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Yan M, Beck RC, Gadde R. Hemophagocyte morphology and hypertriglyceridemia correlate with diagnosis of hemophagocytic lymphohistiocytosis in patients with bone marrow hemophagocytes. Am J Clin Pathol 2024; 161:177-185. [PMID: 37833042 DOI: 10.1093/ajcp/aqad131] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES To investigate laboratory and bone marrow findings that can help predict a diagnosis of hemophagocytic lymphohistiocytosis (HLH) for patients who have demonstrated hemophagocytes (HPCs) in the bone marrow. METHODS A total of 57 cases from 48 patients with HPCs present on bone marrow examination were included. The numbers and morphologic characteristics of HPCs with ingested nucleated cells (nHPC) were counted. Pertinent medical history, relevant laboratory values, and flow cytometry data at the time of bone marrow biopsy were collected. RESULTS A total of 24 patients fulfilled diagnostic criteria for HLH, and the remaining 24 patients did not. By using HLH-2004 cutoffs, only hypertriglyceridemia (≥265 mg/dL) was significantly associated with HLH diagnosis. The HLH cases more frequently had nHPC-ingesting granulocytic cells (gHPC) (75.9% vs 24.1%, P = .009). The percentage of gHPC to all nHPC was also significantly higher in HLH cases (median, 15.4% vs 0%; P = .0002). Both triglyceride level (area under the curve [AUC] = 0.88, P < .0001) and gHPC percentage (AUC = 0.81, P = .0005) were significant in predicting HLH diagnosis. Finally, no overt immunophenotypic abnormality was noted for 19 HLH cases with available flow cytometry data. CONCLUSIONS The presence of hypertriglyceridemia and more frequent gHPC has predictive value for HLH diagnosis in patients with bone marrow HPC.
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Affiliation(s)
- Mingfei Yan
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, US
| | - Rose C Beck
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, US
| | - Ramya Gadde
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, US
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2
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Moore ME, Courville EL, Prakash S, Brown LE, Beck RC, Qualtieri JN, Siddon AJ, Wake LM. An interactive e-learning module on peripheral blood smear analysis is an effective option for teaching pathology trainees. Am J Clin Pathol 2023; 160:150-156. [PMID: 36905942 DOI: 10.1093/ajcp/aqad014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/13/2023] Open
Abstract
OBJECTIVES This study compares the effectiveness of an interactive e-learning module with a traditional text-based method for teaching peripheral blood smear analysis. METHODS Pathology trainees at Accreditation Council for Graduate Medical Education residency programs were asked to participate. Participants completed a multiple-choice test on peripheral blood smear findings. Trainees were randomized into completing an e-learning module or a PDF reading exercise with the same educational content. Respondents rated their experience and completed a postintervention test composed of the same questions. RESULTS In total, 28 participants completed the study; 21 improved their score in the posttest (mean, 21.6 correct answers) compared with the pretest (19.8; P < .001). This improvement was seen in both the PDF (n = 19) and interactive (n = 9) groups, with no difference in performance between the 2 groups. Trainees with less clinical hematopathology experience showed a trend of having the largest performance improvement. Most participants completed the exercise within 1 hour, rated the exercise as easy to navigate, were engaged, and reported learning new information about peripheral blood smear analysis. All participants indicated that they would likely complete a similar exercise in the future. CONCLUSIONS This study suggests that e-learning is an effective tool for hematopathology education and equivalent to traditional narrative-based methods. This module could easily be incorporated into a curriculum.
