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Sungwan P, Panaampon J, Kariya R, Kamio S, Nakagawa R, Hirozane T, Ogura Y, Abe M, Hirabayashi K, Fujiwara Y, Kikuta K, Okada S. Establishment and characterization of TK-ALCL1: a novel NPM-ALK-positive anaplastic large-cell lymphoma cell line. Hum Cell 2024; 37:1215-1225. [PMID: 38755432 DOI: 10.1007/s13577-024-01077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
TK-ALCL1, a novel anaplastic lymphoma kinase (ALK)-positive anaplastic large-cell lymphoma (ALK+ ALCL) cell line, was established from the primary tumor site of a 59-year-old Japanese male patient. The immune profile of TK-ALCL1 corresponds to that seen typically in primary ALCL cells, i.e., positive for ALK, CD30, EMA, and CD4, but negative for CD2, CD3, CD5, CD8a, and EBV-related antigens. The rearrangement of the T cell receptor-gamma locus shows that TK-ALCL1 is clonally derived from T-lineage lymphoid cells. FISH and RT-PCR analysis revealed that TK-ALCL1 has the nucleophosmin (NPM)-ALK fusion transcript, which is typical for ALK+ ALCL cell lines. When TK-ALCL1 was subcutaneously inoculated into 6-week-old BALB/c Rag2-/-/Jak3-/- (BRJ) mice, it formed tumor masses within 4-6 weeks. Morphological, immunohistochemical, and molecular genetic investigations confirmed that the xenograft and the original ALCL tumor were identical. The ALK inhibitors Alectinib and Lorlatinib suppressed proliferation in a dose-dependent manner. Thus, TK-ALCL1 provides a useful in vitro and in vivo model for investigation of the biology of ALK+ ALCL and of novel therapeutic approaches targeting ALK.
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Affiliation(s)
- Prin Sungwan
- Division of Hematopoiesis, Joint Research Center for Human Retrovirus Infection & Graduate, School of Medical Sciences, Kumamoto University, 2-2-1 Honjo, Chuou-ku, Kumamoto, 860-0811, Japan
| | - Jutatip Panaampon
- Division of Hematopoiesis, Joint Research Center for Human Retrovirus Infection & Graduate, School of Medical Sciences, Kumamoto University, 2-2-1 Honjo, Chuou-ku, Kumamoto, 860-0811, Japan
- Division of Hematologic Neoplasia, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Ryusho Kariya
- Division of Hematopoiesis, Joint Research Center for Human Retrovirus Infection & Graduate, School of Medical Sciences, Kumamoto University, 2-2-1 Honjo, Chuou-ku, Kumamoto, 860-0811, Japan
- Institute of Industrial Nanomaterials, Kumamoto University, 2-39-1 Kurokami, Chuou-ku, Kumamoto, 860-8555, Japan
| | - Satoshi Kamio
- Division of Musculoskeletal Oncology and Orthopaedics Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Rumi Nakagawa
- Division of Musculoskeletal Oncology and Orthopaedics Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Toru Hirozane
- Division of Musculoskeletal Oncology and Orthopaedics Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Yukiko Ogura
- Clinical Laboratory Center, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Makoto Abe
- Division of Diagnostic Pathology, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Kaoru Hirabayashi
- Division of Diagnostic Pathology, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Yukio Fujiwara
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuou-ku, Kumamoto, 860-0556, Japan
| | - Kazutaka Kikuta
- Division of Musculoskeletal Oncology and Orthopaedics Surgery, Tochigi Cancer Center, 4-9-13 Yohnan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Seiji Okada
- Division of Hematopoiesis, Joint Research Center for Human Retrovirus Infection & Graduate, School of Medical Sciences, Kumamoto University, 2-2-1 Honjo, Chuou-ku, Kumamoto, 860-0811, Japan.
- Institute of Industrial Nanomaterials, Kumamoto University, 2-39-1 Kurokami, Chuou-ku, Kumamoto, 860-8555, Japan.
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Sekar MD, Gochhait D, Venkatesan D, Siddaraju N, Kar R. The Difficulties and Ease of Diagnosing Anaplastic Large Cell Lymphomas on Cytology. J Cytol 2024; 41:59-66. [PMID: 38779607 PMCID: PMC11108035 DOI: 10.4103/joc.joc_50_23] [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] [Received: 03/21/2023] [Revised: 12/16/2023] [Accepted: 01/31/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction and Objectives Anaplastic large cell lymphoma (ALCL), a unique non-Hodgkin lymphoma (NHL), is a CD30-positive neoplasm of T-cell lineage. Its distinctive yet variable cytomorphology makes diagnosing fine needle aspiration cytology (FNAC) challenging. This study was undertaken to study the cytomorphology and the utility of immunocytochemical (ICC) stains on cytology in ALCL and to discuss their morphological differential diagnosis. Materials and Methods The present study was conducted in the Department of Pathology of a tertiary care center. A retrospective review was done from January 2017 to July 2022, and all histopathologically and immunohistochemically (IHC) diagnosed cases of ALCL were taken and correlated with the cytological diagnosis. Results Twenty-one cases of histopathology examination and IHC-proven cases of ALCL were retrieved from the departmental archives and reviewed. The ages ranged from 3 to 80 years (median age 28 years). Commonly noted cytomorphologic features included singly dispersed large pleomorphic cells, hallmark cells, and Reed-Sternberg-like cells. CD15, CD30, epithelial membrane antigen, and anaplastic lymphoma kinase-1 were some of the ICC stains used in this study. All 21 cases had cytology correlation. Fourteen cases had concordant cyto-histological correlation. Seven cases of histopathologically proven ALCL were reported as Hodgkin lymphoma (HL) in three, ALCL/anaplastic diffuse large B-cell lymphoma, HL/ALCL, poorly differentiated carcinoma, and NHL in one case each on cytology. Conclusion ALCL has a reasonably distinct cytomorphologic appearance and ICC staining pattern, and a careful interpretation of both helps arrive at a reliable FNAC diagnosis.
