American journal of clinical pathology最新文献_第3页

An electronic health record-based solution to reduce the volume of CBC differentials performed on inpatients. 一种基于电子健康记录的解决方案，可减少住院患者的CBC差异量。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-25 DOI: 10.1093/ajcp/aqaf106

Elizabeth Margolskee, Robert Klenk, Tracey Polsky

{"title":"An electronic health record-based solution to reduce the volume of CBC differentials performed on inpatients.","authors":"Elizabeth Margolskee, Robert Klenk, Tracey Polsky","doi":"10.1093/ajcp/aqaf106","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf106","url":null,"abstract":"Objective: We sought to investigate the use of same-day, repeat complete blood cell count (CBC) with differential orders in a large pediatric institution and design an intervention to limit CBC with differential testing and, thereby, manual differential performance to once per calendar day, without placing a burden on ordering clinicians.Methods: We created a seamless electronic health record (EHR)-based back-end workflow that reaccessions CBC with differential orders to a CBC without differential if a CBC with differential has been resulted within that calendar day. Clinicians have an opportunity to override at the time of test order entry in the EHR.Results: Repeat CBC with differential orders originated predominantly in intensive care units (ICUs) and oncology inpatient units and accounted for 18% of all CBC with differential orders. Implementation of our EHR workflow led to an average annual reduction of 9% in CBC with differential tests and a 16% reduction in manual differentials performed. This change amounts to a combined annual cost savings (direct cost of testing plus laboratory technologist time) of approximately $45 000 and improved CBC with differential test turnaround times.Conclusions: Our EHR-based solution resulted in a substantial and sustained decrease in CBC with differential tests and manual differential slide reviews performed in a critically ill pediatric population. This approach is a potential alternative to traditional educational and other clinician-dependent stewardship interventions that aim to improve test utilization.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136069","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}

引用次数: 0

Underfilled tubes revisited: What blood tests can be reported on short draws? 重新审视未充血的试管：短抽时可以报告哪些血液检查？

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-25 DOI: 10.1093/ajcp/aqaf109

Lawrence de Koning, Sally Ezra, Fangze Cai, Isolde Seiden-Long, Tariq Roshan, Jessica L Gifford, Albert K Y Tsui

{"title":"Underfilled tubes revisited: What blood tests can be reported on short draws?","authors":"Lawrence de Koning, Sally Ezra, Fangze Cai, Isolde Seiden-Long, Tariq Roshan, Jessica L Gifford, Albert K Y Tsui","doi":"10.1093/ajcp/aqaf109","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf109","url":null,"abstract":"Objective: Underfilled blood tubes (short draws) are often collected from children or those with poor venous access. In a pilot study, we investigated which tests among a large acute care panel could be reported on short draws.Methods: Blood was drawn in BD vacutainers (short draw: 1 mL [33%-56% fill volume] vs complete draw: 1.8-3 mL [100% fill volume]) from 12 volunteers for 3 coagulation tests, 36 chemistry tests, and the complete blood count (CBC) with differential. Tests that were strong candidates for reporting did not have statistically significant biases between short and complete draws, whereas potential candidates had statistically significant biases that were small (<25% of total allowable error and less than desirable bias from biological variation). Biases that increased or decreased across concentration ranges invalidated reporting candidacy.Results: Two coagulation tests, 14 chemistry tests, and 15 CBC components were strong candidates for reporting. There were 9 chemistry tests and 2 CBC components that were potential candidates for reporting.Conclusions: Underfilled blood tubes, or short draws, may be valid collections for several coagulation, chemistry, and hematology tests-which may prevent additional unnecessary phlebotomy. Laboratories should perform their own studies to determine if short draws are acceptable for limited testing using their tube and instrument types.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136291","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}

引用次数: 0

The first report of biliary NUT carcinoma with a fatal outcome. 胆道NUT癌致死性的首个报告。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-25 DOI: 10.1093/ajcp/aqaf104

