American journal of clinical pathology最新文献

{"title":"Urothelial carcinoma in situ with \"early papillary formation\" vs \"lateral spread/shoulder lesion\" of prior high-grade noninvasive papillary urothelial carcinoma: A survey of pathologist and urologist interpretations.","authors":"Ankur R Sangoi, Ali Shahabi, Michelle S Hirsch, Chia-Sui Sunny Kao, Mustafa Deebajah, Justine A Barletta, Gladell P Paner, Steven C Smith, David J Grignon, Eva Compérat, Mahul B Amin, Fiona Maclean, Rajal B Shah, Kenneth A Iczkowski, Warick Delprado, Liang Cheng, Chin-Chen Pan, Jesse K McKenney, Jae Y Ro, Francesca Khani, Rodolfo Montironi, Brian D Robinson, Hikmat Al-Ahmadie, Jonathan I Epstein, Kiril Trpkov, Maria Tretiakova, Steven S Shen, Shaheen Alanee, Christopher J Weight, Mahmut Akgul, Sean R Williamson","doi":"10.1093/ajcp/aqae167","DOIUrl":"10.1093/ajcp/aqae167","url":null,"abstract":"<p><strong>Objectives: </strong>Urothelial carcinoma in situ (CIS) with early papillary formation is terminology sometimes used to suggest incipient high-grade papillary urothelial carcinoma (PUC) but may lead to confusion between true CIS and lateral flat spread of PUC.</p><p><strong>Methods: </strong>It remains unclear how pathologists and urologists interpret this scenario, so a survey was circulated to 68 pathologists (group 1 = 28 academic genitourinary pathologists; group 2 = 17 pathologists with a self-reported genitourinary focus; group 3 = 23 pathologists self-reported as not genitourinary specialists) and 32 urologists.</p><p><strong>Results: </strong>Regarding atypical urothelial lesions that appear mainly flat but contain possible papillae, group 3 was more likely to label this as CIS compared with groups 1 and 2 (35% for group 3 vs 13% for groups 1 and 2), while groups 1 and 2 more often adopted another descriptive diagnosis, such as \"CIS with early papillary features\" (38% for groups 1 and 2 vs 13% for group 3). Among all 3 groups, group 1 was most likely to diagnose concomitant CIS and PUC in the same specimen but in different tissue fragments (58%). Pagetoid spread was reported to favor CIS predominantly by group 1 (61%). Urologists felt that the term lateral spread/shoulder was unclear (75%) and preferred early PUC (44%) or PUC with early growth (44%). Half (53%) of urologists felt that reporting CIS instead of lateral spread of PUC would change management.</p><p><strong>Conclusions: </strong>Documentation of flat lesions lacks consensus among pathologists and may benefit from standardized terminology. Moreover, the distinction between CIS and early or lateral spread of PUC is not always clear to urologists and can influence disease management.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"629-640"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885218","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":"Reply to \"Escalation process of critical values when these cannot be communicated on first attempt: a hospital-wide process improvement project\".","authors":"Jeannette Guarner","doi":"10.1093/ajcp/aqae165","DOIUrl":"10.1093/ajcp/aqae165","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"643"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373473","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":"Follow the LINE: A novel case of dilated cardiomyopathy caused by a LINE-1 insertion in the TTN gene.","authors":"Qiliang Ding, Jenna Fine, Frank T Hoffman, Michelle L Kluge, Rhonda K Kuennen, Sarah M Thieke, Nicole L Hoppman, Cherisse A Marcou, Ross A Rowsey, Erik C Thorland, Linnea M Baudhuin, Ann M Moyer, Alessia Buglioni","doi":"10.1093/ajcp/aqae170","DOIUrl":"10.1093/ajcp/aqae170","url":null,"abstract":"<p><strong>Objectives: </strong>Protein-truncating variants in the TTN gene are a well-established cause of dilated cardiomyopathy (DCM). We report a novel case of DCM caused by a mobile element insertion (MEI) in TTN, through which we highlight the key features of MEIs in next-generation sequencing data. Because of the rarity of MEIs, the next-generation sequencing data features associated with these events may be mistaken as noise, potentially leading to missed diagnoses.</p><p><strong>Methods: </strong>Next-generation sequencing gene panel testing for DCM was performed on a 17-year-old male patient presenting with severe left ventricular dilatation and systolic dysfunction. Manta was used for structural variant detection, followed by manual review of NGS data for potential structural variants.</p><p><strong>Results: </strong>Manta detected a potential insertion in TTN. Manual review identified hallmark features consistent with a LINE-1 MEI. This finding was orthogonally confirmed by long-range polymerase chain reaction and gel electrophoresis, which indicated an insertion of approximately 4 to 5 kilobase pairs. The insertion disrupted the reading frame of TTN within an A-band exon, resulting in protein truncation that was classified as likely pathogenic.</p><p><strong>Conclusions: </strong>This case expands the mutational spectrum of TTN protein-truncating variants. It also underscores the importance of recognizing rarer types of pathogenic variants (eg, MEIs) to produce accurate genetic diagnostics.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"511-515"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381569","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":"How I diagnose B-cell lymphoproliferative disorders with plasmacytic differentiation.","authors":"Jonathan H Young, Olga Pozdnyakova","doi":"10.1093/ajcp/aqae163","DOIUrl":"10.1093/ajcp/aqae163","url":null,"abstract":"<p><strong>Objectives: </strong>B-cell lymphomas with plasmacytic differentiation is a broad category that includes small and large B-cell lymphomas. In this review, we focus on the small B-cell lymphomas, which include lymphoplasmacytic lymphoma and marginal zone lymphomas, among others. We aimed to review the diagnostic criteria of each entity and the features that distinguish them from each other.