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Histologic Reaction Patterns of Lymph Node Involvement in Ovarian Serous Borderline Tumors. 卵巢浆液性交界性肿瘤淋巴结受累的组织学反应模式。
Pub Date : 2024-12-09 DOI: 10.5858/arpa.2024-0191-OA
Jisup Kim, Kyu-Rae Kim

Context.—: Lymph node (LN) involvement (LNI) is not infrequently observed in ovarian serous borderline tumors (SBTs) but is not considered equivalent to malignant tumor metastasis, as it reportedly does not impact recurrence or survival in patients with SBT. However, the reasons underlying the insignificant clinical impact of LNI remain unclear.

Objective.—: To determine whether histologic reaction patterns (HRPs) are associated with SBT prognosis.

Design.—: We compared HRPs around tumor cell clusters in LNs of patients with SBT and low-grade serous carcinoma. HRPs were classified into 4 categories (HRP 1-HRP 4) based on tumor cell location in LNs, the presence of their adhesion to surrounding lymphoid tissue, or pericellular desmoplastic reactions.

Results.—: Although LNI itself was linked to reduced recurrence-free survival (RFS), no recurrence was observed in patients with HRP 1 or 2, characterized by freely floating tumor cells in the lumens of afferent/efferent lymphatics or intranodal sinus with surrounding free spaces. Conversely, HRP 3 or higher, characterized by firm tumor cell adhesion to lymphoid tissue (HRP 3) or peritumoral desmoplastic reaction (HRP 4), independently impacted RFS, albeit not overall survival.

Conclusions.—: The prognosis of SBT with LNI is not uniformly favorable, and HRPs around the LNI significantly influence patient outcomes. Patients with firm tumor cell adhesion to surrounding tissue, with or without peritumoral desmoplastic reaction (HRP ≥3), independently experience decreased RFS, although this does not correlate with reduced overall survival.

上下文。-:淋巴结(LN)累及(LNI)在卵巢浆液交界性肿瘤(SBT)中并不罕见,但不被认为等同于恶性肿瘤转移,因为据报道它不影响SBT患者的复发或生存。然而,LNI临床影响不显著的原因尚不清楚。目的:确定组织学反应模式(HRPs)是否与SBT预后相关。-:我们比较了SBT患者和低级别浆液性癌患者LNs中肿瘤细胞团周围的HRPs。根据肿瘤细胞在LNs中的位置、是否与周围淋巴组织粘连或细胞周围结缔组织增生反应,将HRP分为4类(HRP 1-HRP 4)。-:虽然LNI本身与降低无复发生存率(RFS)有关,但在HRP 1或2患者中未观察到复发,其特征是肿瘤细胞在传入/传出淋巴管或结内窦内自由漂浮,周围有自由间隙。相反,HRP 3或更高,以肿瘤细胞粘附淋巴组织(HRP 3)或瘤周结缔组织增生反应(HRP 4)为特征,独立影响RFS,尽管不是总体生存。-: SBT合并LNI的预后并不一致有利,LNI周围的HRPs显著影响患者的预后。肿瘤细胞与周围组织粘连牢固的患者,无论有无瘤周结缔组织增生反应(HRP≥3),RFS都会下降,尽管这与总生存率降低无关。
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引用次数: 0
Fumarate Hydratase-Deficient Renal Cell Carcinoma With Predominant Tubulocystic Features Mimics Tubulocystic Renal Cell Carcinoma. 富马酸氢化酶缺陷型肾细胞癌以管囊肿为主要特征,与管囊肿型肾细胞癌相似。
Pub Date : 2024-12-01 DOI: 10.5858/arpa.2023-0330-OA
Xiaoqun Yang, Yang Liu, Huafeng Wang, Yunze Xu, Huizhi Zhang, Ming Zhao, Xiaoqing Luo, Hongtao Jin, Ji Xiong, Lili Tao, Jiankun Xu, Luting Zhou, Xiangyun Li, Haimin Xu, Lei Dong, Chaofu Wang

Context.—: Fumarate hydratase (FH)-deficient renal cell carcinoma (RCC) rarely exhibits a predominant tubulocystic architecture with few other components. RCC with pure tubules and cysts lined by eosinophilic tumor cells with prominent nucleoli would raise the diagnosis of tubulocystic RCC. It is important to differentiate the 2 entities because they lead to different outcomes.

Objective.—: To address this concern, a multicenter study was implemented to explore useful clinicopathologic features in differentiation between tubulocystic FH-deficient RCC and tubulocystic RCC.

Design.—: Clinical factors included age, sex, tumor size, and outcome. Morphologic factors included cell morphology, presence or absence of a nontubulocystic component, and stromal findings. Immunohistochemistry, fluorescence in situ hybridization, and next-generation sequencing were performed to explore the protein expression and molecular profiles of the 2 entities.