Aryeh Stock, Chao Fan, Sara Lewis, Myron Schwartz, Swan Thung

{"title":"The first report of biliary NUT carcinoma with a fatal outcome.","authors":"Aryeh Stock, Chao Fan, Sara Lewis, Myron Schwartz, Swan Thung","doi":"10.1093/ajcp/aqaf104","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf104","url":null,"abstract":"Objective: NUT carcinoma (NC) is a rare epithelial malignancy caused by a rearrangement of the nuclear protein in testis gene (NUTM1), with fewer than 200 cases reported worldwide to date. The majority of cases have occurred in young patients (ie, ≤25 years of age), most commonly in the thoracic and head and neck regions. This case marks the first documented occurrence of NC in the hepatobiliary system.Methods: A 35-year-old woman presented with abdominal pain radiating to the back that has persisted for 2 weeks. Liver tests revealed obstructive jaundice. An abdominal magnetic resonance imaging scan demonstrated diffuse intrahepatic bile duct dilatation resulting from a stricture at the biliary confluence. Subsequent endoscopic retrograde cholangiopancreatography biopsy confirmed an invasive, poorly differentiated carcinoma, and a stent was placed in the left hepatic duct. Following right portal vein embolization, the patient underwent an extended right hepatectomy.Results: Pathology revealed a firm 2.5-cm gray-white mass at the hepatic duct bifurcation. The initial diagnosis was a biliary carcinoma characterized by mass formation and a periductal infiltrating pattern. The tumor exhibited distinctive features, such as nested architecture, open vesicular chromatin, focal squamous differentiation, and perineural vascular invasion. Positive immunohistochemistry for CK7, CK19, P40, P63, and NUT protein and identification on DNA sequencing of a BRD3::NUTM1 fusion led to a final diagnosis of NC. Despite adjuvant chemotherapy, the patient succumbed to recurrent disease 18 months after surgery.Conclusions: This case highlights the importance of recognizing NC in atypical locations and emphasizes the need for a thorough investigation in young patients with malignancies that display squamous differentiation. This report expands our understanding of biliary NC and underscores the challenges associated with its diagnosis and management.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136254","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}

引用次数: 0

Guide to the diagnosis of lymphoid neoplasms in blood and bone marrow: A Bone Marrow Pathology Group approach. 血液和骨髓淋巴样肿瘤的诊断指南：骨髓病理组方法。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-25 DOI: 10.1093/ajcp/aqaf068

Kathryn Foucar, Adam Bagg, Daniel A Arber, Carlos E Bueso-Ramos, Julia T Geyer, Robert P Hasserjian, Attilio Orazi, Kaaren K Reichard, Wayne Tam, Sa A Wang, Olga K Weinberg, Eric D Hsi

{"title":"Guide to the diagnosis of lymphoid neoplasms in blood and bone marrow: A Bone Marrow Pathology Group approach.","authors":"Kathryn Foucar, Adam Bagg, Daniel A Arber, Carlos E Bueso-Ramos, Julia T Geyer, Robert P Hasserjian, Attilio Orazi, Kaaren K Reichard, Wayne Tam, Sa A Wang, Olga K Weinberg, Eric D Hsi","doi":"10.1093/ajcp/aqaf068","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf068","url":null,"abstract":"Objective: The successful diagnosis and classification of lymphoid neoplasms in blood and bone marrow is the responsibility of the practicing pathologist. This guide provides a general \"roadmap\" for this process, from initial case recognition to final classification.Methods: The integration of hematologic, morphologic, immunophenotypic, and genetic features for the full spectrum of precursor and mature B-cell, T-cell, and natural killer-cell neoplasms that typically manifest in blood and bone marrow is included.Results: Classification systems for lymphoid neoplasms provide criteria for pathologists to render a diagnosis that is optimal for patient care, treatment, and outcome prediction.Conclusions: This guide provides diagnostic strategies for lymphoid neoplasms encountered in blood and bone marrow specimens using both the International Consensus Classification and the World Health Organization fifth edition classification systems. Key tips are provided for each entity along with testing requirements, differential diagnosis, nonneoplastic mimics, and other unique features based on the experience of the Bone Marrow Pathology Group members.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136178","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}

引用次数: 0

Seven-year retrospective review of medical microbiologist consultations on cytology specimens at an academic medical center. 某学术医学中心细胞学标本医学微生物学家咨询的7年回顾性回顾。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-25 DOI: 10.1093/ajcp/aqaf100

Jonathan D Marotti, Edward J Gutmann, Nicole A Loeven, Xiaoying Liu, Darcy A Kerr, Louis J Vaickus, Isabella W Martin

