American journal of clinical pathology最新文献

Objectives: Recent studies show that blocking CD47-SIRPα interactions is a promising target in checkpoint inhibition for cancer immunotherapy. However, to date, the expression of CD47 is not well characterized in various hematolymphoid neoplasms.

Methods: This study evaluates CD47 expression in a wide range of hematolymphoid neoplasms using immunohistochemistry on 834 cases.

Results: Results show variable but widespread CD47 expression among tumor types and within individual samples in both intensity and percentage. The highest CD47 expressions in both percentage of positive lymphoma cells and intensity was seen in small B-cell lymphomas, particularly chronic lymphocytic leukemia/small lymphocytic lymphoma, mantle cell, marginal zone, and follicular lymphomas. T and B lymphoblastic, diffuse large B-cell, peripheral T-cell, γδ T-cell, angioimmunoblastic T-cell lymphomas and myelodysplastic syndrome showed moderate CD47 expression. Acute and chronic myeloid leukemia as well as classic Hodgkin, anaplastic large cell, and natural killer/T-cell lymphomas showed low expression. Burkitt lymphoma is a notable standout, with little to no CD47 expression in all 14 cases examined.

Conclusions: Understanding the prevalence of CD47 expression in hematolymphoid neoplasms is crucial for identifying potential therapeutic targets and selecting patients who may benefit from CD47-targeted therapies. Additionally, CD47 may serve as a valuable diagnostic marker in neoplasms such as Burkitt lymphoma.

Objective: Cutaneous lupus erythematosus (CLE) is a chronic autoimmune disorder of the skin.

Methods: 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.

Conclusions: 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.

Objectives: To inform the pathology and laboratory field of the most recent national wage data. Historically, the results of this biennial survey have served as a basis for additional research on laboratory professional recruitment, retention, education, marketing, certification, and advocacy.

Methods: The 2023 Wage Survey was conducted in collaboration between the American Society for Clinical Pathology's (ASCP's) Institute of Science, Technology, and Policy in Washington, DC, and ASCP Board of Certification in Chicago, Illinois.

Results: Compared to 2021, results show that more occupations at the staff level had an increased average hourly wage (pathologists' assistant, molecular biology technologist, phlebotomist, cytogenetic technologist, and medical laboratory technician [MLT]), after adjusting for inflation. Wages by time in current occupational title are significantly higher in 2023 than in 2021. Histotechnicians, histotechnologists, and MLTs show consistent increases in pay rates for a longer length of time in the laboratory. Over half (52.4%) of the respondents feel the pandemic continues to influence their salary and/or well-being.

Conclusions: Survey results call for continued efforts in promoting visibility of the profession and greater representation through advocacy. While burnout rates are lower compared to 2021, staffing challenges remain a relevant concern. Efforts to support the workforce have multiplied since the pandemic and have been the forefront focus of the laboratory community. However, continued support and advocacy are needed to increase the promotion and value of laboratory careers for laboratory professionals and patients alike.

Objectives: Acute myeloid leukemia with CBFA2T3::GLIS2 fusion can initially present as extramedullary lesions (myeloid sarcoma), leading to a misdiagnosis of nonhematologic pediatric solid tumors.

Methods: We characterized the clinicopathologic features of 4 cases of CBFA2T3::GLIS2 fusion-positive myeloid sarcoma in pediatric patients where the sarcoma presented either without leukemic involvement (isolated myeloid sarcoma; 3/4 [75%]) or had concurrent leukemic disease (1/4 [25%]).

Results: All cases mimicked nonhematopoietic tumors at morphologic and immunophenotypic levels, so the initial evaluation did not raise suspicion for acute myeloid leukemia/myeloid sarcoma. After extensive workup, however, including molecular studies, the diagnosis of myeloid sarcoma with CBFA2T3::GLIS2 fusion was rendered.

Conclusions: This study highlights the need for a high suspicion index of GLIS2-rearranged myeloid sarcoma in the differential diagnosis of pediatric small round cell tumors in tissue biopsies and the application of adequate workup to avoid misdiagnosing this entity.