</p><p><strong>Methods: </strong>We discuss the clinical presentation, morphology, immunophenotype, molecular features, and potential pitfalls of diagnosing B-cell lymphomas with plasmacytic differentiation and provide 2 illustrative cases.</p><p><strong>Results: </strong>In some instances, small B-cell lymphomas with plasmacytic differentiation, particularly lymphoplasmacytic lymphoma and certain marginal zone lymphomas, have overlapping morphologic and immunophenotypic features. As a result, differentiating them may be difficult.</p><p><strong>Conclusions: </strong>In cases where classification is challenging, integration with clinical, radiologic, and laboratory findings may be helpful in arriving at a specific diagnosis. Instances remain, however, in which classification is difficult.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"501-510"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555532","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":"Survey of anatomic and clinical pathology services and infrastructure in Nigeria.","authors":"Jonathan Tucci, Jeremy W Jacobs, Zainab U Ibrahim, Aminu A Yusuf, Ali Bala Umar, Danny A Milner, Quentin Eichbaum","doi":"10.1093/ajcp/aqae156","DOIUrl":"10.1093/ajcp/aqae156","url":null,"abstract":"<p><strong>Objectives: </strong>The paucity of data regarding the availability and extent of diagnostic medical services across sub-Saharan Africa hinders appropriate allocation of resources to improve health care in these regions. We assessed anatomic pathology (AP) and clinical pathology (CP) services in Nigeria, one of the most populous and fastest-growing countries in the world.</p><p><strong>Methods: </strong>Two individual surveys (AP focused and CP focused) were developed by subject matter experts and administered to individuals involved in pathology and laboratory medicine diagnostic services at hospitals and laboratories across Nigeria between June and August 2022 using the American Society for Clinical Pathology email listserv.</p><p><strong>Results: </strong>A total of 75 responses (29 AP and 46 CP) were received from 48 unique laboratories. Twenty-four sites provided AP services and 35 provided CP services. Eleven respondents performed both AP and CP services. Among AP services, basic surgical and cytopathology capabilities were available at most sites; however, the availability of automated technologies (eg, automated sample processing and staining) was more variable. Advanced diagnostic techniques, (eg, immunohistochemistry, human papillomavirus testing, molecular diagnostics) were rarely performed. The most frequently available CP services included hematology, microbiology, and chemistry. Microbiology services appeared to be among the most robust laboratory medicine services, particularly parasitology and bacteriology testing. Similar to AP services, more advanced diagnostic assays, such as flow cytometry, cytogenetics, and molecular testing, were largely unavailable.</p><p><strong>Conclusions: </strong>These findings augment earlier studies and identify gaps that should be prioritized from a policy perspective to improve medical services and the overall health care infrastructure in Nigeria.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"586-600"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805970","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":"Career pathways into the medical laboratory workforce: Education, exposures, and motivations.","authors":"Grace A Guenther, Shahida F Shahrir, Susan M Skillman, Iman Kundu, Edna Garcia, Bianca K Frogner","doi":"10.1093/ajcp/aqae151","DOIUrl":"10.1093/ajcp/aqae151","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this study was to investigate career pathways into the medical laboratory workforce by examining medical laboratory scientists, medical laboratory technicians, histotechnologists, histotechnicians, cytologists, and phlebotomists.</p><p><strong>Methods: </strong>We collected data through an anonymous online survey (May-June 2023) from a convenience sample of medical laboratory professionals in the United States (N = 1243). We performed descriptive analyses of demographics, current employment characteristics, educational and training history, career exposures, motivations, movement, and outlook (eg, job satisfaction, future career plans).</p><p><strong>Results: </strong>Findings show a diverse range of educational backgrounds and varying career pathways across occupations. A majority of respondents reported hearing about laboratory occupations from friends, family, co-workers, and acquaintances. At least one-third to nearly one-half of respondents had a family member with broader professional health care experience. Respondents viewed their jobs favorably, with at least 75% of respondents answering that they would recommend their occupation or another laboratory occupation.</p><p><strong>Conclusions: </strong>This study found overall positive job experiences and satisfaction, but career pathways into medical laboratory occupations are complex and often unclear. Organizations in the field are undertaking promotional efforts to increase the visibility of these occupations. Future research is needed to monitor and evaluate these efforts.