{"title":"Seven-year retrospective review of medical microbiologist consultations on cytology specimens at an academic medical center.","authors":"Jonathan D Marotti, Edward J Gutmann, Nicole A Loeven, Xiaoying Liu, Darcy A Kerr, Louis J Vaickus, Isabella W Martin","doi":"10.1093/ajcp/aqaf100","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf100","url":null,"abstract":"Objective: Cytology samples can harbor clinically significant microorganisms; however, cytopathologists can be challenged by the interpretation of special stains and the description or classification of microorganisms. This study aimed to highlight the value of medical microbiologist consultations on cytology specimens.Methods: This quality assurance project retrospectively reviewed all medical microbiologist consultations on cytology specimens from 2018 to 2024. Special stains used, consultation findings, associated clinical microbiology laboratory studies, and the clinical significance of identified microorganisms were extracted from cytology reports and the electronic medical record.Results: Medical microbiologist consultations were requested on 152 cytology samples from 139 patients. Thoracic sources comprised most cases (110/152, 72%). Clinically significant microorganisms were identified in 30% (45/152), of which most were fungi. The medical microbiologist confirmed artifacts or mimics in 24% (36/152). The microbiologist assisted cytopathologists in the care of 15 patients with clinically significant pathogens but for whom relevant clinical microbiology laboratory studies were negative or not performed.Conclusions: Medical microbiologists and the clinical microbiology laboratory are important resources for the diagnosis of infectious diseases in cytology specimens. This project uniquely documents the consultative and collaborative relationship between cytopathologists and medical microbiologists at a major academic medical center and highlights its positive impact on patient care.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136212","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}

引用次数: 0

CD9: Differential expression of normal bone marrow cellular components and leukemic myeloid blasts. CD9：正常骨髓细胞成分与白血病骨髓母细胞的差异表达。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-17 DOI: 10.1093/ajcp/aqaf087

Afreen Jasim, Winston Lee, Huiyan Ma, Elizabeth Quirk, Joo Song, Scott Hwee, Jessica Hughes, Parastou Tizro, Lori Soma

{"title":"CD9: Differential expression of normal bone marrow cellular components and leukemic myeloid blasts.","authors":"Afreen Jasim, Winston Lee, Huiyan Ma, Elizabeth Quirk, Joo Song, Scott Hwee, Jessica Hughes, Parastou Tizro, Lori Soma","doi":"10.1093/ajcp/aqaf087","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf087","url":null,"abstract":"Objective: Research on CD9 expression has been extensive in B lymphoblastic leukemia, with fewer studies focusing on acute myeloid leukemia (AML). We investigated the usefulness of CD9 in differentiating normal from abnormal myeloid progenitors, as well as expression in normal cell types and in AML.Methods: Flow cytometry was used to assess the level of CD9 expression on normal and leukemic myeloid blasts and other normal bone marrow populations. Geometric mean fluorescence intensity levels and expression patterns were compared among cell types and AML subtypes.Results: In normal subsets (n = 69), the level of CD9 expression was lowest in mature B cells, myeloid blasts, promyelocytes, and neutrophils, with intermediate expression in monocytes and highest in hematogones (stages 1 and 2). Committed myeloid progenitors (CMPs) had lower expression than hematopoietic stem cells (HSCs). CD9 typically has higher expression in AML (n = 58) compared to normal myeloid blasts and promyelocytes, and it is differentially expressed in AML, with the highest expression in PML::RARA AML.Conclusions: Aberrant CD9 expression can be useful differentiating normal from abnormal myeloid progenitors, with the highest level of expression in AML with PML::RARA in our cohort. There was differential expression between HSCs and CMPs in the small numbers studied. Normal mature B cells can be used as an internal negative control in most cases.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090975","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}

引用次数: 0

Role of nucleophosmin 1 immunostain in detecting leukemia cutis of acute myeloid leukemia with NPM1 mutation. 核磷蛋白1免疫染色检测NPM1突变急性髓系白血病表皮的作用。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-17 DOI: 10.1093/ajcp/aqaf089

Rossana N Lazcano Segura, Valentina Nardi, Mai P Hoang

{"title":"Role of nucleophosmin 1 immunostain in detecting leukemia cutis of acute myeloid leukemia with NPM1 mutation.","authors":"Rossana N Lazcano Segura, Valentina Nardi, Mai P Hoang","doi":"10.1093/ajcp/aqaf089","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf089","url":null,"abstract":"Objective: The role of NPM1 immunostaining as a surrogate marker for acute myeloid leukemia (AML) with nucleophosmin (NPM1) mutation (AML-NPM1) in leukemia cutis has not been investigated.Methods: NPM1 immunostaining was performed using a polyclonal antibody on leukemia cutis diagnosed in 2017-2024 of 15 patients with and 15 without the NPM1 mutation. Targeted next-generation sequencing assays were performed on the initial bone marrow biopsy specimens.Results: There were 18 skin biopsy specimens from 15 patients (11 men, 4 women, 33-90 years, median: 66 years) with AML-NPM1. Thirteen (87%) patients had multiple lesions, often on the trunk and extremities. There were 8 and 10 skin biopsies done concurrently and after the bone marrow AML diagnosis, respectively. The time interval between AML-NPM1 diagnosis and leukemia cutis was 0 to 38 months (median, 1 month). NPM1 immunostaining was positive in 18 of 18 skin biopsy specimens of patients with AML-NPM1 with a leukemic infiltrate. NPM1 immunostaining was negative in 15 of 15 leukemia cutis specimens of patients with AML who had other molecular alterations not involving NPM1. The sensitivity and specificity of NPM1 immunostaining in detecting cutaneous AML-NPM1 infiltrate are 100% and 100%, respectively.Conclusions: Although limited in number, our study shows that NPM1 immunostaining is sensitive and specific in detecting AML-NPM1-mutated cells in skin.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091053","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}