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Affiliation(s)
- Margaret E Moore
- Department of Pathology and Laboratory Medicine, University of Virginia Health System, Charlottesville, VA, US
| | - Elizabeth L Courville
- Department of Pathology and Laboratory Medicine, University of Virginia Health System, Charlottesville, VA, US
| | - Sonam Prakash
- Department of Laboratory Medicine, University of California, San Francisco, CA, US
| | - Laura E Brown
- Department of Laboratory Medicine, University of California, San Francisco, CA, US
| | | | | | - Alexa J Siddon
- Department of Pathology, Yale University School of Medicine, New Haven, CT, US
| | - Laura M Wake
- Department of Pathology, Johns Hopkins Hospital/University School of Medicine, Baltimore, MD, US
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3
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Carneiro RK, Gatti GT, Beck RC, Amadori A, Oliveira TD, Feliciano MAR, Alievi MM, Ferreira MP. Musladin-Lueke Syndrome in a Dog: Case Report. Top Companion Anim Med 2022; 51:100694. [PMID: 35850448 DOI: 10.1016/j.tcam.2022.100694] [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: 03/26/2021] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 12/14/2022]
Abstract
The aim of this study is to report the case of a 4-month-old Beagle dog diagnosed with Musladin-Lueke syndrome. The dog appeared to walk on the digits ("tiptoes") with all limbs during ambulation and rigid extension of the carpus, elbow, tarsus, and knee joints during ambulation. Thickening of the fur and auricular cartilage, reduction in radiocarpal, and tibiotarsal joint amplitude, macrocephaly, and lateralized eyes were noticed on physical examination. Echocardiography showed reduced mobility and altered (tortuous) valve morphology. Bilateral abdominal cryptorchidism was confirmed by ultrasonography. Musladin-Lueke syndrome was the presumptive diagnosis, based on the clinical signs presented. The diagnosis was confirmed after DNA testing performed by serial collection of saliva. This is the first paper that describes unprecedented cardiac and reproductive changes of Musladin-Lueke syndrome in which the dog was followed for 2 years, presenting a good quality of life.
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Affiliation(s)
- R K Carneiro
- Department of Veterinary Surgery, UNESP, Jaboticabal, SP, Brazil
| | - G T Gatti
- Department of Diagnostic Imaging, UFRGS, Porto Alegre, RS, Brazil
| | - R C Beck
- Department of Anesthesiology, UFRGS, Porto Alegre, RS, Brazil
| | - A Amadori
- Department of Diagnostic Imaging, UFRGS, Porto Alegre, RS, Brazil
| | - T D Oliveira
- Department of Anesthesiology, UFRGS, Porto Alegre, RS, Brazil
| | - M A R Feliciano
- Department of Large Animal Clinic, UFSM, Santa Maria, RS, Brazil
| | - M M Alievi
- Department of Animal Medicine, UFRGS, Porto Alegre, RS, Brazil
| | - M P Ferreira
- Department of Animal Medicine, UFRGS, Porto Alegre, RS, Brazil.
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4
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Kincaid JWR, Weiss G, Hill-Baskin AE, Schmidt HM, Omoijuanfo O, Thompson CL, Beck RC, Berger NA. Obesity accelerates acute promyelocytic leukemia in mice and reduces sex differences in latency and penetrance. Obesity (Silver Spring) 2022; 30:1420-1429. [PMID: 35610936 PMCID: PMC9256765 DOI: 10.1002/oby.23435] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Obesity has emerged as a prominent risk factor for multiple serious disease states, including a variety of cancers, and is increasingly recognized as a primary contributor to preventable cancer risk. However, few studies of leukemia have been conducted in animal models of obesity. This study sought to characterize the impact of obesity, diet, and sex in a murine model of acute promyelocytic leukemia (APL). METHODS Male and female C57BL/6J.mCG+/PR mice, genetically predisposed to sporadic APL development, and C57BL/6J (wild type) mice were placed on either a high-fat diet (HFD) or a low-fat diet (LFD) for up to 500 days. RESULTS Relative to LFD-fed mice, HFD-fed animals displayed increased disease penetrance and shortened disease latency as indicated by accelerated disease onset. In addition, a diet-responsive sex difference in APL penetrance and incidence was identified, with LFD-fed male animals displaying increased penetrance and shortened latency relative to female counterparts. In contrast, both HFD-fed male and female mice displayed 100% disease penetrance and insignificant differences in disease latency, indicating that the sexual dimorphism was reduced through HFD feeding. CONCLUSIONS Obesity and obesogenic diet promote the development of APL in vivo, reducing sexual dimorphisms in disease latency and penetrance.
