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Callum J, Skubas NJ, Bathla A, Keshavarz H, Clark EG, Rochwerg B, Fergusson D, Arbous S, Bauer SR, China L, Fung M, Jug R, Neill M, Paine C, Pavenski K, Shah PS, Robinson S, Shan H, Szczepiorkowski ZM, Thevenot T, Wu B, Stanworth S, Shehata N. Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines. Chest 2024:S0012-3692(24)00285-X. [PMID: 38447639 DOI: 10.1016/j.chest.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Albumin is used commonly across a wide range of clinical settings to improve hemodynamics, to facilitate fluid removal, and to manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, undergoing kidney replacement therapy, or experiencing complications of cirrhosis. METHODS Cochairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception through November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations Assessment, Development and Evaluation methodology. The guidelines were revised after public consultation. RESULTS The panel made 14 recommendations on albumin use in adult critical care (three recommendations), pediatric critical care (one recommendation), neonatal critical care (two recommendations), cardiovascular surgery (two recommendations), kidney replacement therapy (one recommendation), and complications of cirrhosis (five recommendations). Of the 14 recommendations, two recommendations had moderate certainty of evidence, five recommendations had low certainty of evidence, and seven recommendations had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large-volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin commonly is transfused. CONCLUSIONS Currently, few evidence-based indications support the routine use of albumin in clinical practice to improve patient outcomes. These guidelines provide clinicians with actionable recommendations on the use of albumin.
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Affiliation(s)
- Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston.
| | - Nikolaos J Skubas
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland
| | | | | | - Edward G Clark
- Division of Nephrology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa
| | - Bram Rochwerg
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton
| | - Dean Fergusson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa
| | - Sesmu Arbous
- Department of Critical Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Seth R Bauer
- Department of Pharmacy, Cleveland Clinic, Cleveland
| | - Louise China
- Department of Hepatology and ILDH, The Royal Free NHS Trust and University College London, London
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT
| | - Rachel Jug
- University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Cary Paine
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON
| | - Prakesh S Shah
- Institute of Health Policy, Management, and Evaluation, Mount Sinai Hospital, Toronto, ON; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON
| | - Susan Robinson
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London
| | - Hua Shan
- Department of Pathology, Stanford University School of Medicine, Palo Alto
| | | | - Thierry Thevenot
- Service d'Hépatologie, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - Bovey Wu
- Department of Internal Medicine, Graduate Medical Education, Loma Linda University, Loma Linda, CA
| | - Simon Stanworth
- NHS Blood and Transplant, Oxford, England; Radcliffe Department of Medicine, University of Oxford, Oxford, England; John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Nadine Shehata
- Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON; Transfusion Medicine Laboratory, Mount Sinai Hospital, Toronto, ON
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2
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Jug R, Callum J, Ruijs T, Liu Y, Barty R, Thompson T. Intravenous albumin utilization audit at a large community hospital. Transfusion 2024; 64:39-46. [PMID: 38078484 DOI: 10.1111/trf.17610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/01/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There is a literature gap in terms of albumin utilization practices. METHODS/MATERIALS We conducted a single-center retrospective observational electronic audit of adult admitted patients who received one or more vials of albumin (5% or 25%) between September 1, 2019 and August 31, 2020 at a large community hospital. The Research Ethics Board approval was obtained. Utilization data identified through the laboratory information system were independently adjudicated by two reviewers and resolved by consensus as appropriate-acceptable, appropriate-may be acceptable, or inappropriate. The primary objective of this audit is to determine the proportion of 5% and 25% intravenous albumin infusions meeting a priori appropriateness criteria for indication. Secondary outcomes include determining the patterns of practice surrounding intravenous albumin use: patient demographics, most responsible diagnosis, location at time of order, clinical outcomes of albumin recipients, and types, volumes, and cost of albumin infused. RESULTS The mean total albumin administered was 569.2 mL across 456 total recipients (58% male) with a 29% appropriateness rate. This cohort had an in-hospital mortality rate of 38%, with an average of 6 days from first dose of albumin to death. The mean length of stay was 14 days, with a mean intensive care length of stay of 8 days. The purchase cost of inappropriately transfused albumin was CAD $65,538. CONCLUSION Based on a lack of or an unacceptable indication provided, 71% of patients were inappropriately transfused. Albumin use deviating from guideline recommendations may be contributing to increased healthcare costs, pressure on limited supply, and potential patient harm.
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Affiliation(s)
- Rachel Jug
- University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Ontario, Canada
| | | | - Yang Liu
- Michael DeGroote Centre for Transfusion Research, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
| | - Troy Thompson
- Ontario Regional Blood Coordinating Network (ORBCoN), Toronto, Ontario, Canada
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3
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Shi C, Jug R, Bean SM, Jeck WR, Guy CD. Primary hepatic neoplasms arising in cirrhotic livers can have a variable spectrum of neuroendocrine differentiation. Hum Pathol 2021; 116:63-72. [PMID: 34310982 DOI: 10.1016/j.humpath.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/25/2021] [Accepted: 07/19/2021] [Indexed: 12/17/2022]
Abstract
Primary hepatic neoplasms with neuroendocrine differentiation are extremely rare. Their clinicopathological features and molecular genetic basis are largely unknown. We identified four cases of primary hepatic neoplasms with neuroendocrine differentiation. Electronic medical records were reviewed for clinical history, imaging findings, laboratory results, and follow-up. Pathology slides, immunohistochemistry, and ancillary studies were reviewed. There were two females and two males with age ranging from 52 to 74 years. There was one amphicrine carcinoma with tumor cells simultaneously demonstrating both hepatocellular and neuroendocrine differentiation, one mixed hepatocellular-neuroendocrine carcinoma (NEC) with hepatocellular component intermingled with neuroendocrine component, one small cell NEC, and one well-differentiated neuroendocrine tumor. Next- generation sequencing of the mixed hepatocellular-NEC and small cell NEC showed molecular/genetic alterations commonly seen in hepatocellular carcinoma (HCC). All four cases arose in a background of cirrhosis. Primary hepatic neoplasms arising in cirrhotic livers can have a spectrum of neuroendocrine differentiation. Presence of a NEC component may be an indicator of aggressiveness. In addition, primary hepatic carcinomas with neuroendocrine differentiation likely share the same molecular pathways as HCC.