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Affiliation(s)
- Mithraa Devi Sekar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Devi Venkatesan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Rakhee Kar
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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A new approach to the study of Hodgkin lymphoma by flow cytometry. Pathology 2023; 55:86-93. [PMID: 36137774 DOI: 10.1016/j.pathol.2022.07.005] [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: 01/21/2022] [Revised: 06/28/2022] [Accepted: 07/03/2022] [Indexed: 01/11/2023]
Abstract
Hodgkin lymphoma (HL) appears to originate from germinal centre B cells but lacks expression of most B cell markers. In contrast to non-Hodgkin B lymphomas, HL is not routinely diagnosed using flow cytometry techniques, and diagnosis is mainly based on immunohistochemical and cytomorphological pathology studies. Hodgkin and Reed-Sternberg cells are large and fragile, making them difficult to study by flow cytometry. The aim of this study was to characterise the CD71 expression pattern on CD4+ T cells from HL patients and to design a simple flow cytometry algorithm to complement the histopathological diagnosis of HL. The present study suggests the utility of a conventional staining protocol with a simple panel of seven markers (CD15, CD30, CD4, CD8, CD71, CD3, and CD45) and a well-defined analysis strategy. The proposed algorithm uses the CD71 ratio (calculated as the percentage of CD71+ CD4+ T cells divided by the percentage of CD71+ CD45+ CD3- lymphocytes), with a cut-off of 0.5 to establish diagnosis groups as suggestive (≥0.5) or not suggestive (<0.5) of HL. In HL, CD71 expression is higher on CD4+ T lymphocytes than on non-T lymphocytes. In addition, the CD4+ T cell population is increased in HL patients, with no change in amounts of CD8+ T cells. Application of the CD71 ratio algorithm yielded a sensitivity of 82% and specificity of 87%, with 84.61% of patients correctly diagnosed. Although histopathology remains the gold standard for definitive HL diagnosis, the proposed flow cytometry method provides a rapid method to guide the study that would allow a more robust and integrated diagnosis. Moreover, the procedure is easily applicable in most clinical laboratories as it does not require state-of-the-art cytometers and uses standard reagents.
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The Leukemic Phase of ALK-Negative Anaplastic Large Cell Lymphoma Is Associated with CD7 Positivity, Complex Karyotype, TP53 Deletion, and a Poor Prognosis. Cancers (Basel) 2021; 13:cancers13246316. [PMID: 34944936 PMCID: PMC8699426 DOI: 10.3390/cancers13246316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 01/31/2023] Open
Abstract
Simple Summary Anaplastic large cell lymphoma (ALCL) is a systemic peripheral T-cell neoplasm characterized by strong and uniform CD30 expression and, usually, the aberrant loss of one or more T-cell antigens. ALCL is further classified into anaplastic lymphoma kinase (ALK)-positive and ALK-negative types. ALCL rarely involves the peripheral blood. The reported leukemic phase ALCL cases are almost all pediatric patients with ALK-positive ALCL, which are frequently associated with the small cell morphology, t(2;5)(p23;q35), and a poorer prognosis. Leukemic phase ALK-negative ALCL is extremely rare, with approximately ten cases reported in the literature to date, mostly as single case reports. Here we report on nine patients with leukemic ALK-negative ALCL—the largest case series to date—and we compare these cases with 39 non-leukemic cases of ALK-negative ALCL. We show that the patients with leukemic ALK-negative ALCL have a greater frequency of absolute lymphocytosis, thrombocytopenia, bone marrow involvement, CD7 positivity, complex karyotype, TP53 deletion, and a dismal outcome. These data suggest that leukemic phase ALK-negative ALCL is associated with a number of poor prognostic factors and affected patients may need more aggressive treatment. Abstract Patients with anaplastic large cell lymphoma (ALCL) rarely develop a leukemic phase of the disease. The reported leukemic ALCL cases are almost all ALK-positive, which are frequently associated with small cell morphology, t(2;5)(p23;q35), and a poorer prognosis. Rare leukemic ALK-negative ALCL cases have been reported. In the present study, we investigated the clinical and pathologic features and outcomes of nine patients with leukemic ALK-negative ALCL and compared these features with 39 patients without leukemic disease. Compared with the non-leukemic ALK-negative ALCL group, patients with leukemic disease more often had absolute lymphocytosis (50% vs. 0%, p = 0.008), thrombocytopenia (60% vs. 11%, p = 0.03), bone marrow involvement (50% vs. 14%, p = 0.04), and CD7 positivity (71% vs. 19%, p = 0.02). Four of five (80%) patients with leukemic ALK-negative ALCL had a complex karyotype, which was significantly higher than that of the patients in the non-leukemic group. A fluorescence in situ hybridization for TP53 was performed on six leukemic ALK-negative ALCL cases and all (100%) had TP53 deletion. There were no significant differences in the other clinicopathologic features, treatment, and complete remission rates between patients in the leukemic versus non-leukemic group (all p > 0.05). The median follow-up of this cohort was 18 months with a range of 0.3–140 months. Eight of nine (90%) patients with leukemic ALK-negative ALCL died, and their overall survival was significantly shorter than that of the patients with non-leukemic disease (median 15.5 vs. 60 months, p = 0.001). In conclusion, we show that the leukemic phase of ALK-negative ALCL is associated with high-risk biologic features and, in particular, a complex karyotype and TP53 deletion. Compared with the non-leukemic ALK-negative ALCL patients, the patients with a leukemic phase of disease have poorer survival and may require more aggressive treatment.
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Canellas MC, Bruno-Riscarolli E, Ferreira-Facio CS, Lopes-Alves DV, Botafogo VD, Sutter D, Pontes RM, Land MGP, Bedran Milito C, da Costa ES. Immunophenotypic shifts during minimal residual evaluation in a case of leukemic form of anaplastic large cell lymphoma ALK. Cancer Rep (Hoboken) 2021; 5:e1526. [PMID: 34382381 PMCID: PMC9327670 DOI: 10.1002/cnr2.1526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to describe immunophenotypic explorations at diagnosis and follow up of a pediatric patient with leukemic phase of ALK+ anaplastic large cell lymphoma (ALCL) by multiparametric flow cytometry (MFC). CASE An 8-color MFC combination of antibodies allowed to identify neoplastic cells in concentrations until 0.02% during minimal residual disease (MRD) monitoring. Immunophenotypic shifts occurred in key markers as CD30, CD7, CD2, and CD5, however neoplastic cells were clearly discriminated from normal populations. CONCLUSION MFC can be a useful tool for ALCL diagnosis and MRD monitoring and may support therapeutic decisions.
