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Natal RDA, Carvalho HC, Barra FFDC, Pagnano KBB, Soares FA, Vassallo J. Mast cell neoplasm: a challenging pathological diagnosis. Hum Pathol 2022; 126:55-62. [PMID: 35550832 DOI: 10.1016/j.humpath.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
Systemic mastocytosis (SM) is a myeloid neoplasm characterized by abnormal growth and accumulation of neoplastic mast cells in at least one extracutaneous site. Clinical presentation and course are variable, most patients developing an indolent disease and some, an aggressive/leukemic form. Because of its rarity, most physicians are unfamiliar with this disease and do not readily diagnose it. In the present retrospective study, the authors describe 12 patients diagnosed with mast cell neoplasm. Cases were selected from three institutions from Campinas and São Paulo City, Brazil. Morphological features and diagnostic pitfalls are emphasized. Patients' age ranged from 15 to 81 years (mean 51.6 years). Male and female were affected similarly (1:1). Ten patients were classified as aggressive systemic mastocytosis (SM), one patient as SM with an associated acute promyelocytic leukemia with t(15;17), and one patient with mast cell sarcoma. Most common clinical findings included anemia (9 patients), thrombocytopenia (3 patients) and skin lesions (3 patients). Bone marrow was involved in 11 patients at diagnosis, followed by skin (5 patients). Five morphological patterns were present: mast cell aggregates (5), plasmacytoid (4), monocytoid (2), spindle cell (2) and epithelioid/pleomorphic (1); two patients showed two histological patterns. In all cases neoplastic cells were positive for CD117/C-KIT. C-KIT D816V mutation was present in four patients, C-KIT K509I in two, and del(7q22) in one; in five cases no mutational status was available. Despite limited resources, basically morphology and a restricted immunohistochemical panel, it is possible to diagnose mast cell neoplasm. Of note, pathologist should recognize the different morphological variants of the disease and include the adequate markers when requesting immunohistochemical studies.
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Affiliation(s)
- Rodrigo de Andrade Natal
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil; Anatomic Pathology D'Or Hospitals Network, São Paulo, Brazil.
| | - Humberto Carneiro Carvalho
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil; Anatomic Pathology D'Or Hospitals Network, São Paulo, Brazil
| | - Flávia Fonseca de Carvalho Barra
- Laboratory of Investigative Pathology, CIPED, University of Campinas (Unicamp), Campinas, São Paulo, Brazil; Multipat Laboratory of Pathology, Campinas, São Paulo, Brazil
| | | | - Fernando Augusto Soares
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil; Anatomic Pathology D'Or Hospitals Network, São Paulo, Brazil
| | - José Vassallo
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil; Laboratory of Investigative Pathology, CIPED, University of Campinas (Unicamp), Campinas, São Paulo, Brazil; Anatomic Pathology D'Or Hospitals Network, São Paulo, Brazil; Multipat Laboratory of Pathology, Campinas, São Paulo, Brazil
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3
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Jian J, Qiao Y, Li Y, Guo Y, Ma H, Liu B. Mutations in chronic myelomonocytic leukemia and their prognostic relevance. Clin Transl Oncol 2021; 23:1731-1742. [PMID: 33861431 DOI: 10.1007/s12094-021-02585-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/06/2021] [Indexed: 12/19/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a hematologic malignancy that overlaps with myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS) and tends to transform into acute myeloid leukemia (AML). Among cases of CMML, > 90% have gene mutations, primarily involving TET2 (~ 60%), ASXL1 (~ 40%), SRSF2 (~ 50%), and the RAS pathways (~ 30%). These gene mutations are associated with both the clinical phenotypes and the prognosis of CMML, special CMML variants and pre-phases of CMML. Cytogenetic abnormalities and the size of genome are also associated with prognosis. Meanwhile, cases with ASXL1, DNMT3A, NRAS, SETBP1, CBL and RUNX1 mutations may have inferior prognoses, but only ASXL1 mutations were confirmed to be independent predictors of the patient outcome and were included in three prognostic models. Novel treatment targets related to the various gene mutations are emerging. Therefore, this review provides new insights to explore the correlations among gene mutations, clinical phenotypes, prognosis, and novel drugs in CMML.
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Affiliation(s)
- J Jian
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Y Qiao
- Institute of Hematology, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Y Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Y Guo
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - H Ma
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China. .,Department of Hematology, The First Affiliated Hospital, Lanzhou University, 1 Donggangxilu street, Lanzhou, Gansu, China.
| | - B Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China. .,Department of Hematology, The First Affiliated Hospital, Lanzhou University, 1 Donggangxilu street, Lanzhou, Gansu, China.
