Journal of Hematopathology最新文献

The most prevalent BCL2 fusion in B-cell lymphoma involves the IGH gene, attributable to the t(14;18)(q32;q21) translocation; this chromosomal abnormality is predominantly observed in follicular lymphoma (FL) and serves as one of its diagnostic hallmarks. In contrast, the fusion of BCL2 with IGL via the t(18;22)(q21;q11) translocation occurs less frequently. To investigate the clinicopathological characteristics associated with t(18;22)/IGL::BCL2, we conducted an analysis of five cases of B-cell lymphoma exhibiting the t(18;22) translocation. These patients underwent comprehensive diagnostic assessments, including pathological examination, flow cytometry, karyotyping, fluorescence in situ hybridization (FISH) testing, and genome-wide mutation analysis. Simultaneously, we conducted a literature review. All five patients in the study were male and diagnosed with chronic lymphocytic leukemia (CLL). Two patients exhibited an isolated t(18;22) chromosomal abnormality, while the remaining three presented with an additional +12 abnormality. Genetic rearrangements involving BCL2 and IGL were observed in all patients. Immunophenotypic analysis revealed no significant differences between classical CLL and cases with the t(18;22)/IGL::BCL2 translocation. Genetic testing conducted on three patients confirmed the presence of IGHV mutations. Of the three patients for whom treatment information was available, one demonstrated treatment indications at the initial diagnosis, one demonstrated treatment indications 14 months later, both of them did not respond to the Bruton's tyrosine kinase (BTK) inhibitor, and another one did not meet criteria for treatment. A comprehensive literature review identified 51 cases of the t(18;22)(q21;q11) translocation, primarily associated with CLL diagnoses. Detailed clinical trajectories were available for seven patients, among whom four required treatments at initial diagnosis, and two exhibited resistance to BTK inhibitors. Based on our case series and literature review, these cases appeared to have shorter time to first treatment (TTFT); however, more studies are needed. The t(18;22) chromosomal translocation, resulting in IGL::BCL2 fusion, is an infrequent occurrence predominantly observed in cases of CLL. This genetic anomaly frequently coexists with trisomy 12. Preliminary data suggest that these cases may have a shorter TTFT, though larger cohorts are needed for validation.

Megakaryocytes (MKs), the precursor cells of platelets, have essential roles in a variety of pathophysiological processes in the bone marrow (BM) niche. Megakaryocytes maintain hematopoietic stem cell microenvironment through inflammatory and immunological responses. The primary objective of this research was to investigate the clinical impact of BM-MK counts in high-risk myelodysplastic syndrome and acute leukemia patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT). Three hundred and forty-six patients (median age, 42 (15-71) years; male/female, 207/139) participated in the study. Based on the BM-MK counts on day + 100 of alloHSCT, the study population was classified into normal/high-MK⁺¹⁰⁰ and low-MK⁺¹⁰⁰ groups. The probabilities of progression-free survival (PFS) and overall survival (OS) were significantly better in the normal/high-MK⁺¹⁰⁰ group (p < 0.001, p < 0.001). Nonrelapse mortality was found to be reduced in the same group of patients (p = 0.012). BM-MK⁺¹⁰⁰ count, which was indicated to be a predictor for relapse after alloHSCT (p = 0.018), represented a considerable impact on PFS and OS (p = 0.017, p = 0.009). Megakaryocytes have regulatory roles in association with a comprehensive cytokine network in the BM microenvironment. Although the localization of MKs may be determinative for their spectrum of efficacy, distinct biological subgroups may also help to clarify the heterogeneity of their functional features. Prospective efforts in larger populations are required to illuminate the potential prognostic role of MKs in alloHSCT recipients.

"Dry tap" refers to the failed aspiration of bone marrow hematopoietic elements. Faulty technique is frequently blamed for a dry tap. But, often, the dry tap is associated with an underlying bone marrow pathology. This study aimed to evaluate the causes of dry tap and assess its clinical relevance. This retrospective observational study was conducted in the Department of Pathology over a period of 1 year, from 1 November 2023 to 31 October 2024. A total of 1327 bone marrow aspirates were reviewed. The definitive diagnosis was established by examining the trephine biopsy. A total of 267 aspirates, for which biopsy was not performed or which had suboptimal biopsies, were excluded from the study. A total of 1060 cases were taken for the final study. We attributed 125 (11.8%) cases that were aparticulate and grossly hemodiluted to a "dry tap." Of these, only 20 (16%) of the dry tap could be attributed to improper or faulty technique because their trephine biopsy was adequate and satisfactory for evaluation. An underlying bone marrow pathology, which could plausibly be the reason for dry tap, was identified in 105 (84%) patients. The most common cause was found to be acute leukemia, accounting for 32.8% of the cases. The laboratories should periodically review the cases yielding a dry tap, and if the corresponding biopsies are adequate, then one must focus on improving the technique of bone marrow aspiration. Moreover, a dry tap should serve as a diagnostic alert rather than a basis for disregard of the operator's technique.