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Affiliation(s)
- Chanjuan Shi
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Sarah M Bean
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - William R Jeck
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | - Cynthia D Guy
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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4
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Wahidi MM, Davidson K, Shofer S, Mahmood K, Cheng G, Giovacchini C, Jones C, Jug R, Pavlisko EN, Wang X, Gu L, Weimholt C, Zhou Z, Chen A. Pilot Study of the Performance of 19-G Needle in Endobronchial Ultrasound-guided Transbronchial Aspiration for the Diagnosis and Testing of Molecular Markers in Lung Cancer. J Bronchology Interv Pulmonol 2021; 28:209-214. [PMID: 33273249 DOI: 10.1097/lbr.0000000000000736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become the standard for diagnosis and staging of lung cancer. Historically, 21- and 22-G needles have been paired with EBUS. We evaluated the performance of EBUS-TBNA using a larger 19-G needle in the assessment of tumor tissue obtained and success of testing for molecular markers. METHODS We prospectively enrolled adult patients with lymphadenopathy concerning for metastatic lung cancer. Patients underwent diagnostic EBUS-TBNA utilizing 19-G needles. Cases of non-small cell lung cancer (NSCLC) were evaluated for programmed cell death receptor ligand (PD-L1) expression. Cases of adenocarcinoma or undifferentiated NSCLC were further evaluated for 3 molecular markers for driver mutations: epidermal growth factor receptor (EGFR), c-ros oncogene 1 (ROS-1), and anaplastic lymphoma kinase (ALK). RESULTS Fifty patients were enrolled and underwent EBUS-TBNA using 19-G needles. PD-L1 assay was successfully performed in 90% of NSCLC cases. In adenocarcinoma or undifferentiated NSCLC cases, the success rate in testing was 90% for EGFR and 86% for ALK. ROS-1 testing had a success rate of 67%; 24% of these specimens had adequate tumor cells but there was technical difficulty with the assay. Block quality was judged by total number of tumor cells per hematoxylin and eosin-stained slide of each cell block (58% of specimens had >500 cells and 22% had 200 to 500 cells). There were no adverse events. CONCLUSION EBUS-TBNA using 19-G needles can obtain a high number of tumor cells and has a high rate of success in performing assays for PD-L1, EGFR, and ALK in NSCLC patients without an increase in adverse events. The success rate of ROS-1 testing was lower.
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Affiliation(s)
- Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | | | - Scott Shofer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - George Cheng
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Coral Giovacchini
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care
| | - Claudia Jones
- Department of Pathology, Duke University Medical Center
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center
| | | | - Xiaofei Wang
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | - Lin Gu
- Department of Biostatistics and Bioinformatics, Duke University, Durham
| | | | | | - Alexander Chen
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO
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5
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Dorry M, Davidson K, Dash R, Jug R, Clarke JM, Nixon AB, Mahmood K. Pleural effusions associated with squamous cell lung carcinoma have a low diagnostic yield and a poor prognosis. Transl Lung Cancer Res 2021; 10:2500-2508. [PMID: 34295657 PMCID: PMC8264347 DOI: 10.21037/tlcr-21-123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 01/01/2023]
Abstract
Background Malignant pleural effusion (MPE) portends a poor prognosis in non-small cell lung cancer (NSCLC). However, the yield of pleural fluid cytology as well as survival of patients with MPE associated with squamous cell carcinoma versus adenocarcinoma is not well understood. We conducted this study to assess the diagnostic yield of pleural cytology and survival of patients with NSCLC related MPE. Methods We performed a single-center, retrospective analysis of patients with NSCLC related MPE between 2010 and 2017. Kaplan-Meier method was used to compare survival and Cox proportional hazards analysis to assess if squamous cell cytopathology was associated with mortality. Results We identified 277 patients, 29 with squamous cell and 248 with adenocarcinoma MPE. Pleural fluid cytology from initial thoracentesis was diagnostic in 13.8% (4/29) patients with squamous cell and 80.2% (199/248) with adenocarcinoma (P<0.001). Cytology from second thoracentesis was diagnostic in 13.3% (2/15) patients with squamous cell carcinoma, compared to 37.5% (12/32) with adenocarcinoma (P=0.17). There was no statistically significant difference in the pleural biopsy yield from medical pleuroscopy or video-assisted thoracoscopic surgery (VATS) in the two groups. The median survival of patients with squamous cell MPE was 112 [interquartile range (IQR): 44-220] days versus 194 (IQR: 54-523) days in adenocarcinoma (Log-rank test P=0.04). Multivariate Cox proportional hazards analysis showed that squamous cell cytopathology was independent predictor of mortality (hazard ratio for death of 1.73, 95% CI: 1.1-2.6; P=0.01). Conclusions Pleural fluid cytology has a low diagnostic yield in squamous cell carcinoma MPE, and these patients have a poor survival compared to lung adenocarcinoma.
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Affiliation(s)
- Michael Dorry
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Kevin Davidson
- Department of Medicine, WakeMed Hospital, Raleigh, NC, USA
| | - Rajesh Dash
- Department of Pathology, Duke University, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University, Durham, NC, USA
| | - Jeffrey M Clarke
- Division of Thoracic Oncology, Department of Medicine, Duke University, Durham, NC, USA
| | | | - Kamran Mahmood
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
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6
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Jug R, Booth AL, Buckley AF, Newell J, Kesterson J, Gardner JM, Ozcan L, Liu B, Green CL, Joseph L, Cummings TJ. Multisite Quality Improvement Study of a Patient-Pathologist Consultation Program. Am J Clin Pathol 2021; 155:887-894. [PMID: 33367493 DOI: 10.1093/ajcp/aqaa202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this multisite quality improvement study was to evaluate patients' experiences with the patient-centered pathology (PCP) consultation program and to determine whether PCP enhanced their care experience. METHODS Patients were invited to attend PCP consultations to review their pathology report and slides and have their questions answered by the pathologist privately, with the option to attend the appointment with family members or friends for support. A patient experience questionnaire (PEQ) was administered to patients, who participated voluntarily in the PCP, and survey data were collected and stored in REDCap. Statistical analysis was performed using SAS 9.4 (SAS Institute). RESULTS Sixty-seven patients (95.5% female) aged 18 to 84 years across 4 institutions completed the PEQ. Overall, 58% and 15.8% of patients had breast and brain tumors, respectively, and 59.7% of tumors were newly diagnosed. Most patients thought it was important for them to learn as much as they could about their health condition. However, the majority of patients reported some degree of difficulty learning about their health condition based on written information, despite 97% having completed high school and/or further education. The majority of patients rated their pathologist as "excellent" across communication metrics. Ultimately, 100% of respondents were satisfied, found their visits to be useful, and would recommend the PCP to other patients. CONCLUSIONS Patients found that personalized clinical encounters with pathologists improved their understanding of their health condition and their satisfaction with their care experience. Patients thought pathologists communicated respectfully, effectively, and empathetically.