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Affiliation(s)
- Maria Clara Canellas
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Enrico Bruno-Riscarolli
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Daiana V Lopes-Alves
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vitor D Botafogo
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Deborah Sutter
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberia M Pontes
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo G P Land
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Faculty of Medicine - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristiane Bedran Milito
- Department of Pathology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Integrated Morphology Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elaine Sobral da Costa
- Martagão Gesteira Pediatric Institute - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Pediatrics, Faculty of Medicine - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Kundoo A, Sethy M, Sable MN, Mishra P, Panigrahi A, Adhya AK. Diagnosis of the leukemic phase of ALK-positive anaplastic large cell lymphoma by immunohistochemistry on cell block prepared from peripheral blood buffy coat. INDIAN J PATHOL MICR 2021; 63:642-644. [PMID: 33154326 DOI: 10.4103/ijpm.ijpm_433_19] [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: 11/04/2022] Open
Abstract
A leukemic phase of anaplastic lymphoma kinase positive anaplastic large cell lymphoma (ALK+ ALCL) is rare. The leukemic cells morphologically appear as small to intermediate-sized cells with cerebriform and cloverleaf-like nuclei and are misdiagnosed as other T-Cell lymphomas/leukemia with similar morphology. We describe a case where the diagnosis of leukemic ALK+ ALCL was aided by immunohistochemistry performed on the cell blocks prepared from the peripheral blood buffy coat specimen. The diagnosis of ALK+ ALCL was further confirmed on the biopsy of a cutaneous nodule of this patient. We found the method of immunohistochemistry on peripheral blood buffy coat cell block very useful and suggest that it may be used as an alternative method to flowcytometry in low resource settings.
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Affiliation(s)
- Aditi Kundoo
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Madhusmita Sethy
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukund N Sable
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pritinanda Mishra
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Asuthosh Panigrahi
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Amit K Adhya
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Bertoglio P, Lomangino I, Querzoli G, Bonalumi A, Bogina GS, Terzi AC. Primary Hodgkin lymphoma of the lung arising with hemoptysis and pulmonary consolidation: a case report. Monaldi Arch Chest Dis 2021; 91. [PMID: 34121376 DOI: 10.4081/monaldi.2021.1781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
Classic Hodgkin lymphomas are neoplasms originating from lymphoid tissue. Primary extranodal classic Hodgkin lymphoma (PE-cHL) of the lung is rare. A 37-year-old Caucasian male was referred to our hospital for recurrent episodes of hemoptysis, cough and bronchitis. A CT scan showed a massive left upper lung consolidation, which was positive at the PET scan. After several inconclusive tests and no benefit from medical therapies, the patient underwent a left upper lobectomy; pathology report showed a classical type Hodgkin lymphoma with no lymph-nodes involvement. Four cycles of adjuvant chemotherapy were administered with no toxicity. At the last follow up 14 months after surgery, the patient is alive and free from disease. Primary extranodal classical Hodgkin lymphoma of the lung is a rare entity, but it should be considered as a differential diagnosis in young patients with pulmonary consolidation even without systemic symptoms.
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Affiliation(s)
- Pietro Bertoglio
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (VR).
| | | | - Giulia Querzoli
- Division of Pathological Anatomy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (VR).
| | | | - Giuseppe S Bogina
- Division of Pathological Anatomy, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (VR).
| | - Alberto C Terzi
- Division of Thoracic Surgery, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (VR).
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Plummer RM, Kelting S, Madan R, O'Neil M, Dennis K, Fan F. Triaging of pleural effusion cytology specimens for ancillary flow cytometric analysis. J Am Soc Cytopathol 2020; 9:478-484. [PMID: 32807715 DOI: 10.1016/j.jasc.2020.07.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There are no established criteria in selecting pleural effusion (PE) specimens for flow cytometric analysis (FCA). FCA on effusion specimens may be ordered by a clinician or a cytopathologist. In an effort to improve lab test utilization, this retrospective study aims to identify characteristics of PE specimens on which the addition of FCA has high diagnostic yield. MATERIALS AND METHODS We identified consecutive cases of PE cytology specimens on which FCA was performed over a 5-year period (2014-2019). Patient demographic data and history, FCA diagnosis, cytologic diagnosis, cellular quantity and composition, and peripheral blood cell counts were collected. Chi-square, Mann-Whitney U, and t tests were used when appropriate with a significance level of P < 0.05. RESULTS We identified 164 FCA cases corresponding to 142 patients (age: 19-90 years; male:female 2:1). The majority of cases had no abnormality by cytologic examination, whereas others were obviously malignant due to non-hematologic malignancy. Most (119 of 164, 73%) had negative immunophenotypic studies by FCA. Forty-five of 164 (27%) FCA cases were positive for a monoclonal myeloid or lymphoid population. Clinicopathologic features associated with positive FCA results included a history of hematologic malignancy, peripheral blood lymphocytes of ≥20%, the presence of a monomorphic lymphoid population, large atypical cells, and mitoses. CONCLUSIONS This study identifies features that are associated with positive FCA in PE cytology specimens. Using these features by cytopathologists to order FCA on PE specimens as a reflex test would significantly reduce unnecessary testing and improve FCA utilization.
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Affiliation(s)
- Regina M Plummer
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Sarah Kelting
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Rashna Madan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Maura O'Neil
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Katie Dennis
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Fang Fan
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas.
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Abstract
While our understanding of the biology of CD30 in lymphoma continues to evolve, our need to detect and measure its expression at the protein level remains critically important for diagnosis and patient care. In addition to its diagnostic and prognostic utility, CD30 has emerged as a vehicle for drug targeting through the antibody-drug conjugate brentuximab-vedotin (BV). Given the numerous ways that CD30 is utilized and its emergence as a predictive/prognostic biomarker, pathologists must come to a general consensus on the best reporting structure and methodology to ensure appropriate patient care. In this manuscript, we review the indications for testing, various modalities for testing, technical challenges, pitfalls, and potential standards of reporting. The following questions will try to be addressed in the current review article: What defines a "POSITIVE" level of CD30 expression?; How do we evaluate and report CD30 expression?; What are the caveats in the evaluation of CD30 expression?
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Kourentzi K, Crum M, Patil U, Prebisch A, Chavan D, Vu B, Zeng Z, Litvinov D, Zu Y, Willson RC. Recombinant expression, characterization, and quantification in human cancer cell lines of the Anaplastic Large-Cell Lymphoma-characteristic NPM-ALK fusion protein. Sci Rep 2020; 10:5078. [PMID: 32193476 PMCID: PMC7081362 DOI: 10.1038/s41598-020-61936-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/05/2020] [Indexed: 11/09/2022] Open
Abstract
Systemic anaplastic large cell lymphoma (ALCL) is an aggressive T-cell lymphoma most commonly seen in children and young adults. The majority of pediatric ALCLs are associated with the t(2;5)(p23;q35) translocation which fuses the Anaplastic Lymphoma Kinase (ALK) gene with the Nucleophosmin (NPM) gene. The NPM-ALK fusion protein is a constitutively-active tyrosine kinase, and plays a major role in tumor pathogenesis. In an effort to advance novel diagnostic approaches and the understanding of the function of this fusion protein in cancer cells, we expressed in E. coli, purified and characterized human NPM-ALK fusion protein to be used as a standard for estimating expression levels in cultured human ALCL cells, a key tool in ALCL pathobiology research. We estimated that NPM-ALK fusion protein is expressed at substantial levels in both Karpas 299 and SU-DHL-1 cells (ca. 4-6 million molecules or 0.5-0.7 pg protein per cell; based on our in-house developed NPM-ALK ELISA; LOD of 40 pM) as compared to the ubiquitous β-actin protein (ca. 64 million molecules or 4.5 pg per lymphocyte). We also compared NPM-ALK/ β-actin ratios determined by ELISA to those independently determined by two-dimensional electrophoresis and showed that the two methods are in good agreement.