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Affiliation(s)
- John W R Kincaid
- Center for Science, Health & Society, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gretchen Weiss
- Center for Science, Health & Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anne E Hill-Baskin
- Center for Science, Health & Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Heidi M Schmidt
- Center for Science, Health & Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ovwoioise Omoijuanfo
- Center for Science, Health & Society, Case Western Reserve University, Cleveland, Ohio, USA
| | - Cheryl L Thompson
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rose C Beck
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan A Berger
- Center for Science, Health & Society, Case Western Reserve University, Cleveland, Ohio, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
- Departments of Medicine, Biochemistry, Genetics, and Genome Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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5
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Li Y, Beck RC, Moore EM. Pathogenic Mutations and Atypical Flow Cytometric Findings Characterize the Majority of Unclassifiable Myelodysplastic/Myeloproliferative Neoplasms. Am J Clin Pathol 2021; 156:634-643. [PMID: 33877292 DOI: 10.1093/ajcp/aqaa281] [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] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Myelodysplastic/myeloproliferative neoplasms (MDS/MPN) are a group of rare and heterogeneous hematopoietic disorders that frequently present a diagnostic challenge. Here we present our institutional experience with next-generation sequencing (NGS), together with morphologic, flow cytometric, and cytogenetic evaluation, in the diagnosis of MDS/MPN, with particular emphasis on MDS/MPN unclassifiable (MPN-U). METHODS We evaluated the morphologic, flow cytometric, cytogenetic, and molecular characteristics of all MDS/MPN cases that underwent NGS at our institution between April 2016 and February 2019. RESULTS Thirty-seven cases of MDS/MPN were identified, including 14 cases of MDS/MPN-U. Ninety-seven percent harbored mutations and immunophenotypic aberrancies (36/37), while only 38% had cytogenetic abnormalities (12/32). The MDS/MPN-U group had the highest rate of myeloblast phenotypic abnormalities and had a high mutation rate of approximately 2.7 mutated genes per case, most commonly in JAK2, SRSF2, and ASXL1. CONCLUSIONS No single ancillary study was abnormal in every case, but all cases had at least one abnormal finding, demonstrating the usefulness of a multiparameter approach to the diagnosis of MDS/MPN. Although a few specific mutations were found exclusively in MDS/MPN-U and JAK2 mutations were most prevalent, larger studies are needed to determine whether MDS/MPN-U has a mutational "fingerprint," which may aid in diagnosis and targeted therapy.
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Affiliation(s)
- Yanchun Li
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OHUSA
| | - Rose C Beck
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OHUSA
| | - Erika M Moore
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OHUSA
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6
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Jajosky AN, Havens NP, Sadri N, Oduro KA, Moore EM, Beck RC, Meyerson HJ. Clinical Utility of Targeted Next-Generation Sequencing in the Evaluation of Low-Grade Lymphoproliferative Disorders. Am J Clin Pathol 2021; 156:433-444. [PMID: 33712839 DOI: 10.1093/ajcp/aqaa255] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES We investigated the usefulness of a custom-designed 31-gene next-generation sequencing (NGS) panel implemented on a routine basis for the evaluation of low-grade lymphoproliferative disorders (LPDs). METHODS In total, 147 blood, bone marrow, and tissue specimens were sequenced, including 81% B-cell, 15% T-cell, and 3% natural killer (NK)-cell neoplasms. RESULTS Of the cases, 92 (63%) of 147 displayed at least one pathogenic variant while 41 (28%) of 147 had two or more. Low mutation rates were noted in monoclonal B-cell lymphocytoses and samples with small T- and NK-cell clones of uncertain significance. Pathogenic molecular variants were described in specific disorders and classified according to their diagnostic, prognostic, and potential therapeutic value. Diagnostically, in addition to confirming the diagnosis of 15 of 15 lymphoplasmacytic lymphomas, 10 of 12 T large granular lymphocytic leukemias, and 2 of 2 hairy cell leukemias (HCLs), the panel helped resolve the diagnosis of 10 (62.5%) of 16 challenging cases lacking a specified diagnosis based on standard morphology, phenotype, and genetic analysis. CONCLUSIONS Overall, implementation of this targeted lymphoid NGS panel as part of regular hematopathology practice was found to be a beneficial adjunct in the evaluation of low-grade LPDs.