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Affiliation(s)
| | - Adam L Booth
- Department of Pathology, University of Texas Medical Branch at Galveston
| | | | | | - Joshua Kesterson
- Gynecologic Oncology, Pennsylvania State University Milton S. Hershey Medical Center, Hershey
| | - Jerad M Gardner
- Department of Laboratory Medicine, Geisinger Medical Center, Danville, PA
| | | | - Beiyu Liu
- Biostatistics and Bioinformatics, Duke Health, Durham, NC
| | | | - Lija Joseph
- Pathology, Lowell General Hospital, Lowell, MA
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7
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Liu X, Zhao Y, Luedke C, Jug R, Yang LH, Lu M, Pan Z, Wang D, Lorsbach R, Shi Y, Knez V, Rehder C, Liang X, Wang E. Infantile leukemia-What factors determine its distinct biological nature? Clinicopathological study of 78 cases. Int J Lab Hematol 2021; 43:1117-1122. [PMID: 33847065 DOI: 10.1111/ijlh.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Infantile leukemia encompasses a heterogeneous group which needs stratifying for treatment selection. METHODS We collected 78 cases of infantile leukemia and retrospectively analyzed their clinicopathological data. RESULTS Infantile leukemia featured a ratio of acute myeloid leukemia (AML) to B-lymphoblastic leukemia (B-ALL) of 1:2, with a better survival for AML than B-ALL (median survival 36 vs 24 months). When stratified by age, "early" infantile B-ALL (2-6 months) showed a high rate of KMT2A rearrangement (100%), similar to the rate seen in congenital B-ALL (1 month) (100%) and higher than seen in "late" infantile B-ALL (≥7 months) (68%). The three categories of infantile B-ALL exhibited an age-dependent increase in survival (median survival 8.5, 24, and >24 months, respectively). The age-dependent survival benefit remained after excluding the cases negative for KMT2A rearrangement. Conversely, infantile AML lacked an age-dependent pattern of survival. CONCLUSION The clinical outcome of infantile leukemia depends on the type of leukemia. Given the age-dependent survival, infantile B-ALL can be divided into three subcategories.
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Affiliation(s)
- Xin Liu
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Yue Zhao
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Lian-He Yang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.,Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Mark Lu
- Department of Laboratory Medicine, University of California and Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Zenggang Pan
- Department of Pathology, Yale University Medical Center, New Haven, CT, USA
| | - Dehua Wang
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert Lorsbach
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yang Shi
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
| | - Virginia Knez
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Catherine Rehder
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Xiayuan Liang
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
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8
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Jug R, Anani W, Callum J. A possible case of recipient anti-neutrophil and anti-human leukocyte antigen antibody-mediated fatal reverse transfusion-related acute lung injury. Transfusion 2021; 61:1336-1340. [PMID: 33666248 DOI: 10.1111/trf.16330] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/03/2021] [Accepted: 02/06/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) is a transfusion complication often mediated by recipient exposure to plasma from donors with human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. Recipient anti-donor HLA or HNA antibodies have rarely been implicated. STUDY DESIGN AND METHODS Herein, we describe a case of fatal TRALI mediated by recipient anti-HLA and anti-HNA antibodies. Cognate antibody-antigen match was confirmed with serologic and molecular assays. RESULTS A 69-year-old G5P5 female with no prior transfusion history and metastatic cholangiocarcinoma with thromboembolic complications presented with heart failure and dyspnea. She was transfused 15 ml of a unit of Fya -negative red blood cells and subsequently developed acute onset dyspnea, hypoxemia, hypotension, and fever. Clinical investigations revealed bilateral infiltrates on chest X-ray and cognate recipient HLA and HNA antibodies to donor antigens. The patient died of acute respiratory failure within 24 h of transfusion. In total, the patient had Fya , HLA Class I, HNA, and human platelet antigen (HPA) alloantibodies. The 63-year-old female donor had detectable HLA class II antibodies (recipient class II genotype unavailable). CONCLUSION The pathophysiology of TRALI has traditionally been ascribed to underlying conditions that put the recipient at risk in combination with donor biological response modifiers. This case illustrates alternative pathogenic mediators including alloantibodies to donor HLA and HNA. Additional studies to determine the contribution and frequency of recipient alloantibodies in TRALI may inform future mitigation strategies to further reduce the incidence of TRALI, particularly in female transfusion recipients.