Results.—: We evaluated 6 patients with tubulocystic RCC and 10 patients with tubulocystic FH-deficient RCC. Tubulocystic RCC exhibited a small size (<4.0 cm, pT1a), low Ki-67 index (<5%), retained FH, and negative 2SC expression. Tubulocystic FH-deficient RCC had a relatively large size and a high Ki-67 index. Perinucleolar haloes, loss of FH, and 2SC positivity were always observed. Pure tubulocystic architecture was not observed in FH-deficient RCC, because focal nontubulocystic components can always be seen.

Conclusions.—: We emphasized multiple sectioning to identify a nontubulocystic architecture to exclude tubulocystic RCC. Moreover, tumor size, FH/2SC staining, and the Ki-67 index can differentiate tubulocystic FH-deficient RCC from tubulocystic RCC. The diagnosis of tubulocystic RCC was not recommended in renal mass biopsy because of the limited tissues sampled.

背景:富马酸氢化酶(FH)缺陷型肾细胞癌(RCC)很少表现出以小管囊肿为主、其他成分很少的结构。肾小管和囊肿内有嗜酸性肿瘤细胞,核小体突出的RCC可诊断为肾小管囊性RCC。区分这两种实体非常重要,因为它们会导致不同的结果:为了解决这一问题,我们开展了一项多中心研究,以探索鉴别管状囊肿型FH缺乏症RCC和管状囊肿型RCC的有用临床病理特征:临床因素包括年龄、性别、肿瘤大小和预后。形态学因素包括细胞形态、是否存在非管状囊肿成分以及基质发现。通过免疫组化、荧光原位杂交和新一代测序,研究了这两种实体的蛋白质表达和分子特征:我们评估了6例管状囊肿型RCC患者和10例管状囊肿型FH缺陷型RCC患者。管状囊肿型 RCC 体积较小(结论):我们强调通过多次切片检查来确定非管状囊肿结构,以排除管状囊肿型 RCC。此外,肿瘤大小、FH/2SC染色和Ki-67指数可以区分管状囊肿型FH缺陷RCC和管状囊肿型RCC。由于取样组织有限,不建议在肾脏肿块活检中诊断出肾小管囊肿型 RCC。
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引用次数: 0
Urine PLA2R Antibody Detection in Hazard Stratification of PLA2R-Associated Membranous Nephropathy. 尿PLA2R抗体检测在PLA2R相关膜性肾病危险分层中的应用。
Pub Date : 2024-11-29 DOI: 10.5858/arpa.2024-0161-OA
Tianyu Zheng, Yuan Qin, Xuanli Tang, Peng Bi, Xuxiang Hui, Zixuan Zhou, Yulin Fu, Huiming Sheng, Xiumei Zhou, Xueqin Zhao, Yuanyuan Du, Qiang He, Biao Huang

Context.—: M-type phospholipase A2 receptor (PLA2R) is the major autoantigen of membranous nephropathy (MN). As the specific antibodies of MN, the correlation between serum PLA2R antibody (sPLA2R-Ab) levels and PLA2R-associated MN (PMN) risk stratification is still controversial.

Objective.—: To apply the time-resolved fluorescence immunoassay (TRFIA) method on urine PLA2R-Ab (uPLA2R-Ab), detect, and then establish a more sensitive method of combined serum and urine PLA2R-Ab detection for PMN hazard stratification.

Design.—: A highly sensitive TRFIA method was used to detect the initial serum and urine samples of patients with PMN. Patients were grouped into remission and nonremission groups according to the outcomes after 12 months of treatment and the data were analyzed.

Results.—: The cutoff values of sPLA2R-IgG (sPLA2R-immunoglobulin G), uPLA2R-IgG, sPLA2R-IgG4, and uPLA2R-IgG4 for distinguishing between remission and nonremission groups were 50 relative units (RU)/mL, 3.51 RU/mL, 6835 ng/mL, and 143.4 ng/mL, respectively. The average value in the remission group for sPLA2R-IgG, uPLA2R-IgG, sPLA2R-IgG4, and uPLA2R-IgG4 was 37.39 RU/mL, 1.10 RU/mL, 3498.99 ng/mL, and 33.83 ng/mL, respectively. The average value in the nonremission group for sPLA2R-IgG, uPLA2R-IgG, sPLA2R-IgG4, and uPLA2R-IgG4 was 279.96 RU/mL, 45.36 RU/mL, 25762.47 ng/mL, and 1383.89 ng/mL, respectively. For sPLA2R-Ab as the primary factor, in combination with uPLA2R-Ab, the high-risk predictive value of combined detection of serum and urine PLA2R-IgG and of serum and urine PLA2R-IgG4 was upgraded from 54.55% to 100% and from 75% to 100%, respectively.

Conclusions.—: A highly sensitive TRFIA method was applied in this study; the combined detection of serum and urine PLA2R-Ab improves the efficiency of PMN risk stratification, and can provide a better assessment of PMN monitoring.