引用次数: 0

Anti-platelet factor 4 testing for heparin-induced thrombocytopenia: Assessing the indication for its use for quality improvement as a patient safety measure. 肝素诱导的血小板减少症的抗血小板因子4检测：评估其用于质量改善作为患者安全措施的适应症

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-17 DOI: 10.1093/ajcp/aqaf102

Hisham F Bahmad, Ruben Delgado, Richard R Pacheco, Kei Shing Oh, Lorena P Rojas Gomez, Esha Vallabhaneni, Roshanak Azimi, Vathany Sriganeshan, Lydia Howard, Robert Poppiti, Sarah Alghamdi

{"title":"Anti-platelet factor 4 testing for heparin-induced thrombocytopenia: Assessing the indication for its use for quality improvement as a patient safety measure.","authors":"Hisham F Bahmad, Ruben Delgado, Richard R Pacheco, Kei Shing Oh, Lorena P Rojas Gomez, Esha Vallabhaneni, Roshanak Azimi, Vathany Sriganeshan, Lydia Howard, Robert Poppiti, Sarah Alghamdi","doi":"10.1093/ajcp/aqaf102","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf102","url":null,"abstract":"Objective: To assess the appropriateness and clinical indication of ordering the heparin-induced thrombocytopenia (HIT) platelet factor 4 (PF4) tests (based on the 4T score) for the diagnosis of HIT.Methods: We retrospectively analyzed 261 PF4/polyvinylsulfonate (PVS)-enzyme-linked immunosorbent assay (ELISA) tests performed for 261 patients between January 2020 and June 2022. Patients were divided into 2 groups: 4T score less than 4 (unindicated HIT test requests) and 4T score of 4 or more (appropriately indicated HIT test requests). Clinical characteristics, test results, and treatment decisions were compared between groups.Results: Only 136 (52.11%) of 261 tests were indicated by a 4T score or 4 or higher, whereas 125 (47.89%) of 261 tests were performed in low-probability patients (4T score <4). The PF4/PVS-ELISA positivity rate did not differ significantly between groups (11.03% vs 5.6%, P = .125). Patients with indicated testing had higher baseline platelet counts, longer time to platelet drop, and a greater percent drop in platelets (all P < .001). Among the 22 PF4/PVS-ELISA positive cases, only 10 had serotonin release assay (SRA) testing performed, of which 2 were SRA-positive. Among patients with low clinical probability, 75.20% (94/125) had heparin discontinued, despite the minimal risk.Conclusions: Most HIT testing was inconsistent with guideline recommendations of the American Society of Hematology. Overtesting may lead to unnecessary anticoagulation, and undertreatment may have occurred in high-risk cases. These findings underscore the need for improved implementation of 4T-based decision tools to guide HIT evaluation and treatment.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090929","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}

引用次数: 0

Expanded CD4+CD57+ T-large granular lymphocytes: A diagnostic pitfall in blood staging of mycosis fungoides/Sézary syndrome. CD4+CD57+ t大颗粒淋巴细胞扩增：蕈样真菌病/ ssamzary综合征血液分期的诊断缺陷

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-17 DOI: 10.1093/ajcp/aqaf097

Yumeng Zhang, Dahui Qin, Oluwatobi Ozoya, Frank Glass, Lubomir Sokol, Christopher B Ryder