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Affiliation(s)
- Rachel Jug
- Canadian Blood Services, Toronto, Ontario, Canada
| | - Waseem Anani
- Canadian Blood Services, Toronto, Ontario, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada
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9
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Luedke C, Zhao Y, McCracken J, Maule J, Yang LH, Jug R, Galeotti J, Siddiqi I, Gong J, Lu CM, Wang E. Myeloid neoplasms in the setting of chronic lymphocytic leukaemia/chronic lymphocytic leukaemia-like disease: a clinicopathological study of 66 cases comparing cases with prior history of treatment to those without. J Clin Pathol 2021; 75:292-301. [PMID: 33542108 DOI: 10.1136/jclinpath-2020-207334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/04/2022]
Abstract
AIMS Myeloid neoplasms occur in the setting of chronic lymphocytic leukaemia (CLL)/CLL-like disease. The underlying pathogenesis has not been elucidated. METHODS Retrospectively analysed 66 cases of myeloid neoplasms in patients with CLL/CLL-like disease. RESULTS Of these, 33 patients (group 1) had received treatment for CLL/CLL-like disease, while the other 33 patients (group 2) had either concurrent diagnoses or untreated CLL/CLL-like disease before identifying myeloid neoplasms. The two categories had distinct features in clinical presentation, spectrum of myeloid neoplasm, morphology, cytogenetic profile and clinical outcome. Compared with group 2, group 1 demonstrated a younger age at the diagnosis of myeloid neoplasm (median, 65 vs 71 years), a higher fraction of myelodysplastic syndrome (64% vs 36%; OR: 3.1; p<0.05), a higher rate of adverse unbalanced cytogenetic abnormalities, including complex changes, -5/5q- and/or -7/7q- (83% vs 28%; OR: 13.1; p<0.001) and a shorter overall survival (median, 12 vs 44 months; p<0.05). CONCLUSIONS Myeloid neoplasm in the setting of CLL/CLL-like disease can be divided into two categories, one with prior treatment for CLL/CLL-like disease and the other without. CLL-type treatment may accelerate myeloid leukaemogenesis. The risk is estimated to be 13-fold higher in patients with treatment than those without. The causative agent could be attributed to fludarabine in combination with alkylators, based on the latency of myeloid leukaemogenesis and the cytogenetic profile.
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Affiliation(s)
- Catherine Luedke
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yue Zhao
- Pathology, Duke University Medical Center, Durham, North Carolina, USA .,Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Jenna McCracken
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jake Maule
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lian-He Yang
- Pathology, Duke University Medical Center, Durham, North Carolina, USA.,Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, China
| | - Rachel Jug
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jonathan Galeotti
- Pathology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Imran Siddiqi
- Pathology, University of Southern California, Los Angeles, California, USA
| | - Jerald Gong
- Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Chuanyi Mark Lu
- Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Endi Wang
- Pathology, Duke University Medical Center, Durham, North Carolina, USA
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10
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Al-Riyami AZ, Jug R, La Rocca U, Keshavarz H, Landry D, Shehata N, Stanworth SJ, Nahirniak S. Quality of evidence-based guidelines for platelet transfusion and use: A systematic review. Transfusion 2021; 61:948-958. [PMID: 33483953 DOI: 10.1111/trf.16257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Guidelines for platelet (PLT) transfusion are an important source of information for clinicians. Although guidelines intend to increase consistency and quality of care, variation in methodology and recommendations may exist that could impact the value of a guideline. We aimed to determine the quality of existing PLT transfusion guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument and to describe the inconsistencies in recommendations. STUDY DESIGN AND METHODS A systematic search was undertaken for evidence-based guidelines from January 1, 2013, to January 25, 2019. Citations were reviewed in duplicate for inclusion and descriptive data extracted. Four physicians appraised the guideline using the AGREE II instrument and the scaled score for each item evaluated was calculated. The protocol was registered in PROSPERO. RESULTS Of 6744 citations, 6740 records were screened. Seven of 28 full-text studies met the inclusion criteria. The median scaled score (and the interquartile range of the scaled score) for the following items were as follows: scope and purpose, 94% (8%); stakeholder involvement, 63% (18%); rigor of development, 83% (14%); clarity of presentation, 94% (6%); applicability, 58% (20%); and editorial independence, 77% (4%). Overall quality ranged from 4 to 7 (7 is the maximum score). Inconsistent recommendations were on prophylactic PLT transfusion in hypoproliferative thrombocytopenia in the presence of risk factors and dose recommendations. CONCLUSION Inconsistencies between guidelines and variable quality highlight areas for future guideline writers to address. Areas of specific attention include issues of stakeholder involvement and applicability.
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Affiliation(s)
- Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rachel Jug
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Ursula La Rocca
- Department of Molecular Medicine, Sapienza University, Rome, Italy.,Italian National Blood Centre, National Institute of Health, Rome, Italy
| | | | | | - Nadine Shehata
- Departments of Medicine, Laboratory Management and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology, Mount Sinai Hospital, Toronto, Ontario, Canada.,Canadian Blood Services, Toronto, Ontario, Canada
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.,Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan Nahirniak
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.,Transfusion Medicine Section, Alberta Precision Laboratories, Edmonton, Alberta, Canada
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11
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Jug R, Bandarenko N, Poisson J. Management of Blood Product Market Withdrawals - A Single Institution's Process and Experience. Ann Clin Lab Sci 2020; 50:536-540. [PMID: 32826252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE While lookback investigations follow specific Food and Drug Administration (FDA) requirements, the management of blood product market withdrawals from suppliers varies widely. Follow-up data are limited, prompting this analysis of the types and reasons for recipient notification and their outcomes. METHODS A single institution retrospective review of market withdrawal and lookback files from 2012-2015 included product type, reason, FDA category, notification, and turnaround time. Descriptive statistics and chi-square analysis were performed. RESULTS Over 4 years, 796/229,549 (0.35%) blood components were implicated in supplier notifications, including market withdrawals (84.3%) and lookbacks (15.7%). Seventy-nine cases resulted in patient notification. 97% of patient notifications were achieved within 3 months. Plasma with human leukocyte antigen antibodies was the most common reason for withdrawal (20.5%). Category 1 notifications were the most commonly reported by this transfusion service, apart from in 2015 when category 4 notifications were highest. Over four years, the proportion of notifications by category remained relatively stable. CONCLUSIONS Market withdrawal investigations involve significant effort to review, document, and appropriately notify. Standardized management and centralized reporting of recipient notification of market withdrawals may improve this process.