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Affiliation(s)
- Audrey N Jajosky
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nathaniel P Havens
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Navid Sadri
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kwadwo A Oduro
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Erika M Moore
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose C Beck
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Howard J Meyerson
- Department of Pathology, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, OH, USA
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7
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Jajosky AN, Sadri N, Meyerson HJ, Oduro KA, Kelkar A, Fitzgerald B, Tomlinson B, Moore EM, Beck RC. Clonal cytopenia of undetermined significance (CCUS) with dysplasia is enriched for MDS-type molecular findings compared to CCUS without dysplasia. Eur J Haematol 2021; 106:500-507. [PMID: 33386622 DOI: 10.1111/ejh.13574] [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: 09/23/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Although morphologic dysplasia is not typically considered a feature of CCUS, we have consistently observed low-level bone marrow (BM) dysplasia among CCUS patients. We sought to determine whether sub-diagnostic BM dysplasia in CCUS patients is associated with other clinico-pathologic findings of myelodysplastic syndrome (MDS). METHODS We identified 49 CCUS patients, 25 with sub-diagnostic dysplasia (CCUS-D), and 24 having no dysplasia (CCUS-ND). We compared the clinical, histologic, and laboratory findings of CCUS-D and CCUS-ND patients to 49 MDS patients, including blood cell counts, BM morphology, flow cytometry, cytogenetics, and results of next-generation sequencing. RESULTS No statistically significant differences were observed between CCUS-D and CCUS-ND patients in the degree of cytopenias, BM cellularity, myeloid-to-erythroid ratio, or the presence of flow cytometric abnormalities. However, compared to CCUS-ND, CCUS-D patients exhibited increased mutations in myeloid malignancy-associated genes, including non-TET2/DNMT3A/ASXL1 variants, spliceosome (SF3B1, SRSF2, ZRSR2, or U2AF1) variants, and IDH2/RUNX1/CBL variants. CCUS-D patients were also enriched for higher variant allele frequencies and co-mutation of TET2/DNMT3A/ASXL1 with other genes. CONCLUSIONS CCUS-D patients exhibit a molecular (but not clinical) profile more similar to MDS patients than CCUS-ND, suggesting CCUS-D may represent a more immediate precursor to MDS and may warrant closer clinical follow-up.
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Affiliation(s)
- Audrey N Jajosky
- Department of Pathology and Laboratory Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Navid Sadri
- Department of Pathology and Laboratory Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Howard J Meyerson
- Department of Pathology and Laboratory Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kwadwo A Oduro
- Department of Pathology and Laboratory Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ashwin Kelkar
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Brynn Fitzgerald
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin Tomlinson
- Division of Hematology and Oncology, Department of Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Erika M Moore
- Department of Pathology and Laboratory Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rose C Beck
- Department of Pathology and Laboratory Medicine, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
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White K, Qualtieri J, Courville EL, Beck RC, Alobeid B, Czuchlewski DR, Teruya-Feldstein J, Soma LA, Prakash S, Gratzinger D. Entrustable Professional Activities in Hematopathology Pathology Fellowship Training: Consensus Design and Proposal. Acad Pathol 2021; 8:2374289521990823. [PMID: 33644302 PMCID: PMC7894592 DOI: 10.1177/2374289521990823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/24/2020] [Accepted: 12/20/2020] [Indexed: 12/16/2022] Open
Abstract
Hematopathology fellowship education has grown in complexity as patient-centered treatment plans have come to depend on integration of clinical, morphologic, immunophenotypic, molecular, and cytogenetic variables. This complexity is in competition with the need for timely hematopathology care with stewardship of patient, laboratory, and societal resources. Accreditation Council for Graduate Medical Education Milestones provide a guidance document for hematopathology training, but fellows and their educators are in need of a simple framework that allows assessment and feedback of growth toward independent hematopathology practice. Entrustable professional activities provide one such framework, and herein, we provide proposed Hematopathology Fellowship Entrustable Professional Activities based on review of pertinent guidelines and literature, with multiple rounds of expert and stakeholder input utilizing a modified mini-Delphi approach. Ten core entrustable professional activities deemed essential for graduating hematopathology fellows were developed together with skills and knowledge statements, example scenarios, and corresponding Accreditation Council for Graduate Medical Education Milestones. Application of these entrustable professional activities in program design, fellow evaluation, and decisions regarding level of supervision is discussed with consideration of benefits and barriers to implementation. These entrustable professional activities may be used by hematopathology fellowship directors and faculty to provide fellows with timely constructive feedback, determine entrustment decisions, provide the Clinical Competency Committee with granular data to support Milestone evaluations, and provide insight into areas of potential improvement in fellowship training. Fellows will benefit from a clear roadmap to independent hematopathology practice with concrete and timely feedback.
