1
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Myrou A. Detection of Nonhematologic Neoplasms in Bone Marrow by Flow Cytometry: A Report of Two Cases. Cureus 2023; 15:e51414. [PMID: 38161533 PMCID: PMC10757854 DOI: 10.7759/cureus.51414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 01/03/2024] Open
Abstract
Multiparameter flow cytometry (MFC) is a well-established method for the diagnosis, prognosis, and follow-up of a vast majority of hematological malignancies; however, it can have a major impact on the rapid diagnosis of nonhematopoietic tumor micrometastases in minimally invasive samples such as bone marrow aspirates (BMAs), body fluids, and tissue samples (lymph nodes, fine needle aspirates). Here, we present two cases of bone marrow micrometastases of neuroendocrine origin (one small cell lung carcinoma [SCLC] and one large cell neuroendocrine carcinoma [LCNEC] of the lungs) readily recognized by routine MFC investigation of BMA and review the existing literature on the role of MFC in the diagnosis of solid tumors of neuroendocrine origin. The clinical application of flow cytometry for the diagnosis of solid tumors is limited despite the accumulating evidence of the value of the method. It can be of great value in situations where the patient's clinical status forbids invasive procedures, and a rapid diagnosis is desirable. Flow cytometry is a valuable tool for the detection of both hematological and nonhematologic neoplasms. Future large-scale patient series will probably confirm its role in the screening, diagnosis, and classification of more tumor types.
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Affiliation(s)
- Athena Myrou
- Department of Internal Medicine, American Hellenic Educational Progressive Association (AHEPA) University Hospital, Thessaloniki, GRC
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2
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Nabeel H, Alobeid B. Utility of Flow Cytometry Analysis in the Detection of Nonhematologic Neoplasms: An Overview. Clin Lab Med 2023; 43:455-465. [PMID: 37481323 DOI: 10.1016/j.cll.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
Flow cytometry analysis has stood the test of time as a powerful tool in the assessment of hematologic neoplasms. The role of flow cytometry has expanded to evaluate various nonhematologic neoplasms encountered in body cavity malignant effusions, lymph nodes, and other body sites. This review explores the use of routine antibody panels as well as specially designed multicolor antibody panels that have been investigated by different groups and reported in the literature for evaluating nonhematologic neoplasms. In this context, the limitations, pitfalls, future directions, and promising applications of flow cytometry analysis are also discussed.
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Affiliation(s)
- Hibbah Nabeel
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 West 168th street, VC14-236 New York, NY 10032, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, 630 West 168th street, VC14-229 New York, NY 10032, USA.
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3
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Bisegna ML, Cordone I, Peragine N, Milani ML, Intoppa S, de Fabritiis P, Martelli M, De Propris MS. Neoplastic bone marrow invasion:rapid exclusion of hematological disease by flow cytometric routine panels. Blood Cells Mol Dis 2023; 99:102721. [PMID: 36459839 DOI: 10.1016/j.bcmd.2022.102721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
Multiparametric flow cytometry is an extensively used technique to assess the presence of different cellular populations in immunology and hematology. During routine immunophenotyping analysis, it is not uncommon to face cells of non-hemopoietic origin, negative for CD45 and other myeloid, megakaryocytic, B and T lineage antigens and positive for at least one antibody among CD56, CD117 and CD138. If cytology cannot identify cell origin, especially in cases of unclear interpretation, the contribution of multiparametric flow cytometry analysis can be crucial. We report 6 patients with a clinical suspicion of hematological disease in which multiparametric flow cytometry was extremely useful to quickly exclude blood disorders in order to initiate patients to the most appropriate diagnostic process.
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Affiliation(s)
- Maria Laura Bisegna
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy.