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Affiliation(s)
- Rachel Jug
- Department of Pathology, Transfusion Services, Duke University Hospital, Durham, NC, USA
| | - Nicholas Bandarenko
- Department of Pathology, Transfusion Services, Duke University Hospital, Durham, NC, USA
| | - Jessica Poisson
- Department of Pathology, Transfusion Services, Duke University Hospital, Durham, NC, USA
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12
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Jug R, Foo WC, Jones C, Ahmadi S, Jiang XS. High-risk and intermediate-high-risk results from the ThyroSeq v2 and v3 thyroid genomic classifier are associated with neoplasia: Independent performance assessment at an academic institution. Cancer Cytopathol 2020; 128:563-569. [PMID: 32339438 DOI: 10.1002/cncy.22283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/12/2020] [Accepted: 03/26/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ThyroSeq panel tests for genetic alterations to risk-stratify cytologically indeterminate nodules. The authors assessed the test performance of the tests, including the latest version (v3), at an academic center. METHODS Results from ThyroSeq testing (v2 and v3) were reviewed over 2 years, and patient demographics, cytology diagnoses, results of ThyroSeq testing, and histopathologic diagnoses on resection (if available) were collected. RESULTS One hundred eighty-five nodules were tested from 178 patients, including 94 nodules tested with v2 and 91 nodules tested with v3. Overall, 28 of 185 nodules (15%) yielded a high-risk or intermediate-high-risk mutation (HRM). Of the patients with these nodules, 19 of 25 (76%) had neoplastic nodules, and 11 of 25 (44%) had a malignancy or a noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Only 16 of 147 nodules (11%) that were negative or had low-risk genetic alterations underwent resection, with 1 false-negative result (a papillary thyroid carcinoma tested with v2). No false-negative results were identified with v3. Two nodules had TP53 mutations identified, both of which were benign on resection. Nodules with HRM that were tested with v2 and v3 had a positive predictive value (PPV) for malignancy of 57% and 39%, respectively, and a PPV for neoplasm of 86% and 72%, respectively. The negative predictive values for v2 and v3 were 92% and 100%, respectively. CONCLUSIONS The PPV of an HRM result on ThyroSeq v3 was low for malignancy or NIFTP, and the PPV for neoplasm was higher. RAS-type mutations were the most commonly identified in both benign and malignant nodules. Thyroseq v3 had a lower PPV for both malignancy/NIFTP and neoplasm than v2 but did not produce any false-negative results.
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Affiliation(s)
- Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Wen-Chi Foo
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Claudia Jones
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Sara Ahmadi
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
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13
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Parajuli S, Jug R, Ahmadi S, Jiang X“S. Hurthle cell predominance impacts results of Afirma gene expression classifier and ThyroSeq molecular panel performance in indeterminate thyroid nodules. Diagn Cytopathol 2019; 47:1177-1183. [DOI: 10.1002/dc.24290] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Shobha Parajuli
- Department of PathologyUniversity of Cincinnati College of Medicine Cincinnati Ohio
| | - Rachel Jug
- Department of PathologyDuke University Medical Center Durham North Carolina
| | - Sara Ahmadi
- Division of Endocrinology, Department of MedicineDuke University Medical Center Durham North Carolina
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14
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Abstract
Molecular tests and mutational panels such as Afirma Gene Expression Classifier (GEC) and ThyroSeq, respectively, have been used to help risk stratify cytologically indeterminate thyroid nodules with the aim to reduce unnecessary surgeries. We studied the effect of molecular testing on the rate of surgical resection in these nodules. Thyroid nodules with indeterminate (Bethesda III/IV) cytology that underwent molecular testing (GEC or ThyroSeq) at our institution between June 2012 and August 2016 were retrospectively reviewed. We collected demographics, cytology diagnoses, molecular test results, and whether surgical resection was performed. Two hundred eighty-three nodules met inclusion criteria: 202 nodules tested with GEC and 81 tested with ThyroSeq. In the cohort of GEC-tested nodules, 99/202 (49%) yielded "suspicious" and 103/202 (51%) yielded "benign" results, with an overall resection rate of 70/99 (71%) in "suspicious" versus 13/103 (13%) in "benign" nodules. In the cohort of ThyroSeq-tested nodules, 13/81 (16%) of nodules yielded a "high-risk mutation" and 68/81 (84%) of nodules yielded "no high-risk mutation," with overall resection rates of 11/13 (85%) and 30/68 (44%), respectively. Rates of resection were higher for Bethesda IV than for III nodules, regardless of molecular results. For both GEC and ThyroSeq, molecular test results seemed to correlate with the rate of resection at our institution. Rates of resection for cytologically indeterminate nodules that were "benign" or "no high-risk mutation" appeared to differ from those that were "suspicious" or "high-risk mutation" on molecular panel testing by GEC and ThyroSeq, respectively. Our findings support that molecular test results are impacting management.
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Affiliation(s)
- Rachel Jug
- Department of Pathology, Duke University Medical Center, Box 3712 DUMC, Durham, NC, 27710, USA
| | - Shobha Parajuli
- Department of Pathology, University of Cincinnati Health, Cincinnati, OH, USA
| | - Sara Ahmadi
- Division of Endocrinology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Box 3712 DUMC, Durham, NC, 27710, USA.