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Affiliation(s)
- Katerina Kourentzi
- Department of Chemical & Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA.
| | - Mary Crum
- Department of Chemical & Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA
| | - Ujwal Patil
- Department of Biology & Biochemistry, University of Houston, Houston, TX, 77204, USA
| | - Ana Prebisch
- Department of Chemical & Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA
| | - Dimple Chavan
- Department of Biology & Biochemistry, University of Houston, Houston, TX, 77204, USA
| | - Binh Vu
- Department of Chemical & Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA
| | - Zihua Zeng
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Dmitri Litvinov
- Department of Electrical & Computer Engineering, University of Houston, Houston, TX, USA
| | - Youli Zu
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.
| | - Richard C Willson
- Department of Chemical & Biomolecular Engineering, University of Houston, Houston, TX, 77204, USA.
- Department of Biology & Biochemistry, University of Houston, Houston, TX, 77204, USA.
- Escuela de Medicina y Ciencias de la Salud ITESM, Monterrey, Mexico.
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Shen J, Medeiros LJ, Li S, Wang SA, Lin P, Khanlari M, Iyer SP, Yin CC, Tang G, Jorgensen JL, Hu S, Miranda RN, Xu J. CD8 expression in anaplastic large cell lymphoma correlates with noncommon morphologic variants and T-cell antigen expression suggesting biological differences with CD8-negative anaplastic large cell lymphoma. Hum Pathol 2020; 98:1-9. [PMID: 32032618 DOI: 10.1016/j.humpath.2020.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/14/2020] [Accepted: 01/28/2020] [Indexed: 02/07/2023]
Abstract
Anaplastic large cell lymphoma (ALCL) is a T-cell neoplasm characterized by uniformly strong CD30 expression and common absence of T-cell markers. Most ALCL cases express CD4, but a small subset of ALCL cases has been reported to express CD8. Little is known about the clinicopathologic and prognostic features of CD8+ ALCL. In this study, CD8 was assessed in 158 patients with systemic ALCL: CD8 was positive in 13 of 67 (19%) ALK+ and 13 of 91 (14%) ALK-negative neoplasms. In ALK+ ALCL, the CD8+ subgroup more often showed a noncommon morphologic pattern (69% vs 13%, P = .0001) and was more often positive for CD2 (100% vs 45%, P = .001), CD3 (92% vs 24%, P = .0001), and CD7 (100% vs. 39%, P = .002), but less frequently positive for CD25 (50% vs. 100%, P = .02). Patients with ALK+ ALCL and CD8+ neoplasms also had a higher relapse rate (82% vs 48%, P = .05) and more often underwent stem cell transplant (73% vs 36%, P = .04). CD8 expression did not correlate with patient overall survival or progression-free survival regardless of ALK status (all P > 0.05). We conclude that CD8+ ALCL cases appear to be biologically different from the more common CD8-negative ALCL cases. Our data suggest that CD8 positivity in ALK+ ALCL helps to identify a subset of patients more prone to relapse or more in need of stem cell transplant during their clinical course, although there was no impact on survival in this cohort.
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Affiliation(s)
- Jing Shen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Hematology, Capital Medical University Beijing Friendship Hospital, Beijing, China
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shaoying Li
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sa A Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pei Lin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mahsa Khanlari
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Swaminathan P Iyer
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Cameron Yin
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey L Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shimin Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jie Xu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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12
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Julien LA, Michel RP, Auger M. Breast implant-associated anaplastic large cell lymphoma and effusions: A review with emphasis on the role of cytopathology. Cancer Cytopathol 2020; 128:440-451. [PMID: 31899606 DOI: 10.1002/cncy.22233] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/27/2022]
Abstract
Breast implants are surgically implanted by the hundreds of thousands every year worldwide for reconstructive or aesthetic purposes. Complications related to breast implants include early and late effusions that are often submitted for cytopathological analysis, particularly to exclude the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare disease that generally follows an indolent clinical course, although it is becoming clearer that a subset of patients with adverse features have a poorer prognosis. Since a late-onset breast implant-associated effusion is the most common initial presentation of BIA-ALCL, cytopathological analysis of these effusions is considered the cornerstone and gold standard for rapid, efficient, reliable diagnosis and is critical for appropriate management and treatment. The National Comprehensive Cancer Network recently published clinical guidelines for the diagnosis and management of BIA-ALCL and stresses the essential role of cytopathological analysis, although it remains a matter of debate if all seromas should undergo immunocytochemistry or flow cytometry, particularly for assessment of expression of CD30 irrespective of morphological appearance on cytology. Herein, we review the current knowledge on BIA-ALCL, review the key cytological findings of reactive and malignant effusions related to breast implants, and present a comprehensive cytopathological workup with the presence of atypical cells as the key and pivotal element triggering further ancillary studies. We believe this approach will ensure appropriate and cost-effective management of effusion specimens from breast implants.
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Affiliation(s)
| | - René P Michel
- Department of Pathology, McGill University, Montreal, Canada
| | - Manon Auger
- Department of Pathology, McGill University, Montreal, Canada
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Jevremovic D, Olteanu H. Flow Cytometry Applications in the Diagnosis of T/NK-Cell Lymphoproliferative Disorders. CYTOMETRY PART B-CLINICAL CYTOMETRY 2019; 96:99-115. [PMID: 30729667 DOI: 10.1002/cyto.b.21768] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 02/02/2023]
Abstract
This article provides an overview of the role of flow cytometry in the diagnosis, prognosis, and follow-up of T and NK-cell lymphoproliferative disorders. For each category, we will briefly discuss the immunophenotypic features of normal T and NK cells, and address technical issues in flow cytometry, the approach to diagnosis in various contexts, pitfalls in interpretation, and its use in follow-up and post-therapy management. In addition to reviewing the diagnostic, prognostic, and therapeutic utility of flow cytometric immunophenotyping in several of specific T and NK cell entities, we will also cover some of the new immunophenotypic markers. Furthermore, we will touch upon incorporation of flow cytometry in the final diagnosis, including correlation with other ancillary tests. © 2019 International Clinical Cytometry Society.