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4
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Marcella S, Petraroli A, Braile M, Parente R, Ferrara AL, Galdiero MR, Modestino L, Cristinziano L, Rossi FW, Varricchi G, Triggiani M, de Paulis A, Spadaro G, Loffredo S. Vascular endothelial growth factors and angiopoietins as new players in mastocytosis. Clin Exp Med 2021; 21:415-427. [PMID: 33687603 PMCID: PMC8266723 DOI: 10.1007/s10238-021-00693-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/08/2021] [Indexed: 12/27/2022]
Abstract
Mastocytosis is a disorder characterized by the abnormal proliferation and/or accumulation of mast cells in different organs. More than 90% of patients with systemic mastocytosis have a gain-of-function mutation in codon 816 of the KIT receptor on mast cells (MCs). The symptoms of mastocytosis patients are related to the MC-derived mediators that exert local and distant effects. MCs produce angiogenic and lymphangiogenic factors, including vascular endothelial growth factors (VEGFs) and angiopoietins (ANGPTs). Serum concentrations of VEGF-A, VEGF-C, VEGF-D, ANGPT1 and ANGPT2 were determined in 64 mastocytosis patients and 64 healthy controls. Intracellular concentrations and spontaneous release of these mediators were evaluated in the mast cell lines ROSAKIT WT and ROSA KIT D816V and in human lung mast cells (HLMCs). VEGF-A, ANGPT1, ANGPT2 and VEGF-C concentrations were higher in mastocytosis patients compared to controls. The VEGF-A, ANGPT2 and VEGF-C concentrations were correlated with the symptom severity. ANGPT1 concentrations were increased in all patients compared to controls. ANGPT2 levels were correlated with severity of clinical variants and with tryptase levels. VEGF-A, ANGPT1 and VEGF-C did not differ between indolent and advanced mastocytosis. ROSAKIT WT, ROSAKIT D816V and HLMCs contained and spontaneously released VEGFs and ANGPTs. Serum concentrations of VEGFs and ANGPTs are altered in mastocytosis patients.
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Affiliation(s)
- Simone Marcella
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Angelica Petraroli
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Mariantonia Braile
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, 84084, Fisciano, SA, Italy
| | - Anne Lise Ferrara
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, 80131, Naples, Italy
| | - Maria Rosaria Galdiero
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy.,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, 80131, Naples, Italy
| | - Luca Modestino
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Leonardo Cristinziano
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Francesca Wanda Rossi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy. .,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy. .,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy. .,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, 80131, Naples, Italy.
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, 84084, Fisciano, SA, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy.,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences, University of Naples Federico II, 80131, Naples, Italy. .,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131, Naples, Italy. .,World Allergy Organization (WAO) Center of Excellence, 80131, Naples, Italy. .,Institute of Experimental Endocrinology and Oncology (IEOS), National Research Council, 80131, Naples, Italy.
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Lobbes H, Reynaud Q, Mainbourg S, Lega JC, Durieu I, Durupt S. [Tryptase: A practical guide for the physician]. Rev Med Interne 2020; 41:748-755. [PMID: 32712042 DOI: 10.1016/j.revmed.2020.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/24/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022]
Abstract
Tryptase is the most abundant endopeptidase released by mast cells degranulation, involved in many pro and anti-inflammatory processes. Normal serum tryptase range is 0-11.4 μg/L. Tryptase is a useful diagnostic tool for anaphylaxis, systemic mastocytosis (SM) and mast cell activation syndrome (MCAS), where specific threshold values must be used. SM diagnosis criteria include evidence of dense mast cell infiltrate either in the bone marrow or the affected organ (such as skin), presence of KIT D816V mutation and elevated serum tryptase level (>20 μg/L). In SM, tryptase level is correlated with the burden of mast cells in bone marrow. MCAS should be considered in case of severe and recurrent typical clinical signs of systemic mast cell activation involving at least two organs, associated with an increase in serum tryptase level of 20% + 2 μg/L from the individual's baseline. Anaphylaxis is the most severe among hypersensitivity reactions. A clonal mast cell disorder is a central question in anaphylaxis and appropriate explorations should be conducted in these patients. Triggers for anaphylactic reactions vary significantly in the general population and in patients with MS or MCAS. Finally, physicians must be aware of the many pathological and physiological situations that affect tryptase levels.
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Affiliation(s)
- H Lobbes
- Service de Médecine Interne, Hôpital Estaing, CHU de Clermont-Ferrand, 1 Place Lucie et Raymond Aubrac, 63000 Clermont-Ferrand, France; Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France.
| | - Q Reynaud
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - S Mainbourg
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - J C Lega
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - I Durieu
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
| | - S Durupt
- Service de Médecine Interne et Vasculaire, Hôpital Lyon Sud, Hospices Civils de Lyon, 165 Chemin du grand Revoyet, 69310 Pierre-Bénite, France
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