上下文。-: m型磷脂酶A2受体(PLA2R)是膜性肾病(MN)的主要自身抗原。作为MN的特异性抗体,血清PLA2R抗体(sPLA2R-Ab)水平与PLA2R相关MN (PMN)危险分层的相关性仍存在争议。-:应用时间分辨荧光免疫分析法(TRFIA)检测尿PLA2R-Ab (uPLA2R-Ab),建立更为灵敏的血清与尿PLA2R-Ab联合检测PMN危害分层的方法。-:采用高灵敏度的TRFIA方法检测PMN患者的初始血清和尿液样本。根据治疗12个月后的结果将患者分为缓解组和非缓解组,并对数据进行分析。-: sPLA2R-IgG (spla2r免疫球蛋白G)、uPLA2R-IgG、sPLA2R-IgG4和uPLA2R-IgG4用于区分缓解组和非缓解组的截止值分别为50相对单位(RU)/mL、3.51 RU/mL、6835 ng/mL和143.4 ng/mL。缓解组sPLA2R-IgG、uPLA2R-IgG、sPLA2R-IgG4和uPLA2R-IgG4的平均值分别为37.39 RU/mL、1.10 RU/mL、3498.99 ng/mL和33.83 ng/mL。非缓解组sPLA2R-IgG、uPLA2R-IgG、sPLA2R-IgG4和uPLA2R-IgG4的平均值分别为279.96 RU/mL、45.36 RU/mL、25762.47 ng/mL和1383.89 ng/mL。以sPLA2R-Ab为主要因素,联合uPLA2R-Ab可将血清和尿液PLA2R-IgG、血清和尿液PLA2R-IgG4联合检测的高危预测值分别从54.55%和75%提高到100%。-:本研究采用高灵敏度的TRFIA方法;血清和尿液PLA2R-Ab联合检测可提高PMN风险分层的效率,并能更好地评估PMN监测情况。
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引用次数: 0
Inpatient Test Utilization and Test Volume Benchmarking: A Q-Probes Study. 住院病人检验利用率和检验量基准:Q-Probes 研究。
Pub Date : 2024-11-28 DOI: 10.5858/arpa.2024-0104-CP
Peter L Perrotta, Suzanne Coulter, Barbara J Blond, Thomas Long, Ron B Schifman

Context.—: Test-ordering practices vary widely between and within health care organizations, and methods used to benchmark test utilization data are unstandardized.

Objective.—: To develop and apply standardized methodology to compare inpatient test utilization data submitted by laboratories enrolled in a College of American Pathologists Q-Probes study.

Design.—: Participating laboratories provided inpatient test volumes for 50 designated analytes and total inpatient days for 2019 or a recent 12-month period. Test utilization patterns were characterized by studying test volumes standardized per 1000 inpatient days. Test volume variability used the standardized median absolute deviation; standardized test volumes were evaluated by calculating comparative ranges for each analyte. Standardized test volumes falling outside their respective comparative ranges are referred to as outliers in this study. Volume data were tested for association with stewardship practices and institutional demographics.

Results.—: Methodology using standardized test volume data identified test groups that are commonly used in the inpatient setting and efficiently identified volume outliers. High test volume outliers included creatine kinase myocardial band, free prostate-specific antigen, myoglobin, serotonin release assay, and hepatitis B serologies; no low-volume outliers were observed. Among 33 participants, 13 (39%) had no test volume outliers, while 5 (15%) showed multiple tests (13-34) with comparatively high volumes. No statistically significant relationships were found between stewardship practices and test-ordering patterns.

Conclusions.—: Our approach can be used to measure inpatient test volume data across organizations and for identifying test volumes falling outside of the standardized comparative ranges that may require interventions to change test utilization practices.

背景医疗机构之间以及医疗机构内部的检验订单做法大相径庭,用于基准检验利用数据的方法也没有标准化:开发并应用标准化方法,对参加美国病理学家学会 Q-Probes 研究的实验室提交的住院病人检验利用率数据进行比较:参与研究的实验室提供 2019 年或最近 12 个月期间 50 种指定分析物的住院检验量和住院总天数。通过研究每 1000 个住院日的标准化检验量来描述检验利用模式。检验量变异性采用标准化中位绝对偏差;标准化检验量通过计算每种分析物的比较范围进行评估。本研究将超出各自比较范围的标准化检测量称为异常值。测试了检测量数据与监管实践和机构人口统计学的关联:使用标准化检验量数据的方法确定了住院环境中常用的检验组,并有效地确定了检验量异常值。高检验量异常值包括肌酸激酶心肌带、游离前列腺特异性抗原、肌红蛋白、5-羟色胺释放测定和乙型肝炎血清学检查;未发现低检验量异常值。在 33 名参与者中,有 13 人(39%)没有检测量异常值,而有 5 人(15%)的多次检测(13-34 次)检测量相对较高。在统计意义上,没有发现管理实践与检验订购模式之间存在明显的关系:我们的方法可用于测量各机构的住院病人检验量数据,并用于识别超出标准化比较范围的检验量,这些检验量可能需要采取干预措施来改变检验使用方法。
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引用次数: 0
Genomic Reporting Practices Across 5 Molecular Disciplines: A Study From the College of American Pathologists. 5 个分子学科的基因组报告实践:美国病理学家学院的一项研究。
Pub Date : 2024-11-22 DOI: 10.5858/arpa.2024-0207-CP
Larissa V Furtado, Annette S Kim, Ann M Moyer, Joel T Moncur, Rena R Xian, Angshumoy Roy, Avni B Santani, Yassmine Akkari, Karl V Voelkerding, Rhona J Souers, Jaimie Halley, Glenn E Palomaki