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15
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Affiliation(s)
- Rachel Jug
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Xiaoyin “Sara” Jiang
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Sarah M. Bean
- From the Department of Pathology, Duke University Medical Center, Durham, North Carolina
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16
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Jug R, Shattuck TM, Jiang XS. Enigma portal case: Phaeohyphomycosis by fine needle aspiration. Cytopathology 2018; 30:330-331. [PMID: 30554449 DOI: 10.1111/cyt.12671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | | | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
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17
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Knez V, Liu X, Schowinsky J, Pan Z, Wang D, Lorsbach R, Lu C, Luedke C, Haag M, Carstens B, Swisshelm K, Yang LH, Jug R, Wang E, Liang X. Clinicopathologic and genetic spectrum of infantile B-lymphoblastic leukemia: a multi-institutional study. Leuk Lymphoma 2018; 60:1006-1013. [DOI: 10.1080/10428194.2018.1508667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Virginia Knez
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
| | - Xin Liu
- Department of Pathology, Duke University, Durham, NC, USA
| | - Jeffrey Schowinsky
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
| | - Zenggang Pan
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
| | - Dehua Wang
- Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Robert Lorsbach
- Division of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Chuanyi Lu
- Department of Laboratory Medicine, University of California and Veterans Affairs Medical Center, San Francisco, CA, USA
| | | | - Mary Haag
- Colorado Genetics Laboratory, University of Colorado School of Medicine, Aurora,CO, USA
| | - Billie Carstens
- Colorado Genetics Laboratory, University of Colorado School of Medicine, Aurora,CO, USA
| | - Karen Swisshelm
- Colorado Genetics Laboratory, University of Colorado School of Medicine, Aurora,CO, USA
| | - Lian-He Yang
- Department of Pathology, Duke University, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University, Durham, NC, USA
| | - Endi Wang
- Department of Pathology, Duke University, Durham, NC, USA
| | - Xiayuan Liang
- Department of Pathology, University of Colorado School of Medicine, Aurora,CO, USA
- Department of Pathology, Children’s Hospital Colorado, Aurora,CO, USA
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18
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Ma S, Sen SS, Jug R, Zhang X, Zhang WL, Shen S, Yu CQ, Xu HT, Yang LH, Wang E. Adrenal relapse of primary central nervous system diffuse large B-cell lymphoma: A case report. Medicine (Baltimore) 2018; 97:e12482. [PMID: 30235749 PMCID: PMC6160128 DOI: 10.1097/md.0000000000012482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary central nervous system lymphoma (PCNSL) is a rare form of non-Hodgkin lymphoma with a dismal outcome. Most patients relapse in intracranial sites and <5% of patients relapse in extracranial sites. Here, we present the first case of PCNSL with an adrenal relapse. PATIENT CONCERNS A 72-year-old woman, first presented 7 years ago with complaints of headache and dizziness. DIAGNOSES Enhanced magnetic resonance imaging revealed the mass within the splenium of the corpus callosum. On histological examination, there was a diffuse growth pattern of neoplastic cells in the brain biopsy. Immunohistochemistry and flow cytometric analysis demonstrated that the neoplastic cells were of B-cell lineage. INTERVENTIONS The patient underwent methotrexate-based chemotherapy and whole-brain radiotherapy after the initial diagnosis of primary central nervous system-large B-cell lymphoma (CNS-DLBCL). OUTCOMES After 4 years of clinical remission, the patient was diagnosed with endometrial cancer. Interestingly, a radiological study following the treatment of endometrial cancer demonstrated a right adrenal mass, which was suspicious for malignancy. Morphologic examination and immunohistochemistry studies confirmed the diagnosis of diffuse large B-cell lymphoma. A fluorescent in situ hybridization panel for lymphoma showed rearrangement of Immunoglobulin heavy chain (IGH) and B-cell lymphoma 6 (BCL6), respectively, suggesting fusion of BCL6/IGH. Immunoglobulin kappa analysis demonstrated a common origin for the brain and adrenal lesions, which led to the final diagnosis of an adrenal relapse of CNS-DLBCL. LESSONS PCNSL is a highly infiltrative neoplasm, particularly at relapse. To the best of our knowledge, this is the first case of CNS-DLBCL with adrenal relapse. Considering the poor outcome of CNS-DLBCL, molecular genetic studies should be done to identify a common origin for the primary and secondary lesion.
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Affiliation(s)
- Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | | | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Xuefeng Zhang
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Wan-Lin Zhang
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Shuai Shen
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Cheng-Qian Yu
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Hong-Tao Xu
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Lian-He Yang
- Department of Pathology, College of Basic Medical Sciences and First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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19
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Zhang WL, Ma S, Jug R, Li F, Wang E, Zhao HY, Xu HT, Cai L, Yu CQ, Shen S, Yang LH. Primary testicular natural killer/T-cell lymphoma: A CARE-case report and review of literature. Medicine (Baltimore) 2018; 97:e0181. [PMID: 29561433 PMCID: PMC5895336 DOI: 10.1097/md.0000000000010181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Primary testicular natural killer (NK)/T-cell lymphoma is an extremely rare and highly aggressive lymphoid malignancy. At present, only 20 cases have been reported. PATIENT CONCERNS A 32-year-old Chinese man complained of discomfort and swelling of his right testicle for 3 months. Physical examination revealed a 10 × 10 × 9.5 cm mass on the right side of the scrotum area. DIAGNOSES Pathologic evaluation showed effacement of normal testicular parenchymal architecture by small-to-medium-sized lymphoid cells with irregular nuclear profiles, and immunohistochemical studies positively expressed CD2, CD56, cytoplasmic CD3, granzyme B, perforin, and TIA-1. Therefore, the patient was diagnosed with primary testicular NK/T-cell lymphoma. INTERVENTIONS The patient underwent CHOP (cyclophosphamide (CTX), pirarubicin (THP-ADM), vincristine (VCR), and prednisolone (PDN)) chemotherapy. OUTCOMES The patient relapsed 5 months after his initial presentation and died after an infection and gastrointestinal bleed. LESSONS Clinicopathological assessment of this rare case highlights the clinical and pathological features required to diagnose testicular NK/T-cell lymphoma. In addition, it highlights the dismal survival of these patients. We hope it may serve as a reference aiding prompt clinical diagnosis, which can hopefully improve the survival and quality of life of these patients.
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Affiliation(s)
- Wan-Lin Zhang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Fan Li
- Department of Library Science, School of Medical informatics, China Medical University, Shenyang, Liaoning, China
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Huan-Yu Zhao
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Hong-Tao Xu
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Lin Cai
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Cheng-Qian Yu
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Shuai Shen
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
| | - Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University
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20
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Ma S, Jug R, Shen S, Zhang WL, Xu HT, Yang LH. Marginal zone lymphoma of palatine tonsil with prominent plasmacytic differentiation: A CARE-compliant article and review of literature. Medicine (Baltimore) 2018; 97:e9648. [PMID: 29480878 PMCID: PMC5943870 DOI: 10.1097/md.0000000000009648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The palatine tonsil is an important component of Waldeyer's ring and a site commonly involved by lymphoma. Interestingly, although it is a site of mucosa-associated lymphoid tissue (MALT), primary MALT lymphoma of the palatine tonsil is rare, especially with prominent plasmacytic differentiation. PATIENT CONCERNS A 59-year-old woman presented to the hospital with a 1-month history of odynophagia. The patient had no fever or pruritus during this period and she declared no family history of hematolymphoid malignancy. DIAGNOSIS Histopathological examination demonstrated effacement of tonsil architecture; normal follicles were replaced by plasmacytoid tumor cells and small lymphocytes. The tumor cells expanded the marginal zone and infiltrated interfollicular regions, as well as scattered residual follicles. Immunostaining showed tumor cells positive for cluster of differentiation (CD)20, CD79a, paired box-5, Mum 1, and B cell lymphoma (Bcl)-2, and negative for CD5, CD 23, cyclin D1, Bcl-6, and CD10. Staining for κ and λ showed prominent light chain restriction. The tumor was classified as tonsil MALT lymphoma with prominent plasmacytic differentiation. INTERVENTIONS After the patient was diagnosed with MALT lymphoma with prominent plasmacytic differentiation, she underwent complete surgical resection and radiotherapy. OUTCOMES There was no recurrence evident at 6-months follow-up. LESSONS Primary tonsil MALT lymphoma with prominent plasmacytic differentiation is very rare and difficult to distinguish from other B-cell lymphomas with plasmacytoid morphology, such as follicular lymphoma, lymphoplasmacytic lymphoma, and chronic lymphocytic leukemia/small lymphocytic lymphoma. Accurate diagnosis of this entity is important in guiding therapy so as to avoid overtreatment.