| | - Iole Cordone
- IRCCS Regina Elena National Cancer Institute, Department of Research, Advanced Diagnostics and Technological Innovation, Clinical Pathology and Cancer Biobank, 00144 Rome, Italy
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
| | - Maria Laura Milani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
| | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
| | | | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
| | - Maria Stefania De Propris
- Hematology, Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
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4
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Quirós-Caso C, Arias Fernández T, Fonseca-Mourelle A, Torres H, Fernández L, Moreno-Rodríguez M, Ariza-Prota MÁ, López-González FJ, Carvajal-Álvarez M, Alonso-Álvarez S, Moro-García MA, Colado E. Routine flow cytometry approach for the evaluation of solid tumor neoplasms and immune cells in minimally invasive samples. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2022; 102:272-282. [PMID: 35703585 DOI: 10.1002/cyto.b.22081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Multidimensional flow cytometry (MFC) is routinely used for the diagnosis and follow-up of hematolymphoid neoplasms but its contribution to the identification of non-hematolymphoid malignant tumors is limited. METHODS The presence of non-hematolymphoid cells in clinical samples obtained via minimally invasive methods was ascertained by using a panel of monoclonal antibodies previously developed in our laboratory comprising a mixture of antibodies: CD9-PacB/CD45-OC515/CD57-FITC/CD56-PE/CD3-PerCP-Cy5.5/CD117-PE-Cy7/CD326-APC/CD81-APC-C750. Histopathological studies were performed using standard techniques. RESULTS 164 specimens of different origins were included. Malignancy was finally confirmed in 142 (86.5%), while 22 non neoplastic samples were identified. The most frequent diagnosis was small cell lung carcinoma (SCLC) (50%). High sensitivity (S = 98.6%) was reached combining MFC and conventional pathology. Individual markers differed according to the cellular origin of the neoplasm, with neuroendocrine tumors showing a unique immunophenotypic profile (CD56+ CD326+ CD117-/+ and variable tetraspanins expression). Principal component analysis efficiently distinguished SCLC from other tumor samples. In immune cell populations, differences between reactive and malignant biopsies were found in different cell compartments, especially in B cells and Plasma cells. Differences also emerged in the percentage of CD4+ CD8- T cells, CD4-CD8+ T cells and NK cells and these were dependent on the origin of the tumor cells. CONCLUSIONS These results support the use of MFC as a rapid and valuable technique to detect non-hematolymphoid tumoral cells in clinical specimens, providing an initial orientation to complement hystopathological studies and allow a more precise diagnosis, especially in neuroendocrine neoplasms. The impact of different immune cell patterns warrants further research.
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Affiliation(s)
- Covadonga Quirós-Caso
- Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Tamara Arias Fernández
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ariana Fonseca-Mourelle
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Héctor Torres
- Surgical Pathology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Fernández
- Surgical Pathology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Maria Moreno-Rodríguez
- Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Sara Alonso-Álvarez
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Enrique Colado
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias
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Parrott AM, Murty VV, Walsh C, Christiano A, Bhagat G, Alobeid B. Interphase fluorescence in situ hybridization analysis of CD19-selected cells: Utility in detecting disease in post-therapy samples of B-cell neoplasms. Cancer Med 2021; 10:2680-2689. [PMID: 33724696 PMCID: PMC8026942 DOI: 10.1002/cam4.3853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/02/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022] Open
Abstract
Context The detection of low‐level persistent or relapsed B‐cell neoplasms, particularly post‐therapy, can be challenging, often requiring multiple testing modalities. Objective Here we investigate the utility of CD19‐based selection of neoplastic B‐cells (CD19S) as an enrichment strategy to improve the detection rate of cytogenetic abnormalities in post‐therapy samples of B‐cell neoplasms, especially those with low‐level disease. Design In a cohort largely comprised of post‐therapy B‐ALL and CLL samples, we performed fluorescence in situ hybridization (FISH) analysis on CD19‐selected cells (CD19S FISH) in 128 specimens from 88 patients, and on non‐selected cells (NS FISH) in a subset of cases. The FISH findings were compared with the concurrent flow cytometry (FC) results in all samples and molecular analysis in a subset. Results CD19S FISH was able to detect cytogenetic aberrations in 86.0% of post‐therapy samples with evidence of disease as determined by routine or MRD FC, compared to 59.1% of samples by NS FISH. CD19S FISH detected significantly higher percentages of positive cells compared to NS FISH (p < 0.001). Importantly, CD19S FISH enabled the detection of emergent subclones (clonal evolution) associated with poor prognosis. Conclusions CD19S FISH can be useful in daily diagnostic practice. Compared to NS FISH, CD19S FISH is quantitatively and qualitatively superior for the detection of cytogenetic aberrations in B‐cell neoplasms, which are important for risk stratification and optimal management of patients with B‐cell neoplasms, especially in the relapsed setting. Although CD19S FISH has a diagnostic sensitivity inferior to that of MRD FC, the sensitivity of this modality is comparable to routine FC for the evaluation of low‐level disease in the post‐therapy setting. Moreover, CD19S samples are invaluable for additional molecular and genetic analyses.