Context.—: Genomic reports are primarily organized in a narrative and unstructured format with variations in content and format. Regulatory requirements and professional guidelines for genetic test reporting exist but provide little guidance for effective communication of information.

Objective.—: To assess clinical genomic reporting practices across 5 disciplines within molecular diagnostics, including germline, somatic solid tumors, somatic hematologic malignancies, pharmacogenomics, and prenatal cell-free DNA screening.

Design.—: Reporting practices were assessed by using a structured review of clinical genomic reports from multiple laboratories in 5 molecular disciplines spanning different practice settings. Report content was reviewed by the presence/absence of from 27 to 44 elements, including 23 elements required by the College of American Pathologists and/or the Clinical Laboratory Improvement Amendments of 1988 (CLIA). If present, the element's location on the report was recorded.

Results.—: A total of 69 genomics reports from 31 laboratories were reviewed. Overall, the reports were compliant with regulatory requirements but showed variability in both format and content. Six of 7 required reporting elements (per CLIA, 42 CFR [Code of Federal Regulations] 493.1291) were included in 90% of the reports. However, these elements were often located in different report sections. Only patient demographics were always found in a specific report section (header).

Conclusions.—: These results show that reports are overall compliant with regulatory requirements, despite some reporting elements being less consistently reported. The lack of consistent presentation of the data elements presents an opportunity to improve the communication of molecular testing results to clinicians and patients.

背景:基因组报告主要以叙述性和非结构化的格式组织,内容和格式各不相同。基因检测报告的监管要求和专业指南已经存在,但对信息的有效沟通几乎没有提供指导:评估分子诊断学中 5 个学科的临床基因组报告实践,包括种系、体细胞实体瘤、体细胞血液恶性肿瘤、药物基因组学和产前无细胞 DNA 筛查:通过对 5 个分子学科的多个实验室的临床基因组报告进行结构化审查,评估了不同实践环境下的报告实践。报告内容根据是否存在 27 至 44 个要素进行审查,其中包括美国病理学家学会和/或 1988 年临床实验室改进修正案(CLIA)要求的 23 个要素。如果存在,则记录该元素在报告中的位置:共审核了 31 家实验室的 69 份基因组学报告。总体而言,这些报告符合监管要求,但在格式和内容上存在差异。90% 的报告中包含了 7 项必要报告要素中的 6 项(根据 CLIA,42 CFR [《联邦法规汇编》] 493.1291)。然而,这些要素往往位于不同的报告章节中。只有患者的人口统计数据总是出现在特定的报告部分(页眉):这些结果表明,尽管某些报告要素的报告不太一致,但报告总体上符合监管要求。数据元素的呈现缺乏一致性,这为改进向临床医生和患者传达分子检测结果提供了机会。
{"title":"Genomic Reporting Practices Across 5 Molecular Disciplines: A Study From the College of American Pathologists.","authors":"Larissa V Furtado, Annette S Kim, Ann M Moyer, Joel T Moncur, Rena R Xian, Angshumoy Roy, Avni B Santani, Yassmine Akkari, Karl V Voelkerding, Rhona J Souers, Jaimie Halley, Glenn E Palomaki","doi":"10.5858/arpa.2024-0207-CP","DOIUrl":"https://doi.org/10.5858/arpa.2024-0207-CP","url":null,"abstract":"<p><strong>Context.—: </strong>Genomic reports are primarily organized in a narrative and unstructured format with variations in content and format. Regulatory requirements and professional guidelines for genetic test reporting exist but provide little guidance for effective communication of information.</p><p><strong>Objective.—: </strong>To assess clinical genomic reporting practices across 5 disciplines within molecular diagnostics, including germline, somatic solid tumors, somatic hematologic malignancies, pharmacogenomics, and prenatal cell-free DNA screening.</p><p><strong>Design.—: </strong>Reporting practices were assessed by using a structured review of clinical genomic reports from multiple laboratories in 5 molecular disciplines spanning different practice settings. Report content was reviewed by the presence/absence of from 27 to 44 elements, including 23 elements required by the College of American Pathologists and/or the Clinical Laboratory Improvement Amendments of 1988 (CLIA). If present, the element's location on the report was recorded.</p><p><strong>Results.—: </strong>A total of 69 genomics reports from 31 laboratories were reviewed. Overall, the reports were compliant with regulatory requirements but showed variability in both format and content. Six of 7 required reporting elements (per CLIA, 42 CFR [Code of Federal Regulations] 493.1291) were included in 90% of the reports. However, these elements were often located in different report sections. Only patient demographics were always found in a specific report section (header).</p><p><strong>Conclusions.—: </strong>These results show that reports are overall compliant with regulatory requirements, despite some reporting elements being less consistently reported. The lack of consistent presentation of the data elements presents an opportunity to improve the communication of molecular testing results to clinicians and patients.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Red Blood Cell Transfusion Practices. 红细胞输血实践。
Pub Date : 2024-11-20 DOI: 10.5858/arpa.2024-0182-CP
Paul F Lindholm, Rasleen K Saluja, Thomas Long, Suzanne Coulter, Barbara J Blond, Peter L Perrotta

