not require phototherapy or transfusions and was discharged on day 2 of life in stable condition. A human erythrocyte antigen genotyping panel confirmed a U+ phenotype.</p><p><strong>Conclusions: </strong>This case demonstrates a passively acquired anti-U in a neonate, born to a mother with a high anti-U titer, who did not show any evidence of HDFN. To date, this is the highest anti-U maternal titer reported in the literature in which the neonate did not require any intervention.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497345","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":"Nocardiosis: clinical and pathologic examination of 140 cases representing 18 species in 6 complexes.","authors":"Ronald K Phillips, Alvaro C Laga, Yin P Hung, Isaac H Solomon","doi":"10.1093/ajcp/aqag018","DOIUrl":"10.1093/ajcp/aqag018","url":null,"abstract":"<p><strong>Objectives: </strong>Before molecular taxonomy, Nocardia species infections were predominantly attributed to Nocardia asteroides; now, more than 50 species are known to infect humans. To better study the range of associated clinicopathologic features, Nocardia species can be grouped into complexes based on gene sequencing, antibiotic susceptibilities, and matrix-assisted laser desorption/ionization with time-of-flight mass spectrometry profiling.</p><p><strong>Methods: </strong>A 20-year retrospective study of laboratory-detected Nocardia species cases from 2 US tertiary-care academic medical centers was performed by review of anatomic pathology slides and electronic health records.</p><p><strong>Results: </strong>From 2004 to 2024, 140 patients with 151 Nocardia species detections were grouped into N abscessus (n = 15), N brevicatena/paucivorans (n = 3), N cyriacigeorgica (n = 13), N farcinica (n = 21), N nova (n = 60), N transvalensis (n = 6) complexes, N asteroides (n = 28) complex, and Nocardia species not further classified (n = 5). The majority of patients were immunocompromised, most commonly due to steroids. Only 16% of cases were clinically suspected, and 15% of the patients died with disease. Nocardiosis predominantly affected lungs, followed by brain and skin/soft tissue. Ninety anatomic pathology specimens from 61 patients were reviewed, identifying abscess as the most common inflammatory pattern across all complexes and methenamine silver stains as the most useful ancillary test for visualizing bacilli.</p><p><strong>Conclusions: </strong>Although Nocardia species cases are rare and clinically diverse and can be difficult to diagnose, this study highlights associations between specific Nocardia complexes and patient risk factors, sites of involvement, and antibiotic susceptibility, providing new insights to aid in the diagnosis and treatment of patients with nocardiosis.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497332","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":"Composite lymphoma composed of follicular lymphoma and nodal T-follicular helper cell lymphoma: report of 3 cases highlighting histopathologic zonation of each neoplastic component.","authors":"Yue Zhao, Ibrahim Hajjali, Yaping Ju, Luis Carrillo, Mark Feng, Qianze Dong, Dongjiang Chen, Imran Siddiqi, Endi Wang","doi":"10.1093/ajcp/aqag012","DOIUrl":"10.1093/ajcp/aqag012","url":null,"abstract":"<p><strong>Objectives: </strong>Composite lymphoma (CL), composed of follicular lymphoma (FL) and nodal T-follicular helper cell lymphoma (nTFHL), is an uncommon and diagnostically challenging entity. We present a small series of such cases to characterize their clinicopathologic and diagnostic features.</p><p><strong>Methods: </strong>We retrospectively analyzed 3 CL cases compared with 6 control cases of FL with expanded reactive T-follicular helper cells.</p><p><strong>Results: </strong>Histologically, all 3 CL cases demonstrated geographic zonation of the 2 neoplastic components, with the B-cell lymphoma residing in follicle centers (B-zones) and the T-cell neoplasm confined to perifollicular/interfollicular areas (T-zones), in contrast to a predominantly (83%) intrafollicular distribution of T-follicular helper cells in the control cases. In all CL cases, FL was suggested by histopathologic features, and the diagnosis was supported by flow cytometry. All 3 cases (100%) showed cytologic atypia and immunophenotypic aberrancy in the T-cell component, whereas none (0%) were observed in the control group. In 2 cases (66.7%), scattered Epstein-Barr virus-positive cells were seen in the T-zone, suggesting latent infection in bystander cells, again compared to none (0%) in the control. Genomic sequencing was performed in 2 cases, both (100%) showing pathogenic mutations associated with nTFHL, while none (0%) of the controls showed such mutations. Biclonality was confirmed by B-cell and T-cell receptor gene rearrangement analyses in all 3 CL cases. All patients with CL presented with an aggressive clinical course.