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Affiliation(s)
- Andrew M Parrott
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Vundavalli V Murty
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Caitlin Walsh
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Alecia Christiano
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
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6
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Ofori K, Soderquist CR, Murty VV, Park D, Vlad G, Leeman‐Neill RJ, Lentzsch S, Alobeid B, Bhagat G. The clinical and pathological features of plasma cell myeloma post solid organ transplantation. Am J Hematol 2020; 95:1531-1541. [PMID: 32864761 DOI: 10.1002/ajh.25988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
Plasma cell neoplasms (PCNs), comprising plasma cell myelomas (PCMs) and plasmacytomas, which occur after solid organ transplantation, represent rare subtypes of monomorphic post-transplant lymphoproliferative disorders (M-PTLDs). Data regarding the clinical and pathological features of post-transplant (PT)-PCMs are limited. To gain a better understanding of disease biology, we performed comprehensive immunophenotypic analysis, reviewed cytogenetic analysis results and evaluated clinical outcomes of PT-PCMs diagnosed and treated at our institution. Fifteen PT-PCM (M: F - 4:1) and two PT-MGUS (two males) cases were identified. The median age of PT-PCM patients was 68 years (29-79 years) and PCMs presented at a median of 9.7 years (0.5-24.7 years) after transplantation. The PT-PCMs accounted for 11.6% of all M-PTLDs and the period prevalence was 9/3108 (0.29%), 3/1071 (0.28%), 2/1345 (0.15%) and 1/878 (0.11%) post kidney, heart, liver and lung transplantation. Lytic bone disease was observed in 1/11 (9%) patients. Marrow plasma cell infiltration ranged from 10%-70% (median 20%), with 10/15 (67%) and 5/15 (33%) cases manifesting immature and plasmablastic morphology. The immunophenotype of all cases and cytogenetic abnormalities, identified in 60% of cases, were similar to multiple myeloma (MM) of immunocompetent individuals. All PT-PCMs were EBER negative. Ten of 11 (91%) patients with active MM were treated, all with proteasome inhibitor-based therapy. Treatment response and 5-year overall survival (54.5%) was comparable to MM of immunocompetent individuals. However, the survival of patients with plasmablastic PCMs was inferior to those with immature PCMs. 0ur findings indicate PT-PCMs to be predominantly late onset PTLDs that have similar clinicopathologic characteristics as conventional MM.
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Affiliation(s)
- Kenneth Ofori
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Craig R. Soderquist
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Vundavalli V. Murty
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - David Park
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - George Vlad
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Rebecca J. Leeman‐Neill
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Suzanne Lentzsch
- Division of Hematology/Oncology Columbia University Irving Medical Center New York City New York US
| | - Bachir Alobeid
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
| | - Govind Bhagat
- Department of Pathology and Cell Biology Columbia University Irving Medical Center New York New York US
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Parrott AM, Haggiagi AM, Murty VV, Bhagat G, Alobeid B. Primary large B-cell lymphoma of the central nervous system with cyclin D1 expression and t(11;14) (IGH-CCND1): Diffuse large B-cell lymphoma with CCND1 rearrangement or mantle cell lymphoma? Hematol Oncol 2020; 38:817-822. [PMID: 32639587 DOI: 10.1002/hon.2779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
Mantle cell lymphomas (MCLs) are the prototypic B-cell non-Hodgkin lymphomas defined by cyclin D1 gene (CCND1; or other cyclin D family gene) rearrangements. However, extremely rare cases of diffuse large B-cell lymphomas (DLBCLs) harboring CCND1 rearrangements, resulting in cyclin D1 protein expression, have also been reported. In this report, we describe an unusual primary large B-cell lymphoma of non-germinal center immunophenotype of the central nervous system (CNS) in an elderly male patient, which was negative for CD5 and SOX11, and exhibited cyclin D1 expression. Fluorescence in situ hybridization analysis detected IGH-CCND1 and BCL6 rearrangements. This case may represent the first report of a primary CNS DLBCL with IGH-CCND1 rearrangement. The clinico-pathologic features that can help differentiate primary CNS MCL from primary DLBCL of the CNS with IGH-CCND1 rearrangement are discussed.
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Affiliation(s)
- Andrew M Parrott
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Aya M Haggiagi
- Department of Neurology & Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Vundavalli V Murty
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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Wong‐Arteta J, Rey M, Aragón L, Gil‐Rodríguez E, Bujanda L. The utility of flow cytometry in the diagnostic work up of malignant effusions due to nonhematopoietic neoplasms. CYTOMETRY PART B-CLINICAL CYTOMETRY 2020; 98:504-515. [PMID: 32506689 DOI: 10.1002/cyto.b.21886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Jhonatan Wong‐Arteta
- Biochemistry Donostia University Hospital San Sebastián País Vasco Spain
- School of Medicine University of the Basque Country (UPV‐EHU) San Sebastián País Vasco Spain
- Hematology Asuncion Clinic Tolosa País Vasco Spain
| | - Mercedes Rey
- Immunology Donostia University Hospital San Sebastián País Vasco Spain
| | - Larraitz Aragón
- Immunology Donostia University Hospital San Sebastián País Vasco Spain
| | - Eva Gil‐Rodríguez
- Biochemistry Donostia University Hospital San Sebastián País Vasco Spain
| | - Luis Bujanda
- School of Medicine University of the Basque Country (UPV‐EHU) San Sebastián País Vasco Spain
- Gastroenterology Donostia University Hospital San Sebastián País Vasco Spain
- Department of Liver and Gastrointestinal Diseases Biodonostia Health Research Institute San Sebastián País Vasco Spain
- National Institute for the Study of Liver and Gastrointestinal Diseases (CIBERehd) Carlos III National Institute of Health Madrid Spain
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