Context.—: Opportunities to improve transfusion safety occur at lower hemoglobin (Hgb) thresholds and single-unit transfusions. Efforts to improve compliance with transfusion guidelines and single-unit transfusion practices reduce transfusions and lead to improved outcomes.

Objective.—: To evaluate demographic and practice characteristics associated with lower Hgb thresholds and single red blood cell (RBC) unit transfusion practices.

Design.—: This study used the College of American Pathologists (CAP) Q-Probes format with the recent 2020 and 2017 surveys of participating institutions.

Results.—: High rates of transfusion review and compliance were observed with institutions reporting RBC transfusions meeting institutional guidelines. CAP inspection participants and those with a formal policy to encourage single-unit transfusions showed a trend toward greater compliance. Comparison of 2020 and 2017 survey results showed favorable downward trends in the Hgb threshold for transfusion compliance review and pretransfusion and posttransfusion Hgb values. Institutions reporting initiatives to decrease transfusions, teaching hospitals, and those with updated guidelines in alignment with recent literature reported lower pretransfusion Hgb levels in both studies. The 2020 study showed greater single-unit transfusion use among hospitals with patient blood management programs, larger institutions, and those training pathology residents. Single-unit transfusion rates varied by hospital service, with highest rates reported within hematology/oncology (99 of 138 [71.7%]), intensive care (147 of 215 [68.4%]), and medicine (419 of 666 [62.9%]) services.

Conclusions.—: Transfusion practice improvement programs to decrease RBC transfusions include the use of single-unit transfusions and lower institutional pretransfusion Hgb thresholds. Opportunities to lower transfusion thresholds and increase single-unit transfusions exist in surgical and obstetrics services.

背景在血红蛋白(Hgb)阈值较低和单次输血时,存在提高输血安全性的机会。努力提高输血指南和单单位输血实践的合规性可减少输血并改善治疗效果:评估与降低血红蛋白阈值和单个红细胞(RBC)单位输血实践相关的人口统计学特征和实践特征:本研究采用了美国病理学家学会(CAP)的 Q-Probes 格式,并对参与机构进行了 2020 年和 2017 年的最新调查:据观察,报告RBC输血符合机构指南的机构的输血审查率和合规率都很高。CAP 检查参与者和制定了鼓励单单位输血正式政策的机构显示出更高的合规性趋势。对 2020 年和 2017 年调查结果的比较显示,输血合规性审查的血红蛋白阈值以及输血前和输血后血红蛋白值呈良好的下降趋势。在这两项研究中,报告有减少输血措施的机构、教学医院以及根据最新文献更新指南的医院报告的输血前血红蛋白水平都较低。2020 年的研究显示,有患者血液管理计划的医院、规模较大的医院和培训病理科住院医师的医院使用单次输血的比例较高。单次输血率因医院服务而异,血液/肿瘤科(138 例中的 99 例[71.7%])、重症监护(215 例中的 147 例[68.4%])和内科(666 例中的 419 例[62.9%])的单次输血率最高:结论:减少红细胞输注的输血实践改进计划包括使用单单位输血和降低机构输血前血红蛋白阈值。在外科和产科服务中存在降低输血阈值和增加单单位输血的机会。
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引用次数: 0
The Impact of Pathologist Review on Peripheral Blood Smears: A College of American Pathologists Q-Probes Study of 22 Laboratories. 病理学家审查对外周血涂片的影响:美国病理学家学会对 22 个实验室进行的 Q-Probes 研究。
Pub Date : 2024-11-11 DOI: 10.5858/arpa.2024-0117-CP
Megan O Nakashima, Suzanne Nelson Coulter, Barbara J Blond, Richard W Brown, Jeffrey A Vos

Context.—: The aim of the study was to determine the impact of peripheral blood (PB) smear review by a pathologist when requested by a technologist or provider to measure the rate of pathologist-detected clinically relevant findings.

Objective.—: To report and analyze the results of clinically relevant morphologic findings on PB smears that were pathologist reviewed because of either a request from a technologist or an order from a provider.