Objectives: The current recommendation for hysterectomy specimens performed for cervical cancer following conization is that the entire cervix be submitted for histologic examination. Given the high cost of medical procedures and concerns regarding difficulties with laboratory staffing, we sought to evaluate the potential for selective histologic examination in this setting.

Methods: Post-conization hysterectomy cases were reviewed for the presence of residual disease in relation to the findings of the prior conization, with consideration of margin status. Residual disease was then assessed for clinical significance. The number of submitted blocks was recorded and the associated costs were estimated.

Results: Among 32 cases with invasive carcinoma, only cases with margins positive for invasive carcinoma on the conization specimen had residual invasion in the hysterectomy (n = 7), and there were no upgrades due to subtle microscopic disease; 1 case had a change in pathologic stage from pT1b1 to pT2b due to parametrial involvement in the setting of a grossly apparent lesion. Among 20 cases performed following a diagnosis of dysplasia, none were upgraded to invasive carcinoma. Based on protocol-based submission of the entire cervix, 16 blocks of cervix were submitted on average (range, 4-41).

Conclusions: We estimate that representative sections from each cervical quadrant would save approximately 2 work hours for laboratory staff per case and up to 6 hours for larger cases, reducing costs for the laboratory accordingly. Selective cervical sampling in the setting of negative margins on conization provides an opportunity for improved resource utilization without compromising patient care; as this is a small study, confirmation of these findings in a larger number of cases may be warranted. Additional studies are necessary to determine what other contexts in surgical pathology could benefit from a similar reductive approach.

Objectives: As mismatch repair status confers differential prognosis in colorectal cancers, this study aimed to determine associations of α-smooth muscle actin (α-SMA) protein expression in mismatch repair-proficient (pMMR) and mismatch repair-deficient (dMMR) colorectal tumors with clinicopathologic and prognostic features.

Methods: Tissue microarrays from patients with colorectal cancer, immunostained with α-SMA, were assessed through digital image analysis. Total (n = 962), pMMR (n = 782), and dMMR (n = 156) stromal H-scores were assessed for associations with clinicopathologic and survival data.

Results: Higher α-SMA expression was correlated with pMMR status (P = 5.2223 × 10-8). In the pMMR subgroup, higher α-SMA stromal expression at the tumor periphery was correlated with higher T stage (P = .002), perineural invasion (P = .038), infiltrative tumor edge (P = .01), involved nodal status (P = .036), metastases (P = .013), synchronous metastases (P = .007), recurrence (P = .004), and both 3-year and 5-year survival (P = .018). dMMR tumors showed no significant correlations with α-SMA staining.

Conclusions: The findings highlight that immunostaining with α-SMA in pMMR colorectal tumors, especially at the tumor periphery, has the potential to identify patients with adverse prognostic features. Digital assessment of α-SMA may offer improved objectivity, accuracy, economy of time, and risk stratification for management.

Objectives: Acute infectious diseases are some of the most common reasons for receiving medical care, and analysis of the host immune response is an attractive approach for their diagnosis. The present study aimed to evaluate the potential usefulness of CD169 expression on peripheral monocytes (mCD169) as a marker of viral-associated host immune response.

Methods: In a large mono-institutional cohort of 4,025 patients evaluated for SARS-CoV-2 (CoV2) and other viral infections, mCD169 analysis was performed by rapid flow cytometry assay.

Results: Increased mCD169 values (median, 17.50; IQR, 8.40-25.72) were found in 1,631 patients with CoV2+ acute infection compared to 2,394 in CoV2- patients (median, 2.35; IQR, 2.0-3.25) (odds ratio [OR], 21.84; 95% CI ,17.53-27.21; P < .001). Among CoV2- patients, 1,484 (62.0%) were assessed for other viral infections, and viral etiology was laboratory confirmed in 428 patients (CoV2- Vir+), with RNA viruses most frequently detected (94.6%). Higher levels of mCD169 were also confirmed in CoV2- Vir+ compared to CoV2- Vir- patients (OR, 10.05; 95% CI, 7.35-13.74; P < .001).

Conclusions: mCD169 analysis by rapid flow cytometry assay may be a sensitive broad marker useful for the rapid triage of patients with suspected acute viral infections and could potentially be directly applied to eventual new emergent viral outbreaks.