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Affiliation(s)
- Dragan Jevremovic
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
| | - Horatiu Olteanu
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota
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14
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15
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Wang W, Gao L, Gong M, Tang Y, Li Y, Zhang WT, Huang FZ, Zhang CX, Chen YR, Gao YY, Li ZL, Ma YG. Non-malignant T-cells lacking multiple pan-T markers can be found in lymph nodes. Leuk Lymphoma 2015; 59:155-161. [PMID: 26293843 DOI: 10.3109/10428194.2015.1055482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Wei Wang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Li Gao
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Ming Gong
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yin Tang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yan Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Wen-Tao Zhang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Fan-Zhou Huang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Chun-Xia Zhang
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yan-Rong Chen
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Ya-Yue Gao
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Zhen-Ling Li
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
| | - Yi-Gai Ma
- Department of Hematology, China-Japan Friendship Hospital, Beijing, PR China
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16
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Paul T, Gautam U, Rajwanshi A, Das A, Trehan A, Malhotra P, Srinivasan R. Flow cytometric immunophenotyping and cell block immunocytochemistry in the diagnosis of primary Non-Hodgkin's Lymphoma by fine-needle aspiration: Experience from a tertiary care center. J Cytol 2014; 31:123-30. [PMID: 25538379 PMCID: PMC4274521 DOI: 10.4103/0970-9371.145577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Accurate diagnosis of Non-Hodgkin's Lymphoma (NHL) on fine-needle aspiration (FNA) specimen is challenging and requires ancillary testing. Aim: The feasibility of flow cytometric immunophenotyping (FCI) along with cell block immunocytochemistry (CB-ICC) as adjunct techniques in the diagnosis of NHL as per the current World Health Organization (WHO) classification was evaluated. Materials and Methods: All cases of suspected lymphoma underwent FNA, and the sample was triaged for light microscopic evaluation, FCI, and CB-ICC, and each case was classified as per the current WHO classification. Results: A total of 65 cases was analyzed which included 40 B-cell, 21 T-cell, and 4 unclassifiable lymphomas. Of 61 cases, FCI alone was contributory in 74% (45/61) cases whereas CB-ICC alone was contributory in 65.5% (40/61) cases in typing the lymphoma. In 11.4% (7/61) cases, the lymphoma could not be classified by either technique. Thus, in a total of 88.5% (54/61) cases a combination of FCI and CB-ICC from FNA enabled a diagnosis of lymphoma with its subtyping. Conclusion: Flow cytometric immunophenotyping and ICC on CBs are feasible on FNA material and are very useful in a suspected case of NHL especially when a biopsy may not be possible or feasible.
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Affiliation(s)
- Tuhin Paul
- Department of Cytology and Gynecological Pathology, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Upasana Gautam
- Department of Cytology and Gynecological Pathology, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Histopathology, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatrics, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Division of Hematology-Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Hebeda K, Preijers F. Flow cytometric pattern recognition of lymph node biopsies with lymphomas that lack lineage characteristics. Int J Lab Hematol 2014; 36:254-60. [PMID: 24750671 DOI: 10.1111/ijlh.12229] [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: 01/17/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
Although immunophenotyping (IPT) using flow cytometry is a routine technique that is applied in many laboratories as a diagnostic tool for lymphadenopathy, some diagnostic challenges persist. In this review, we will discuss pitfalls in the daily practice of lymph node diagnostics with the focus on general characteristics as lymphoid scatter patterns and lineage specific antigens that are used to define lymphoid populations. The absence of these characteristics on proliferating lymphoid cells can potentially lead to a wrong diagnosis. At the same time, this provides evidence for malignant transformation. Sporadic examples of reactive lymphoid proliferations with similar phenotypes are also discussed, illustrating the need for correlating IPT with morphology and clinical features.
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Affiliation(s)
- K Hebeda
- Department of Pathology, Radboudumc, Nijmegen, The Netherlands
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Leukemic phase of ALK(+) anaplastic large-cell lymphoma, small-cell variant: clinicopathologic pitfalls of a rare entity. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e123-6. [PMID: 24685107 DOI: 10.1016/j.clml.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/12/2014] [Indexed: 11/21/2022]
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19
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Abstract
FNA is a simple, safe, and an inexpensive sampling technique that plays an important role in the evaluation of lymphadenopathy. The key to enhancing the accuracy of FNA diagnosis of lymphoma is the multi parameter approach in which the cytomorphologic features are evaluated in correlation with the results of ancillary studies and clinical context. A full understanding of the current lymphoma classification, clinical features associated with each lymphoma subtype and the impact of the diagnosis on patient management is essential in FNA diagnosis of lymphoma. It is also important to recognize the limitations of FNA in the primary diagnosis of some subtypes of lymphoma, and tissue biopsy should be recommended for a definitive diagnosis and subclassification in such cases.
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Affiliation(s)
- Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,
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20
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Singh A, Schabath R, Ratei R, Stroux A, Klemke CD, Nebe T, Flörcken A, van Lessen A, Anagnostopoulos I, Dörken B, Ludwig WD, Pezzutto A, Westermann J. Peripheral blood sCD3⁻ CD4⁺ T cells: a useful diagnostic tool in angioimmunoblastic T cell lymphoma. Hematol Oncol 2013; 32:16-21. [PMID: 23798351 DOI: 10.1002/hon.2080] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 11/08/2022]
Abstract
Angioimmunoblastic T cell lymphoma (AITL) belongs to the subgroup of mature T cell lymphomas according to the World Health Organization and is one of the common T cell lymphomas in Western countries. Particularly in cases in which histological confirmation cannot be easily achieved, immunophenotyping of peripheral blood can give important information for the differential diagnosis of AITL. sCD3⁻ CD4⁺ T cells are a typical feature of AILT in flow cytometry of peripheral blood. In this retrospective study, the diagnostic value of flow cytometry for the diagnosis 'AITL' was assessed by comparing the frequency of sCD3⁻ CD4⁺ T cells in leukemic AITL patients and in patients with other leukemic CD4⁺ T cell lymphomas. Immunophenotyping of peripheral blood by flow cytometry was performed in a lymphocyte gate using fluorochrome-labelled antibodies against CD3, CD2, CD4, CD5, CD7, CD8, CD10, CD14, CD16, CD19, CD56, CD57 and T cell receptor. In 17/17 leukemic AITL patients, a small but distinct population of sCD3⁻ CD4⁺ T cells was detected (mean percentage of sCD3⁻ CD4⁺ T cells in the lymphocyte gate: 11.9 ± 15.4%, range 0.1-51.8%). In contrast, sCD3⁻ CD4⁺ T cells were found in only 1/40 patients with other leukemic CD4⁺ T cell lymphomas (one patient with mycosis fungoides). sCD3⁻ CD4⁺ T cells have a high positive predictive value (94%) for the diagnosis 'AITL'. Flow cytometry is particularly useful in the differential diagnosis of AITL, even if the aberrant T cell population has a very low frequency. Further biological characterization of this subfraction of lymphoma cells is warranted.