Design.—: During a 4-week study period, participants enrolled in the College of American Pathologists Q-Probes program submitted data on PB smear reviews including review request source, reason for review request, and if the pathologist's review resulted in a clinically relevant morphologic finding.

Results.—: Twenty-two institutions submitted data on 835 eligible PB smears. Pathologists identified clinically relevant findings on a median 53.4% of technologist-requested PB smear reviews and a median 14.3% of provider-ordered PB smear reviews .The most frequently identified pathologist finding on technologist-requested PB smear reviews was "blasts" in 91 of 532 (17.1%) followed by "atypical (possibly neoplastic) lymphocytes" in 74 of 532 (13.9%); the most frequent finding on provider-ordered reviews was "other" in 55 of 315 (17.5%) followed by "immature cells/left shift in myeloid cells or monocytes" in 12 of 315 (3.8%). Pathologists agreed with technologists' indications for review in 458 of 513 requested reviews (89.3%). Institutions that conducted postanalytic follow-up on previously reviewed PB smears had a higher rate of clinically relevant findings detected on technologist-requested smears.

Conclusions.—: Pathologist review of PB smears flagged by technologists for review frequently yielded clinically relevant findings. This was higher in institutions that conducted postanalytic reviews. Provider-ordered reviews resulted in clinically relevant findings in a median of 14.3% of smears.

研究背景该研究旨在确定在技术人员或医疗服务提供者要求下由病理学家对外周血(PB)涂片进行审查的影响,以衡量病理学家发现的临床相关结果的比率:报告并分析因技术人员或医疗服务提供者的要求而由病理学家复查的外周血涂片上与临床相关的形态学结果:在为期 4 周的研究期间,美国病理学家学会 Q-Probes 计划的参与者提交了 PB 涂片审查数据,包括审查请求来源、审查请求原因以及病理学家的审查是否导致了临床相关的形态学发现:22家机构提交了835份符合条件的PB涂片数据。病理学家在技术人员要求的 PB 涂片审查中,发现临床相关结果的比例中位数为 53.4%,在医疗机构要求的 PB 涂片审查中,发现临床相关结果的比例中位数为 14.3%。在技术人员要求的 PB 涂片审查中,病理学家最常发现的结果是 "爆裂",532 例中有 91 例(17.1%),其次是 "非典型"。1%),其次是 "非典型(可能是肿瘤性)淋巴细胞",532 例中有 74 例(13.9%);在医疗服务提供者要求的涂片复查中,最常见的发现是 "其他",315 例中有 55 例(17.5%),其次是 "未成熟细胞/髓系细胞或单核细胞左移",315 例中有 12 例(3.8%)。病理学家同意技术专家在 513 例复查申请中提出的 458 例(89.3%)复查指征。对之前复核过的PB涂片进行分析后随访的机构,在技术人员要求复核的涂片中发现临床相关结果的比例较高:病理学家对技术人员要求复查的 PB 涂片进行复查后,经常会发现与临床相关的结果。在进行分析后复查的机构中,这种情况更多。由医疗服务提供者要求进行复查的涂片中位数为14.3%,复查结果与临床相关。
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引用次数: 0
Pathologists Providing Direct Patient Care in Thoracic Transplant: Same Objective, Different Scope. 病理学家在胸腔移植手术中直接为患者提供护理:目标相同,范围不同。
Pub Date : 2024-11-11 DOI: 10.5858/arpa.2024-0226-OA
Melanie C Bois, Marie-Christine Aubry, Anja C Roden, Jennifer M Boland, Diane M Meyer, Rachel K Askelson, Kevin M Praska, Alfredo Clavell, Cassie Kennedy, John P Scott, Rebecca K Ameduri, Jonathan M Morris, Ying-Chun Lo, Nicole L Larson, Kelsey L Ness, Kally M Gleichner, Kristina Peters, Andrew J Layman, Eunhee S Yi, Joseph J Maleszewski

Context.—: Cardiac and pulmonary allograft recipients represent a unique population, frequently interacting with support groups and exhibiting intense curiosity about their pathology. Like other solid organ transplant patients, they have enduring and frequent interaction with the laboratory for routine allograft surveillance.

Objective.—: To address patient requests to understand what happens to their explanted organ and to better understand their disease while simultaneously improving awareness of pathologists' role in their continuing care.

Design.—: At routine follow-up appointments, transplant nurse coordinators offer each allograft recipient the opportunity to interact with a pathologist in our "On My Path" program. Organ viewing occurs in a private setting, in a specialized room. Relevant pathology is discussed, and questions are answered, with documentation in the medical record. The patient is subsequently gifted a 3-dimensional model of their explanted organ. Transplant coordinators were surveyed for their feedback on the experience.

Results.—: One hundred fifty-eight interactions have been documented (2017-2022), including patients who underwent cardiac transplant (96, 61%), single or bilateral lung transplant (54, 34%), or combination lung and heart transplant (8, 5%). Transplant coordinators reported an increase in patient understanding of their disease and emotional closure related to the disease through the On My Path program.