{"title":"Expanded CD4+CD57+ T-large granular lymphocytes: A diagnostic pitfall in blood staging of mycosis fungoides/Sézary syndrome.","authors":"Yumeng Zhang, Dahui Qin, Oluwatobi Ozoya, Frank Glass, Lubomir Sokol, Christopher B Ryder","doi":"10.1093/ajcp/aqaf097","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf097","url":null,"abstract":"Objective: Accurate blood staging in mycosis fungoides (MF)/Sézary syndrome (SS) is essential for precise diagnosis, prognostication, and effective management. Through 3 illustrative cases, we highlight the complexity of blood staging of MF/SS caused by expanded CD4-positive T-cell large granular lymphocyte (T-LGL) populations that mimic malignant involvement and complicate accurate disease assessment.Methods: We identified 3 patients with MF/SS and more than 250/µL of CD4-positive, CD7-negative and/or CD4-positive, CD26-negative T cells in blood but with discordant T-cell receptor profiles between blood and skin samples. We also analyzed 100 consecutive T-cell blood flow cytometry panels ordered for patients evaluated in our cutaneous lymphoma clinic to determine the frequency of such populations.Results: Each case demonstrated expanded CD4-positive T-LGL populations in the blood characterized by at least partial CD8, CD56, and CD57 expression and absent or decreased CD26 and/or CD7 expression. Blood from these patients exhibited distinct clonotypes from skin lesions, suggesting a reactive rather than malignant origin. Analysis of 100 consecutive cutaneous lymphoma staging blood flow cytometry cases identified similar CD4-positive, CD57-positive T cells of 250/μL or more in 3 of 100 cases, plus 1 atypical case of SS with partial, dim CD57 expression.Conclusions: The presence of expanded T-LGL populations in blood can confound accurate staging of MF/SS, potentially leading to misclassification and ineffective or unnecessary treatment. These cases exemplify how comprehensive molecular and immunophenotypic profiling, including multicolor flow cytometry and T-cell receptor comparisons, along with morphologic evaluation of blood ensure accurate disease assessment to inform better clinical decision-making in MF/SS.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091006","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}

引用次数: 0

Immunohistochemical expression of EZH2 in germ cell tumors of the testis: New insights into the genesis and epigenetic reprogramming of these fascinating tumors. EZH2在睾丸生殖细胞肿瘤中的免疫组织化学表达：这些令人着迷的肿瘤的发生和表观遗传重编程的新见解。

IF 1.9 4区医学

American journal of clinical pathology Pub Date : 2025-09-17 DOI: 10.1093/ajcp/aqaf098

Sofia Melotti, Francesca Ambrosi, Tania Franceschini, Francesca Giunchi, Francesco Vasuri, Agnese Orsatti, Luisa Di Sciascio, Alessia Grillini, Eugenia Franchini, Francesco Massari, Veronica Mollica, Andrea Marchetti, Federico Mineo Bianchi, Maurizio Colecchia, Andres Martin Acosta, João Lobo, Michelangelo Fiorentino, Costantino Ricci

{"title":"Immunohistochemical expression of EZH2 in germ cell tumors of the testis: New insights into the genesis and epigenetic reprogramming of these fascinating tumors.","authors":"Sofia Melotti, Francesca Ambrosi, Tania Franceschini, Francesca Giunchi, Francesco Vasuri, Agnese Orsatti, Luisa Di Sciascio, Alessia Grillini, Eugenia Franchini, Francesco Massari, Veronica Mollica, Andrea Marchetti, Federico Mineo Bianchi, Maurizio Colecchia, Andres Martin Acosta, João Lobo, Michelangelo Fiorentino, Costantino Ricci","doi":"10.1093/ajcp/aqaf098","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf098","url":null,"abstract":"Objective: Several studies analyzed the \"reprogramming\" of germ cell tumors of the testis (GCTT), known to be an epigenetic process that results in the preservation of stem cell features and/or differentiation of GCTT. EZH2 is a methyltransferase involved in the epigenetic regulation of tumors and has become a promising therapeutic target, but few studies have analyzed its expression in GCTT, germ cell neoplasia in situ (GCNIS), and adjacent testis.Methods: We tested 131, 36, and 29 GCTT components, GCNIS, and adjacent testes, respectively. EZH2 expression was evaluated by H-score and compared between different subgroups by adopting median values and the Fisher exact test.Results: We found that EZH2 was more highly expressed by adjacent testis/GCNIS rather than by GCTT (P < .001), with adjacent testis showing the highest values and being statistically significant compared to GCNIS (P < .001). In adjacent testis, EZH2 expression was mainly detected in spermatocytes (primary and secondary) and spermatids, with scattered positive spermatogonia. Seminoma/embryonal carcinoma showed statistically significantly higher EZH2 expression compared to the other nonseminomatous GCTT (P = .027).Conclusions: EZH2 is differentially expressed during GCTT reprogramming (adjacent testis [very high levels] → GCNIS [high levels] → seminoma/embryonal carcinoma [moderate levels] → other nonseminomatous GCTT [low/absent levels]), supporting its involvement in the epigenetic regulation for determining the fate of GCTT.","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145090934","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}

引用次数: 0