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Affiliation(s)
- Anju Singh
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany; Labor Berlin Charité Vivantes GmbH, Berlin, Germany
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21
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Abramov D, Oschlies I, Zimmermann M, Konovalov D, Damm-Welk C, Wössmann W, Klapper W. Expression of CD8 is associated with non-common type morphology and outcome in pediatric anaplastic lymphoma kinase-positive anaplastic large cell lymphoma. Haematologica 2013; 98:1547-53. [PMID: 23716548 DOI: 10.3324/haematol.2013.085837] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Anaplastic lymphoma kinase-positive anaplastic large T-cell lymphoma is characterized by morphological variability. Morphological variants (non-common subtype) are associated with a poor outcome. They display abundant reactive bystander cells admixed with the lymphoma cells. So far, the difficulty in distinguishing lymphoma cells from bystander cells by visual inspection has prevented detailed and reliable immunophenotypic analysis using conventional immunohistochemistry. To overcome these limitations, we analyzed 124 cases of pediatric anaplastic lymphoma kinase-positive anaplastic large cell lymphoma treated within clinical trials using immunofluorescence multi-staining and digital image analysis combining antibodies against anaplastic lymphoma kinase to specifically identify lymphoma cells with antibodies against CD30, CD3, CD5, CD8, Ki67 and phosphorylated STAT3. Non-common type anaplastic lymphoma kinase-positive anaplastic large cell lymphomas express CD8 more frequently than common type anaplastic lymphoma kinase-positive anaplastic large cell lymphomas (35.4% and 5.6%, respectively; P=0.0002). CD8 expression was associated with a poorer outcome. Importantly, in a multivariate analysis including clinical risk factors, histological subtype and CD8 expression, CD8-positivity proved to be an independent prognostic predictor of worse outcome (hazard ratio for survival 3.38, P=0.042).
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22
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Ferreira-Facio CS, Milito C, Botafogo V, Fontana M, Thiago LS, Oliveira E, da Rocha-Filho AS, Werneck F, Forny DN, Dekermacher S, de Azambuja AP, Ferman SE, de Faria PAS, Land MGP, Orfao A, Costa ES. Contribution of multiparameter flow cytometry immunophenotyping to the diagnostic screening and classification of pediatric cancer. PLoS One 2013; 8:e55534. [PMID: 23472067 PMCID: PMC3589426 DOI: 10.1371/journal.pone.0055534] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 12/27/2012] [Indexed: 12/13/2022] Open
Abstract
Pediatric cancer is a relatively rare and heterogeneous group of hematological and non-hematological malignancies which require multiple procedures for its diagnostic screening and classification. Until now, flow cytometry (FC) has not been systematically applied to the diagnostic work-up of such malignancies, particularly for solid tumors. Here we evaluated a FC panel of markers for the diagnostic screening of pediatric cancer and further classification of pediatric solid tumors. The proposed strategy aims at the differential diagnosis between tumoral vs. reactive samples, and hematological vs. non-hematological malignancies, and the subclassification of solid tumors. In total, 52 samples from 40 patients suspicious of containing tumor cells were analyzed by FC in parallel to conventional diagnostic procedures. The overall concordance rate between both approaches was of 96% (50/52 diagnostic samples), with 100% agreement for all reactive/inflammatory and non-infiltrated samples as well as for those corresponding to solid tumors (n = 35), with only two false negative cases diagnosed with Hodgkin lymphoma and anaplastic lymphoma, respectively. Moreover, clear discrimination between samples infiltrated by hematopoietic vs. non-hematopoietic tumor cells was systematically achieved. Distinct subtypes of solid tumors showed different protein expression profiles, allowing for the differential diagnosis of neuroblastoma (CD56hi/GD2+/CD81hi), primitive neuroectodermal tumors (CD271hi/CD99+), Wilms tumors (>1 cell population), rhabdomyosarcoma (nuMYOD1+/numyogenin+), carcinomas (CD45−/EpCAM+), germ cell tumors (CD56+/CD45−/NG2+/CD10+) and eventually also hemangiopericytomas (CD45−/CD34+). In summary, our results show that multiparameter FC provides fast and useful complementary data to routine histopathology for the diagnostic screening and classification of pediatric cancer.
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Affiliation(s)
| | - Cristiane Milito
- Department of Pathology, Faculty of Medicine, UFRJ, Rio de Janeiro, Brazil
| | - Vitor Botafogo
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcela Fontana
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Leandro S. Thiago
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Pediatric Hematology and Oncology Program, Cancer Research Center, Brazilian National Cancer Institute (INCa), Rio de Janiero, Brazil
| | - Elen Oliveira
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Danielle N. Forny
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Sima Esther Ferman
- Department of Pediatric Oncology/Brazilian National Cancer Institute (INCa), Rio de Janiero, Brazil
| | | | - Marcelo G. P. Land
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Alberto Orfao
- Cytometry Service, Department of Medicine and Cancer Research Center (IBMCC, University of Salamanca-CSIC and IBSAL), University of Salamanca, Salamanca, Spain
| | - Elaine S. Costa
- Pediatric Institute IPPMG, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- * E-mail:
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Demurtas A, Stacchini A, Aliberti S, Chiusa L, Chiarle R, Novero D. Tissue flow cytometry immunophenotyping in the diagnosis and classification of non-Hodgkin's lymphomas: a retrospective evaluation of 1,792 cases. CYTOMETRY PART B-CLINICAL CYTOMETRY 2013; 84:82-95. [PMID: 23325563 DOI: 10.1002/cyto.b.21065] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 10/23/2012] [Accepted: 11/21/2012] [Indexed: 12/17/2022]
Abstract
A retrospective analysis of 1,792 solid tissues suggestive of lymphoma, submitted over a 12-year period, was carried out and flow cytometry (FC) results were compared with histologic findings. The final histologic diagnosis of cases documented in this report is as follows: 1,270 non-Hodgkin's lymphomas (NHL); 17 composite lymphomas; four NHL plus carcinomas; five post-transplant lymphoproliferative disorders; 105 Hodgkin's lymphomas (HL); eight acute leukemias; 42 tissue cancers; and 341 non-neoplastic diseases. A strong correlation between morphology and FC data was observed among hematological malignancies (1,268/1,304, 97.2%) with the exception of HL. Among B-NHL, FC detection of clonally restricted B-cell allowed the identification of lymphomas that were not histologically clear and the differential diagnosis between follicular lymphoma and reactive hyperplasia. A high correlation level (r = 0.83; P < 0.0001) was obtained in comparing proliferation results obtained by FC and immunohistochemistry. Among T-NHL, FC detection of an aberrant phenotype direct histologic diagnosis in cases having less than 20% of neoplastic cells. In nine cases, FC suggested the need to evaluate a neoplastic population, not morphologically evident. Results show that FC routinely performed on tissue samples suspected of lymphomas is a fundamental adjunct to morphology in the diagnosis of NHL and may enhance the performance of the histologic evaluation so as to achieve the final diagnosis. To the best of our knowledge, this is the first report in the literature of a wide series of tissues also studied by FC.