Conclusions.—: Pathologists providing direct patient care is a feasible model that addresses currently unmet desires of the transplant population to better understand their pathology. Providing a 3-dimensional model helps to empower patients and drives satisfaction. These interactions also improve awareness about pathology as a discipline and its importance in the continued care of transplant recipients.

背景心脏和肺部异体移植受者是一个独特的群体,他们经常与支持小组互动,并对自己的病理表现出强烈的好奇心。与其他实体器官移植患者一样,他们也需要与实验室进行持久而频繁的互动,以便对异体移植物进行常规监测:满足患者的要求,让他们了解移植器官的情况,更好地了解自己的疾病,同时提高他们对病理学家在持续护理中的作用的认识:设计:在例行复诊时,移植护士协调员为每位异体移植物受者提供与病理学家在我们的 "我的路径 "项目中互动的机会。观看器官的过程是在一间专门的私人病房中进行的。病理学家会讨论相关病理,回答问题,并在病历中记录。随后,患者将获赠其移植器官的三维模型。移植协调员接受了调查,以了解他们对这一体验的反馈意见:记录了 158 次互动(2017-2022 年),包括接受心脏移植(96 例,61%)、单侧或双侧肺移植(54 例,34%)或肺和心脏联合移植(8 例,5%)的患者。移植协调员报告称,通过 "我的道路 "项目,患者对自身疾病的了解和与疾病相关的情感封闭程度都有所提高:病理学家提供直接的患者护理是一种可行的模式,它能满足移植人群目前尚未实现的更好地了解其病理的愿望。提供三维模型有助于增强患者的能力,提高满意度。这些互动还提高了人们对病理学作为一门学科及其在持续护理移植受者方面的重要性的认识。
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引用次数: 0
Lymphangioleiomyomatosis: A Review. 淋巴管瘤病:综述。
Pub Date : 2024-11-11 DOI: 10.5858/arpa.2024-0206-RA
Mohammed Amine Bouanzoul, Yale Rosen

Context.—: Lymphangioleiomyomatosis is a rare multisystem disorder belonging to the family of neoplasms exhibiting perivascular epithelioid differentiation. It primarily affects women of childbearing age. The disease is characterized by a proliferation of smooth muscle-like cells (lymphangioleiomyomatosis cells) within all lung compartments, leading to cystic parenchymal destruction and, in some cases, respiratory failure. These cells carry mutations in one or both tuberous sclerosis (TSC) genes and coexpress smooth muscle and melanocytic markers. Female hormones, particularly estrogens, influence the course of the disease. Symptoms of lymphangioleiomyomatosis vary significantly among patients, ranging from exertional dyspnea and coughing to chest pain and recurrent pneumothorax.

Objective.—: To present the latest advancements in the understanding of disease pathogenesis and diagnosis, illustrate the pathologic and radiologic findings, provide a reference for pathologists and other health care professionals, briefly discuss recent evidence-based therapeutic approaches, and emphasize the importance of adopting a multidisciplinary approach to diagnosis and optimization of patient care.

Data sources.—: A comprehensive review of pertinent medical literature published in the last 30 years, focusing on publications written in the English language, was performed.

Conclusions.—: Despite the recent significant advancements in the understanding and management of lymphangioleiomyomatosis, there are still significant gaps in our knowledge of its pathophysiology and the role of the immune system in the genesis and progression of the disease. The current changes in diagnostic algorithms favor the adoption of minimally invasive procedures as the standard of care. As a result, the clinical laboratory will play a larger role in the diagnosis of lymphangioleiomyomatosis, and surgical pathologists will likely be less involved in the diagnosis of pulmonary lymphangioleiomyomatosis than they currently are.

内涵:淋巴管瘤病是一种罕见的多系统疾病,属于血管周围上皮样分化的肿瘤家族。它主要影响育龄妇女。该病的特点是平滑肌样细胞(淋巴管瘤细胞)在肺部各处增生,导致肺实质囊性破坏,在某些情况下还会导致呼吸衰竭。这些细胞携带一个或两个结节性硬化症(TSC)基因突变,共同表达平滑肌和黑色素细胞标记。女性荷尔蒙,尤其是雌激素会影响疾病的进程。淋巴管瘤病的症状因人而异,从劳累性呼吸困难和咳嗽到胸痛和复发性气胸不等:介绍在了解疾病发病机制和诊断方面的最新进展,说明病理学和放射学检查结果,为病理学家和其他医护人员提供参考,简要讨论最新的循证治疗方法,并强调采用多学科方法进行诊断和优化患者护理的重要性:数据来源:对过去 30 年出版的相关医学文献进行了全面回顾,重点是以英语撰写的出版物:尽管近年来对淋巴管瘤病的认识和治疗取得了重大进展,但我们对其病理生理学以及免疫系统在疾病发生和发展过程中的作用的认识仍有很大差距。目前诊断算法的变化有利于采用微创手术作为治疗标准。因此,临床实验室将在淋巴管瘤病的诊断中发挥更大的作用,而外科病理学家在肺淋巴管瘤病的诊断中的参与度可能会比现在低。
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引用次数: 0
Exploring the Incidence of Testicular Neoplasms in the Transgender Population: A Case Series. 探索变性人睾丸肿瘤的发病率:病例系列。
Pub Date : 2024-11-11 DOI: 10.5858/arpa.2024-0218-OA
Elayna M Shanker, Qinghu Ren, Lee C Zhao, Rachel Bluebond-Langner, Fang-Ming Deng