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"545-580"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142826968","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":"Trop-2 and Ephrin B2 expression in urothelial carcinoma with divergent differentiation and aggressive urothelial carcinoma subtypes.","authors":"Katherine B Case, Dylan J Martini, Melad N Dababneh, Samuel Bidot, Bassel Nazha, Jacqueline Brown, Shreyas Joshi, Vikram Narayan, Vaunita Parihar, Faisal Saeed, Mehmet Asim Bilen, Lara R Harik","doi":"10.1093/ajcp/aqae161","DOIUrl":"10.1093/ajcp/aqae161","url":null,"abstract":"<p><strong>Objectives: </strong>Urothelial carcinomas (UCs) encompass a heterogeneous group of tumors. Several histopathologic features are associated with poor clinical outcomes and limited treatment options. With new rising therapeutic modalities, we aimed to determine the pattern of expression of Trop-2 and ephrin B2 in UC with aggressive subtype histology and/or divergent differentiation (SH/DD).</p><p><strong>Methods: </strong>We performed a retrospective analysis of 113 UC samples with SH/DD at our institution from 2011 to 2021. Immunohistochemical staining for Trop-2 and ephrin B2 expression was performed on all cases. Expression was determined by the percentage of samples with a moderate or strong H-score.</p><p><strong>Results: </strong>Our results show Trop-2 expression was the highest in squamous cell carcinoma and UC with squamous differentiation, adenocarcinoma and UC with glandular differentiation, and plasmacytoid subtype, while ephrin B2 expression was highest in adenocarcinoma, UC with glandular differentiation, and small cell carcinoma.</p><p><strong>Conclusions: </strong>Expression of Trop-2 and ephrin B2 may demonstrate therapeutic possibilities for patients with SH/DD, who usually have limited treatment options, particularly in small cell carcinoma, in which few targets have been identified. Clinical trials to investigate the efficacy of these novel treatments are warranted.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"618-628"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869280","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":"Factors impacting tumor displacement artifact and pseudo-lymphovascular invasion in testicular germ cell tumors.","authors":"Reem O Ahmed, Debra L Zynger","doi":"10.1093/ajcp/aqae147","DOIUrl":"10.1093/ajcp/aqae147","url":null,"abstract":"<p><strong>Objectives: </strong>Testicular germ cell tumors are susceptible to tumor displacement artifact (TDA), which produces pseudo-lymphovascular invasion (LVI) and confounds the identification of true LVI. Our study aimed to evaluate tumor displacement artifact and pseudo-LVI in testicular germ cell tumors and determine if prolonged fixation improves histological quality.</p><p><strong>Methods: </strong>A retrospective search identified 121 orchiectomies with slides that were reviewed to assess TDA and pseudo-LVI.</p><p><strong>Results: </strong>Seminoma had more TDA (68% vs 45%, P = .01) and pseudo-LVI (53% vs 19%, P < .001) than mixed germ cell tumor. Seminoma and mixed germ cell tumor with TDA and pseudo-LVI were larger than those without. Mixed germ cell tumor with ≥50% composition of seminoma had a higher rate of TDA (89% vs 38%, P = .008) and pseudo-LVI (44% vs 15%, P = .06) than those with less. TDA was reduced in seminoma with >1 night fixation compared to no fixation (50% vs 82%, P = .046), with a similar trend in mixed germ cell tumor (31% vs 60%, P = .15). A trend in reduction of pseudo-LVI was seen with >1 night fixation compared to no fixation in seminoma (64% vs 39%, P = .12).</p><p><strong>Conclusions: </strong>Seminomas and larger germ cell tumors were more prone to TDA and pseudo-LVI. Prolonged formalin fixation improved histological quality in testicular germ cell tumors. Based on these data, we recommend fixation for at least 2 nights before sectioning orchiectomy specimens, particularly for larger tumors.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"516-525"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612170","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":"Cutaneous lupus erythematosus presenting as a nonhealing ulcer in an African American woman: A case report.","authors":"Kevin M Burningham, Mohamad Taha, Seo Won Cho, Mahmud Alkul, Anisha B Patel, Stephen K Tyring","doi":"10.1093/ajcp/aqaf017","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf017","url":null,"abstract":"<p><strong>Objective: </strong>Cutaneous lupus erythematosus (CLE) is a chronic autoimmune disorder of the skin.</p><p><strong>Methods: </strong>In this report, we describe the case of an African American woman with CLE who had an ulcer on her posterior thigh. Despite this, initial biopsy specimen of the lesion revealed no evidence of CLE until a repeat biopsy 5 months later.</p><p><strong>Conclusions: </strong>This case underscores the importance of considering CLE in patients with chronic ulcers resistant to initial therapy and demonstrates the value of performing a re-biopsy when the results of the initial biopsy do not explain the clinical presentation.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603483","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":"Use of anatomic pathology tools in global oncology outreach.","authors":"Harm Veerkamp, Cary Adams","doi":"10.1093/ajcp/aqae134","DOIUrl":"10.1093/ajcp/aqae134","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"325-326"},"PeriodicalIF":2.3,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805972","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}