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Affiliation(s)
- Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Shuai Shen
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Wan-Lin Zhang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Hong-Tao Xu
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
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21
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Wu B, Ingersoll K, Jug R, Yang LH, Luedke C, Lo A, Su P, Liu X, Rehder C, Gong J, Lu CM, Wang E. Myeloid Neoplasms Following Solid Organ Transplantation: Clinicopathologic Studies of 23 Cases. Am J Clin Pathol 2017; 149:55-66. [PMID: 29228125 DOI: 10.1093/ajcp/aqx133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Myeloid neoplasms (MNs) after solid organ transplant are rare, and their clinicopathologic features have not been well characterized. METHODS We retrospectively analyzed 23 such cases. RESULTS The ages ranged from 2 to 76 years, with a median of 59 years at the diagnosis. The median interval between the transplant and diagnosis was 56 months (range, 8-384 months). The transplanted organs included liver in five, kidney in six, lung in five, heart in six, and heart/lung in one case(s). The types of MN included acute myeloid leukemia (AML) in 12, myelodysplastic syndrome (MDS) in five, chronic myelogenous leukemia (CML) in four, and myeloproliferative neoplasms (MPNs) in two cases. Cytogenetics demonstrated clonal abnormalities in 18 (78.3%) cases, including unbalanced changes in 10 (55.6%), Philadelphia chromosome in four (22.2%), and other balanced aberrations in four (22.2%) cases. Thirteen (56.5%) patients died, with an estimated median survival of 9 months. With disease stratification, AML and MDS have short median survivals (3.5 and 7 months, respectively), with an initial precipitous decline of the survival curve. CONCLUSIONS Posttransplant MNs have a latency period between that seen in AML/MDS related to alkylators and that associated with topoisomerase II inhibitors. The cytogenetic profile suggests a mutagenic effect on leukemogenesis. The clinical outcome for AML/MDS is dismal, with death occurring at an early phase of treatment.
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MESH Headings
- Adult
- Aged
- Bone Marrow/pathology
- Child, Preschool
- Cytogenetics
- Humans
- Kaplan-Meier Estimate
- Kidney/pathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Liver/pathology
- Lung/pathology
- Middle Aged
- Mutation
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/mortality
- Myelodysplastic Syndromes/pathology
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/mortality
- Myeloproliferative Disorders/pathology
- Myocardium/pathology
- Organ Transplantation/adverse effects
- Retrospective Studies
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Affiliation(s)
- Bin Wu
- Division of Hematology, Department of Medicine, Shengjing Hospital affiliated to China Medical University, Shenyang, China
- Department of Pathology, Duke University Medical Center, Durham, NC
| | | | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Lian-He Yang
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Amanda Lo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Pu Su
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Xin Liu
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Catherine Rehder
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Jerald Gong
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA
| | - Chuanyi Mark Lu
- Department of Laboratory Medicine, University of California, San Francisco
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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22
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Tanaka J, Su P, Luedke C, Jug R, Yang LH, Deak K, Rapisardo S, Zhang Y, Delos Angeles M, Xie Y, Wang E. Composite lymphoma of follicular B-cell and peripheral T-cell types with distinct zone distribution in a 75-year-old male patient: a case study. Hum Pathol 2017; 76:110-116. [PMID: 29217426 DOI: 10.1016/j.humpath.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/28/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022]
Abstract
Composite lymphoma of T-/B-cell type is rare, and follicular lymphoma composite with peripheral T-cell lymphoma (PTCL) has not previously been reported. We report such a case with both neoplastic components displaying a unique zone of distribution. A 75-year-old male patient presented with generalized lymphadenopathy. Sections of axillary lymph node demonstrated potentially 2 clonal processes, PTCL with aberrant CD20 expression and follicular lymphoma. Interestingly, the 2 neoplastic components were confined to their respective classic distribution zones, with PTCL occupying the interfollicular areas and follicular lymphoma residing in follicles. Both populations were detected by flow cytometry, but their immunophenotypes were insufficient to define clonality. Nonetheless, biclonality was demonstrated by lymphoid receptor gene rearrangement analyses. Molecular cytogenetics showed IGH/BCL2 fusion in the follicular lymphoma and amplification of IGH gene or trisomy/tetrasomy 14 in the PTCL. The current case underscores the complexity of composite lymphoma and advocates a multimodal approach to establishing the diagnosis.
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MESH Headings
- Aged
- Antigens, CD20/analysis
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Composite Lymphoma/genetics
- Composite Lymphoma/immunology
- Composite Lymphoma/pathology
- Composite Lymphoma/therapy
- Gene Amplification
- Gene Fusion
- Genes, Immunoglobulin Heavy Chain
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Proto-Oncogene Proteins c-bcl-2/genetics
- Tetrasomy
- Trisomy
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Affiliation(s)
- John Tanaka
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Pu Su
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Catherine Luedke
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rachel Jug
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Lian-He Yang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kristen Deak
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sarah Rapisardo
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yang Zhang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Marc Delos Angeles
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Endi Wang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA.