Context.—: The use of hormonal therapy and gender-affirming surgery in the transgender community has been rising during the last several years. Although it is generally safe, hormonal therapy's link to testicular cancer remains uncertain.

Objective.—: To review the incidence of testicular cancer in specimens from gender-affirming orchiectomies at our institution and evaluate the tumors for histologic and genetic alterations.

Design.—: Pathology reports for gender-affirming orchiectomies (January 1, 2018, to August 1, 2023) were reviewed for testicular neoplasms, with additional analysis for chromosome 12 abnormalities. Incidence and chromosome variations were compared with those in the general population.

Results.—: Among 458 cases during 5.5 years, 5 germ cell neoplasms in 4 patients emerged. Our institution's annual incidence rate (159 per 100 000) is 26.5 times higher than the National Cancer Institute's previous report (6.0 per 100 000). Although they were morphologically no different from germ cell neoplasms in the general population, fluorescence in situ hybridization tests showed no i(12p) in 4 of 5 neoplasms (80%) in our cohort.

Conclusions.—: The cause behind this rise in incidence remains uncertain but may be due to long term pretreatment with hormones or blockers. The lower isochromosome 12p frequency suggests an alternative mechanism driving tumor development, which requires more detailed molecular studies.

背景在过去几年中,变性人群体中使用激素疗法和性别确认手术的人数不断增加。尽管激素疗法总体上是安全的,但它与睾丸癌的关系仍不确定:回顾我院性别确认睾丸切除术标本中睾丸癌的发病率,并评估肿瘤的组织学和遗传学改变:对性别确认睾丸切除术(2018年1月1日至2023年8月1日)的病理报告进行了睾丸肿瘤审查,并对12号染色体异常进行了额外分析。将发病率和染色体变异情况与普通人群进行了比较:在5年半的458例病例中,有4名患者罹患5种生殖细胞肿瘤。我院的年发病率(159/10 万)是美国国家癌症研究所之前报告(6.0/10 万)的 26.5 倍。虽然这些肿瘤在形态上与普通人群中的生殖细胞瘤无异,但荧光原位杂交检测显示,在我们的队列中,5 个肿瘤中有 4 个(80%)没有 i(12p):结论:发病率上升的原因尚不明确,但可能与长期使用激素或阻断剂预处理有关。较低的 12p 染色体同工酶频率表明,肿瘤发生有另一种机制,需要进行更详细的分子研究。
{"title":"Exploring the Incidence of Testicular Neoplasms in the Transgender Population: A Case Series.","authors":"Elayna M Shanker, Qinghu Ren, Lee C Zhao, Rachel Bluebond-Langner, Fang-Ming Deng","doi":"10.5858/arpa.2024-0218-OA","DOIUrl":"https://doi.org/10.5858/arpa.2024-0218-OA","url":null,"abstract":"<p><strong>Context.—: </strong>The use of hormonal therapy and gender-affirming surgery in the transgender community has been rising during the last several years. Although it is generally safe, hormonal therapy's link to testicular cancer remains uncertain.</p><p><strong>Objective.—: </strong>To review the incidence of testicular cancer in specimens from gender-affirming orchiectomies at our institution and evaluate the tumors for histologic and genetic alterations.</p><p><strong>Design.—: </strong>Pathology reports for gender-affirming orchiectomies (January 1, 2018, to August 1, 2023) were reviewed for testicular neoplasms, with additional analysis for chromosome 12 abnormalities. Incidence and chromosome variations were compared with those in the general population.</p><p><strong>Results.—: </strong>Among 458 cases during 5.5 years, 5 germ cell neoplasms in 4 patients emerged. Our institution's annual incidence rate (159 per 100 000) is 26.5 times higher than the National Cancer Institute's previous report (6.0 per 100 000). Although they were morphologically no different from germ cell neoplasms in the general population, fluorescence in situ hybridization tests showed no i(12p) in 4 of 5 neoplasms (80%) in our cohort.</p><p><strong>Conclusions.—: </strong>The cause behind this rise in incidence remains uncertain but may be due to long term pretreatment with hormones or blockers. The lower isochromosome 12p frequency suggests an alternative mechanism driving tumor development, which requires more detailed molecular studies.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Archives of pathology & laboratory medicine
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