Various types of lymphoma/leukemia can present with leukemic involvement by neoplastic cells with prominent nucleoli. Patients with chronic lymphocytic leukemia (CLL) most commonly can present in this fashion but other, less common types include mantle cell lymphoma, splenic marginal zone lymphoma, splenic diffuse red pulp small B-cell lymphoma, and splenic B-cell lymphoma/leukemia with prominent nucleoli (SBLPN). The latter is a newly proposed category in the fifth edition of the World Health Organization classification of hematolymphoid neoplasms. This category includes most cases that were previously designated hairy cell leukemia-variant and rare cases of CD5-negative B-prolymphocytic leukemia. A case of extranodal marginal zone lymphoma (EMZL) is reported to highlight the presence of nucleolated lymphocytes in the peripheral blood and bone marrow and their impact on the differential diagnosis, particularly with SBLPN. An 80-year-old woman with a reported history of "CLL", diagnosed and treated with clinical remission, developed gastric EMZL which relapsed twice after chemotherapy. At time of last relapse, a peripheral blood smear and bone marrow aspiration and biopsy specimens were evaluated to assess the presence and extent of blood and bone marrow involvement. The pathologic findings and differential diagnosis are discussed. A complete blood count showed a leukocyte count of 7.9 × 10⁹/L and review of the peripheral blood smear showed 32% nucleolated lymphocytes (absolute lymphocyte count, 2.5 × 10⁹/L). Bone marrow aspiration and biopsy showed a nodular, interstitial, and focal sinusoidal lymphoid infiltrate with a subset of lymphocytes displaying nucleoli. Flow cytometry immunophenotypic analysis of the bone marrow showed a CD5-negative, monotypic small B-cell population consistent with extranodal MZL. This case illustrates that nucleolated lymphocytes can be observed in the peripheral blood smear of patients with EMZL. These findings expand the differential diagnosis of circulating nucleolated lymphocytes in the blood.

We report the case of a 42-year-old female presented with cytopenia and abnormal promyelocytes on blood film. The promyelocytes were HLA-DR positive by flow cytometry. The rapid FISH for PML::RARA was negative. Myeloid NGS identified PML::RARA fusion, which was confirmed by molecular karyotyping and PCR. She was treated with ATRA and ATO to complete molecular remission. This case highlighted the importance of using rapid RNA sequencing to identify cryptic fusion and rare fusions and combining morphologic, immunophenotypic, cytogenetic and molecular analyses to ensure correct diagnosis and optimal management.

A 20-year-old man with a history of Wiskott-Aldrich syndrome (WAS) underwent excisional biopsy of a femoral lymph node for evaluation of lymphadenopathy. Histologic examination showed paracortical expansion by a lymphohistiocytic infiltrate, and reactive follicles with regressive changes. The interfollicular histiocytes had clumped nuclei and showed occasional emperipolesis. Special stains were negative for infectious organisms. The microscopic findings in this lymph node are related to the underlying WAS. Emperipolesis has previously been reported in lymph nodes of patients with WAS. Recognition of reactive microscopic features in lymph nodes of these patients is important, as they are at increased risk for lymphoproliferative disorders.

Bone marrow cytology plays a key role for the diagnosis and classification of hematological disease and is often the first step in the acute setting of unclear cytopenia. AI applications represent a powerful tool in digital image analysis and can improve the diagnostic workflow and accuracy. The aim of this study was to develop an algorithm for the automated detection and classification of hematopoietic cells in digitized bone marrow aspirate smears for potential implementation in the clinical laboratory. The AIFORIA create platform (Aiforia Technologies, Plc, Helsinki, Finland) was used to develop a convolutional neural network algorithm based on nine cell classes. Digitized bone marrow aspirate smears from normal hospital controls were used for AI training. External validation was performed on separate data sets. Automated cell classification was assessed in whole-slide images (WSI) and regions of interest (ROI). A total of 1950 single-cell annotations were applied for AI training with a final total class error of 0.15% with 99.9% precision and sensitivity (FI-score 99.2%). External validation showed an overall precision and sensitivity of 96% and 97% and a F1-score of 96%. Automated cell classification correlated highly across ROI with variable correlation to WSI. The average execution time for classifying 500 hematopoietic cells was < 1 s and ≤ 260 s for WSI. A cloud-based, deep-learning algorithm for automated detection and classification of hematopoietic cells in bone marrow aspirate smears is a very useful, reliable, and rapid screening tool in combination with cytomorphology.

Multiple myeloma is a clonal plasma cell malignancy often characterized by complex cytogenetic abnormalities that influence prognosis and treatment strategies. This report describes a 63-year-old male with kappa light chain multiple myeloma and a rare finding of double translocation involving t(11;14) and t(14;16), detected by FISH analysis. This case emphasizes the clinical implications of such genetic abnormalities and their impact on disease progression and therapeutic decisions.