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23
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Shen S, Chen M, Jug R, Yu CQ, Zhang WL, Yang LH, Wang L, Yu JH, Lin XY, Xu HT, Ma S. Radiological presentation of chondromyxoid fibroma in the sellar region: A CARE-compliant article and literature review. Medicine (Baltimore) 2017; 96:e9049. [PMID: 29245307 PMCID: PMC5728922 DOI: 10.1097/md.0000000000009049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Chondromyxoid fibroma (CMF) is a rare benign bone neoplasm which often occurs in the lower extremities. Little is known about the radiological and histological presentation of CMF in the sellar region. PATIENT CONCERNS A 16-year-old Asian male presented to the hospital 12 months ago with bilateral diplopia involving right visual fields, intermittent headaches, and dizziness. INTERVENTIONS After the patient underwent enough examinations, the lesion was surgically removed by curettage. DIAGNOSIS Postoperatively, the lesion was pathologically confirmed to be CMF. OUTCOMES There was no recurrence at the 12-month follow-up. LESSONS To the best of our knowledge, this is the second reported case of CMF in the sellar region which was clinically suspected to be a pituitary macroadenoma, craniopharyngioma, or schwannoma due to its location and radiographic features. We reviewed the morbidity, symptoms, radiographic features, pathological findings, and differential diagnosis of CMF. Because of its rarity, attention should be paid to avoid misdiagnosis of this lesion.
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Affiliation(s)
- Shuai Shen
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liao Ning, China
| | - Miao Chen
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liao Ning, China
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Cheng-Qian Yu
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liao Ning, China
| | - Wan-Lin Zhang
- Department of Pathology, First Affiliated Hospital of China Medical University and College of Basic Medical Sciences, Shenyang, Liao Ning, China
| | - Lian-He Yang
- Department of Pathology, First Affiliated Hospital of China Medical University and College of Basic Medical Sciences, Shenyang, Liao Ning, China
| | - Liang Wang
- Department of Pathology, First Affiliated Hospital of China Medical University and College of Basic Medical Sciences, Shenyang, Liao Ning, China
| | - Juan-Han Yu
- Department of Pathology, First Affiliated Hospital of China Medical University and College of Basic Medical Sciences, Shenyang, Liao Ning, China
| | - Xu-Yong Lin
- Department of Pathology, First Affiliated Hospital of China Medical University and College of Basic Medical Sciences, Shenyang, Liao Ning, China
| | - Hong-Tao Xu
- Department of Pathology, First Affiliated Hospital of China Medical University and College of Basic Medical Sciences, Shenyang, Liao Ning, China
| | - Shuang Ma
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liao Ning, China
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24
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Wu B, Jug R, Luedke C, Su P, Rehder C, McCall C, Lagoo AS, Wang E. Lineage Switch Between B-Lymphoblastic Leukemia and Acute Myeloid Leukemia Intermediated by "Occult" Myelodysplastic Neoplasm: Two Cases of Adult Patients With Evidence of Genomic Instability and Clonal Selection by Chemotherapy. Am J Clin Pathol 2017; 148:136-147. [PMID: 28898985 DOI: 10.1093/ajcp/aqx055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Lineage switch occurs in rare leukemias, and the mechanism is unclear. We report two cases of B-lymphoblastic leukemia (B-ALL) relapsed as acute myeloid leukemia (AML). METHODS Retrospective review of clinical and laboratory data. RESULTS Complex cytogenetic abnormalities were detected in B-ALL for both cases with subclone heterogeneity. Postchemotherapy marrow biopsies showed trilineage hematopoiesis without detectable B-ALL. Cytogenetics in both showed stemline abnormalities. The cases were considered "occult" myelodysplastic syndrome (MDS) preceding B-ALL. The patients relapsed 6.5 and 9 months following induction, respectively. Case 1 relapsed as AML-M5 initially, was treated as such, and then relapsed again as B-ALL. Case 2 relapsed as AML-M6. Cytogenetics demonstrated persistent abnormalities. Both patients died soon after relapse. CONCLUSIONS Lineage switch between B-ALL and AML could be intermediated by occult MDS. A pluripotent progenitor likely undergoes neoplastic transformation, resulting in a genomically unstable clone. This leads to a repertoire of heterogeneous subclones that may be selected by chemotherapy. Lineage switch heralds a dismal clinical outcome.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cell Transformation, Neoplastic/drug effects
- Cell Transformation, Neoplastic/genetics
- Chromosome Aberrations
- Genomic Instability
- Humans
- Leukemia, B-Cell/genetics
- Leukemia, B-Cell/pathology
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Myelodysplastic Syndromes/genetics
- Myelodysplastic Syndromes/pathology
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Young Adult
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Affiliation(s)
- Bin Wu
- Division of Hematology, Department of Medicine, Shengjing Hospital affiliated with China Medical University, Shenyang, People's Republic of China
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Pu Su
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Catherine Rehder
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Chad McCall
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Anand S Lagoo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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25
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Su P, Jug R, Liu X, Wang E. An Epstein-Barr virus-positive classical Hodgkin lymphoma with exclusive sinusoidal growth pattern: An unusual morphologic variant. Pathol Res Pract 2017; 213:710-712. [PMID: 28552534 DOI: 10.1016/j.prp.2017.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/24/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
Classical Hodgkin lymphoma (cHL) typically involves lymph node parenchyma, and a case with Hodgkin cells confined within nodal sinusoids is extremely rare. Herein we report a case of cHL with a sinusoidal growth pattern. This 15-year old patient presented with B symptoms and was found to have bilateral cervical lymphadenopathy and an anterior mediastinal mass. Biopsy of a cervical lymph node demonstrated cohesive clusters of Reed-Sternberg (RS)-like cells suggestive of sinusoidal growth with an extrasinusoidal mixed inflammatory cell infiltrate characteristic of the microenvironment seen in cHL. The RS cells/variants were positive for CD30 and CD15, and showed down-regulation of B-cell program and CD45, an immunophenotypic profile consistent with cHL. The sinusoidal growth pattern was also highlighted by EBV staining. To the best of our knowledge, this is the first case of EBV-positive cHL that displays a sinusoidal growth pattern. The patient was treated with children's high risk cHL chemotherapy protocol and responded well.
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Affiliation(s)
- Pu Su
- Department of Medicine, East Hospital affiliated to Tongji University School of Medicine, Shanghai, People's Republic of China; Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Xin Liu
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
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