</p><p><strong>Conclusions: </strong>This series highlights the unique histopathologic characteristics of CL and underscores the importance of a multifaceted approach to diagnosis.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147363657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing awareness of effective laboratory test utilization via case-based microlearning.","authors":"Melissa A Kelly, Debby Basu, Sachin Gupta, Saashiv Gupta","doi":"10.1093/ajcp/aqag008","DOIUrl":"10.1093/ajcp/aqag008","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose was to examine how effective a case-based microlearning course was in increasing knowledge of evidence-based practices in effective test utilization of laboratory testing pertaining to an array of diseases and illnesses, including pancreatitis, cardiac injury, inflammation, Lynch syndrome, and respiratory viruses.</p><p><strong>Methods: </strong>The course presented learners with a scenario targeting aspects of effective test utilization, such as the use of unnecessary tests, the underutilization of appropriate tests, and the overconsumption of supplies, and asked them about a specific recommendation or course of action. Learning was measured via a pretest and posttest.</p><p><strong>Results: </strong>More than 8725 learners completed the course, the majority of whom were medical laboratory scientists (n = 4979, 57.1%). Mean (SD) test scores increased significantly, from 31.7 (17.4) to 92.8 (17.2), t(8724) = 245.9, P < .01, η2 = 0.9. For each assessment item, χ2 analyses showed that the percentage of respondents who answered correctly on the posttest was significantly higher than on the pretest, with increases ranging from 35.5% to 75.8%.</p><p><strong>Conclusions: </strong>The results from the pretest and posttest showed that the course significantly increased knowledge of evidence-based testing practices for diagnosing a variety of diseases and illnesses, including pancreatitis, cardiac injury, inflammation, Lynch syndrome, and respiratory viruses.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497308","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":"A combination of 2 rapid immunoassays significantly improves diagnostic sensitivity for heparin-induced thrombocytopenia.","authors":"Giulia Ciarrocca Taranta, Angela Rogolino, Alessia Bertelli, Andrea Sorrentino, Michela Di Gioia, Francesca Cesari, Betti Giusti, Elena Sticchi, Martina Berteotti, Anna Maria Gori, Rossella Marcucci","doi":"10.1093/ajcp/aqag016","DOIUrl":"10.1093/ajcp/aqag016","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic performance of chemiluminescent immunoassay (CLIA), latex immunoturbidimetric assay (LIA), and the combination of CLIA/LIA with respect to the functional heparin-induced platelet aggregation (HIPA) test.</p><p><strong>Methods: </strong>An observational retrospective study was conducted on 100 patients. All samples were initially tested with CLIA on the ACL TOP AcuStar, and then we performed LIA and CLIA tests concurrently (on the same samples on the ACL TOP 970 CL) and the HIPA test.</p><p><strong>Results: </strong>The CLIA test was performed on both the AcuStar and the ACL TOP 970 CL, and results were concordant: 68% of patients were negative, and 32% were positive. The HIPA test confirmed a diagnosis in 26 of 32 and identified 6 false-positive patients and 1 false-negative patient. The LIA test was performed on the ACL TOP 970 CL: 64% of patients were negative, and the remaining 36% were positive. The HIPA test confirmed a diagnosis in 24 patients and identified 12 false-positive and 3 false-negative patients. The combination of CLIA and LIA tests allowed us to categorize 27 true-positive, 13 false-positive, 0 false-negative, and 60 true-negative patients.</p><p><strong>Conclusions: </strong>The combination of CLIA/LIA provides high sensitivity with a progressively greater probability of detecting platelet-activating antibodies with a higher assay reactivity, reaching 100% when both automated assays yield moderate or strong results.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":"165 3","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}