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Affiliation(s)
- Anna Demurtas
- Flow Cytometry Unit, Anatomical Pathology Laboratory 2, Molinette Hospital, University of Turin, Italy
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24
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Shen H, Tang Y, Xu X, Tang H, Gu W. Simultaneous cytomorphological and multiparameter flow cytometric analysis of ALK-positive anaplastic large cell lymphoma in children. Oncol Lett 2012; 5:515-520. [PMID: 23420373 PMCID: PMC3573140 DOI: 10.3892/ol.2012.1034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/13/2012] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to investigate the pathological features of anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) in children and to establish the effectiveness of screening and diagnosing ALCL with multiparameter flow cytometry immunophenotyping (FCI) of lymphoid tissue samples. A total of 121 lymph node tissue specimens obtained from 121 patients with a suspected diagnosis of lymphoma were analyzed with cytomorphological and FCI analysis. Fifteen cases were diagnosed as ALK-positive ALCL based on the pathological features and immunohistochemical results. Of these, there were 3 different types, common type (10 cases), lymphohistiocytic type (4 cases) and neutrophil-rich type (1 case). Thirteen cases (10 common, 2 lymphohistiocytic and 1 neutrophil-rich type) were diagnosed as ALCL using FCI. These cases were CD30-positive and aberrantly expressed at least two T-cell antigens, including CD4 (84.6%), CD2 (76.9%), CD7 (61.5%), CD3 (53.8%) and CD5 (38.4%). Neoplastic cells accounted for only a small proportion of the total cells in FCI, with a median of 19.3% (range, 7.9-31.8%), which was significantly higher than those in the control groups (all <1.0%). The sensitivity of FCI for diagnosing ALCL in lymph node samples was 86.7% with a specificity of 100%. The majority of neoplastic cells demonstrated high light forward and high light side scatter, similar to monocytes or granulocytes in dot plots. FCI may be used as an adjunct to histopathological examination for rapid and reliable diagnosis of pediatric ALCL. Flexible gating strategies and careful analysis are required to identify neoplastic cells with FCI.
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Affiliation(s)
- Hongqiang Shen
- Division of Hematology-Oncology, Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou 310003, P.R. China
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25
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Shen H, Tang Y, Xu X, Wang L, Wang Q, Xu W, Song H, Zhao Z, Wang J. Rapid detection of neoplastic cells in serous cavity effusions in children with flow cytometry immunophenotyping. Leuk Lymphoma 2012; 53:1509-14. [DOI: 10.3109/10428194.2012.661050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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de Tute RM. Flow cytometry and its use in the diagnosis and management of mature lymphoid malignancies. Histopathology 2011; 58:90-105. [PMID: 21261686 DOI: 10.1111/j.1365-2559.2010.03703.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The last decade has seen major advances in flow cytometric immunophenotyping and this has expanded the utility of flow cytometry to investigate the antigens present on normal and neoplastic haematopoietic cells. This review summarizes how flow cytometry is used currently in the diagnosis and management of mature lymphoid malignancies. The establishment of disease-specific phenotypes allows the creation of assays which can detect neoplastic cells with high specificity and sensitivity. Certain lymphoid neoplasms are well defined immunophenotypically, while others are more heterogeneous. The availability of more sophisticated cytometers and a wider selection of antibodies in routine diagnostic laboratories will lead to the resolution of these more complex disease entities.
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Affiliation(s)
- Ruth M de Tute
- Haematological Malignancy Diagnostic Service, St James' University Hospital, Leeds, UK.
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Kinney MC, Higgins RA, Medina EA. Anaplastic large cell lymphoma: twenty-five years of discovery. Arch Pathol Lab Med 2011; 135:19-43. [PMID: 21204709 DOI: 10.5858/2010-0507-rar.1] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The year 2010 commemorates the 25th year since the seminal publication by Karl Lennert and Harald Stein and others in Kiel, West Germany, describing an unusual large cell lymphoma now known as anaplastic large cell lymphoma (ALCL). Investigators at many universities and hospitals worldwide have contributed to our current in-depth understanding of this unique peripheral T-cell lymphoma, which in its systemic form, principally occurs in children and young adults. OBJECTIVE To summarize our current knowledge of the clinical and pathologic features of systemic and primary cutaneous ALCL. Particular emphasis is given to the biology and pathogenesis of ALCL. DATA SOURCES Search of the medical literature (Ovid MEDLINE In-Process & Other Non-Indexed Citations and Ovid MEDLINE: 1950 to Present [National Library of Medicine]) and more than 20 years of diagnostic experience were used as the source of data for review. CONCLUSIONS Based on immunostaining for activation antigen CD30 and the presence of dysregulation of the anaplastic lymphoma kinase gene (2p23), the diagnosis of ALCL has become relatively straightforward for most patients. Major strides have been made during the last decade in our understanding of the complex pathogenesis of ALCL. Constitutive NPM-ALK signaling has been shown to drive oncogenesis via an intricate network of redundant and interacting pathways that regulate cell proliferation, cell fate, and cytoskeletal modeling. Nevertheless, pathomechanistic, therapeutic, and diagnostic challenges remain that should be resolved as we embark on the next generation of discovery.
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Affiliation(s)
- Marsha C Kinney
- Department of Pathology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229-3900, USA.
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28
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Mittag A, Pinto FE, Endringer DC, Tarnok A, Lenz D. Cellular analysis by open-source software for affordable cytometry. SCANNING 2011; 33:33-40. [PMID: 21319173 DOI: 10.1002/sca.20220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 01/11/2011] [Indexed: 05/30/2023]
Abstract
Image cytometry is an important technique in affordable healthcare and cellular research. Some efforts toward establishing a personal, low-cost cytometer have been described in the literature. However, a self-assembled fluorescence microscope requires software for cytometric analysis. There are some open-source image-based software analysis applications available. However, for a quantitative analysis of images, software that can generate data comparable to those of previously evaluated cytometric analyses programs is required. Hence, the aim of this study is to compare results of a commercially available image cytometry program to data obtained using the open-source software CellProfiler (CP). Leukocytes and fluorescent bead images obtained using a Laser Scanning Cytometer were analyzed by CP and the results compared with those of conventional cytometric analyses' programs. Algorithms were developed enabling the analysis of leukocytes and beads by CP. CP provided similar results to those obtained by the cytometer software. Hallmark parameters, including cell count and fluorescence intensity, revealed a high correlation in the analysis of both programs. Therefore, CP is appropriate for cellular analysis on a self-assembled microscope, thereby enabling affordable cytometry.
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Affiliation(s)
- Anja Mittag
- Translational Centre for Regenerative Medicine, Leipzig, Germany
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29
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Meyerson HJ. A practical approach to the flow cytometric detection and diagnosis of T-cell lymphoproliferative disorders. ACTA ACUST UNITED AC 2010; 16:32-52. [PMID: 20858587 DOI: 10.1532/lh96.10001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The flow cytometric analysis of T-cell malignancies is difficult due to the heterogeneity of T-cells and the lack of convenient methods to detect T-cell clonality. Neoplastic T-cells are most often detected by their altered level of surface antigen expression, and detection requires an extensive knowledge of the phenotype of normal T-lymphocytes. This review focuses on the methods to distinguish malignant T-cells from their normal counterparts and the phenotypic features of the T-cell lymphoproliferative disorders.
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Affiliation(s)
- Howard J Meyerson
- Department of Pathology and Ireland Cancer Center of Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, Ohio 44106 , USA.
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30
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Gustafson S, Medeiros LJ, Kalhor N, Bueso-Ramos CE. Anaplastic large cell lymphoma: another entity in the differential diagnosis of small round blue cell tumors. Ann Diagn Pathol 2010; 13:413-27. [PMID: 19917480 DOI: 10.1016/j.anndiagpath.2009.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
Abstract
We saw in consultation a biopsy specimen from a 6-year old girl with anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL). The tumor arose in soft tissue of the neck, and diagnostic tissue was obtained by core needle biopsy. Histologically, the neoplasm was cellular without pattern. Immunohistochemical workup with a large panel of antibodies at another institution showed immunoreactivity for NB84 and neuron specific enolase (dim). Antibodies specific for CD3, CD20, and CD45/LCA were negative; CD30 or ALK were not assessed. Electron microscopy showed cytoplasmic structures thought to be neurosecretory granules. The neoplasm was interpreted initially as a neuroblastoma. At the time of our review, we considered the possibility of ALCL. Immunohistochemical analysis for CD30 showed bright, uniform expression and ALK was positive in a nuclear and cytoplasmic pattern, confirming the diagnosis of ALK+ ALCL. The purpose of this review is to discuss ALK+ ALCL and many of the other entities included under the rubric of small round blue cell tumor, with a focus on tumors that occur in children.
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Affiliation(s)
- Steven Gustafson
- Department of Hematopathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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31
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Zhang QY, Foucar K. Bone marrow involvement by hodgkin and non-hodgkin lymphomas. Hematol Oncol Clin North Am 2009; 23:873-902. [PMID: 19577173 DOI: 10.1016/j.hoc.2009.04.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Bone marrow evaluation plays a critical role in staging and predicting prognosis in patients with Hodgkin lymphoma or non-Hodgkin lymphoma. Bone marrow can be the initial site of detection of lymphoma in patients with unexplained symptoms or cytopenias. A comprehensive evaluation of bone marrow includes complete blood counts, blood morphology, bone marrow aspirate, and generous core biopsy sections. Specialized testing should be used in a logical fashion on a case by case basis.
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Affiliation(s)
- Qian-Yun Zhang
- Department of Pathology, Health Sciences Center, School of Medicine, University of New Mexico, MSC08 4640, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.
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32
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Mittag A, Tárnok A. Basics of standardization and calibration in cytometry--a review. JOURNAL OF BIOPHOTONICS 2009; 2:470-481. [PMID: 19504519 DOI: 10.1002/jbio.200910033] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Standardization, calibration, and controls (negative and positive controls) are essential for quality assurance. Cytometers are capable of reliable and repeatable cellular analyses. However, a prerequisite is instrument calibration and standardized preanalytics. Calibration is often done by beads. Beads are available for different quality control applications, e.g. calibration of size and measuring scale, compensation, absolute cell counting, and laser alignment. Results can be standardized by converting MFI values into MESF or ABC values. Standardized data allow comparison of experiments over a long period of time and between different instruments and laboratories. Alterations in the sensitivity of the cytometer can be detected by routinely performing quality control. The process of quality assurance quantifies and helps manage the variance from the desired value. Results can thus be compared objectively with those of other laboratories. Standardization is the basis of cytometry and a prerequisite for obtaining reliable data.
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Affiliation(s)
- Anja Mittag
- Dept. of Pediatric Cardiology, Heart Center Leipzig, University of Leipzig, Strümpelstr. 39, 04275 Leipzig, Germany.
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33
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Nguyen JT, Condron MR, Nguyen ND, De J, Medeiros LJ, Padula A. Anaplastic large cell lymphoma in leukemic phase: extraordinarily high white blood cell count. Pathol Int 2009; 59:345-53. [PMID: 19432678 DOI: 10.1111/j.1440-1827.2009.02376.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a distinct type of T/null-cell non-Hodgkin lymphoma that commonly involves nodal and extranodal sites. The World Health Organization of lymphoid neoplasms recognizes two types: anaplastic lymphoma kinase (ALK) positive or ALK negative, the former as a result of abnormalities involving the ALK gene at chromosome 2p23. Patients with ALCL rarely develop a leukemic phase of disease, either at the time of initial presentation or during the clinical course. Described herein is a patient with ALK+ ALCL, small cell variant, associated with the t(2;5)(p23;q35), who initially presented with leukemic involvement and an extraordinarily high leukocyte count of 529 x 10(9)/L, which subsequently peaked at 587 x 10(9)/L. Despite chemotherapy the patient died 2(1/2) months after diagnosis. In the literature review 20 well-documented cases are identified of ALCL in leukemic phase reported previously, with a WBC ranging from 15 to 151 x 10(9)/L. Leukemic phase of ALCL occurs almost exclusively in patients with ALK+ ALCL, most often associated with the small cell variant and the t(2;5)(p23;q35), similar to the present case. Patients with leukemic phase ALK+ ALCL appear to have a poorer prognosis than most patients with ALK+ ALCL.
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Affiliation(s)
- Jacqueline T Nguyen
- Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas, USA
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