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Affiliation(s)
- Kristie White
- Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Julianne Qualtieri
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Elizabeth L. Courville
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rose C. Beck
- Department of Pathology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - David R. Czuchlewski
- Department of Pathology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Julie Teruya-Feldstein
- Department of Pathology, Molecular, and Cell-Based Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Lorinda A. Soma
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, WA, USA
| | - Sonam Prakash
- Department of Laboratory Medicine, University of California at San Francisco School of Medicine, San Francisco, CA, USA
| | - Dita Gratzinger
- Stanford University School of Medicine, Stanford, CA, USA
- Dita Gratzinger, Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA 94305, USA.
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9
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Abstract
OBJECTIVES At a discussion on molecular/cytogenetic education for hematopathology fellows at the 2018 Society for Hematopathology Program Directors Meeting, consensus was that fellows should understand basic principles and indications for and limitations of molecular/cytogenetic testing used in routine practice. Fellows should also be adept at integrating results of such testing for rendering a final diagnosis. To aid these consensus goals, representatives from the Society for Hematopathology and the Association for Molecular Pathology formed a working group to devise a molecular/cytogenetic curriculum for hematopathology fellow education. CURRICULUM SUMMARY The curriculum includes a primer on cytogenetics and molecular techniques. The bulk of the curriculum reviews the molecular pathology of individual malignant hematologic disorders, with applicable molecular/cytogenetic testing for each and following the 2017 World Health Organization classification of hematologic neoplasms. Benign hematologic disorders and bone marrow failure syndromes are also discussed briefly. Extensive tables are used to summarize genetics of individual disorders and appropriate methodologies. CONCLUSIONS This curriculum provides an overview of the current understanding of the molecular biology of hematologic disorders and appropriate ancillary testing for their evaluation. The curriculum may be used by program directors for training hematopathology fellows or by practicing hematopathologists.
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Affiliation(s)
- Rose C Beck
- Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH (Society for Hematopathology Representative)
| | - Annette S Kim
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (Association for Molecular Pathology Representative)
| | - Rashmi S Goswami
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Olga K Weinberg
- Department of Pathology, Boston Children’s Hospital, Boston, MA
| | - Cecilia C S Yeung
- Department of Pathology, University of Washington, and Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Mark D Ewalt
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora
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10
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Tomlinson B, Raess PW, Beck RC, Moore EM. Erythroblastic sarcoma with rare PDGFRA rearrangement responding to tyrosine kinase inhibitor therapy. Br J Haematol 2020; 188:e98-e100. [PMID: 31951668 DOI: 10.1111/bjh.16379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin Tomlinson
- Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, OH, USA
| | - Philipp W Raess
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Rose C Beck
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Erika M Moore
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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11
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Hamadeh F, Awadallah A, Meyerson HJ, Beck RC. Flow Cytometry Identifies a Spectrum of Maturation in Myeloid Neoplasms Having Plasmacytoid Dendritic Cell Differentiation. Cytometry B Clin Cytom 2019; 98:43-51. [PMID: 30614203 DOI: 10.1002/cyto.b.21761] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neoplasms derived from plasmacytoid dendritic cells (PDCs) are currently divided into two broad categories: mature PDC proliferations associated with myeloid neoplasms (MPDMN) and blastic plasmacytoid dendritic cell neoplasm (BPDCN); only BPDCN is recognized in the WHO 2016 classification of hematopoietic neoplasms. We present seven patients with high grade myeloid neoplasms (MNs), mostly acute leukemias, having a spectrum of PDC differentiation and not fitting with MPDMN or BPDCN. METHODS We analyzed seven MN cases having increased myeloblasts and prominent CD56-negative PDC proliferations comprising 5-26% of bone marrow or blood cellularity as measured by flow cytometry. The cases included five acute myeloid leukemia (three FAB M4 subtype, two unclassified), one mixed phenotype acute leukemia, and one case of unclassified MN. RESULTS Six cases demonstrated immunophenotypic evidence of PDC differentiation from leukemic blasts, based on variable expression of CD34, CD45, CD123, and CD304 by the leukemic cells. Four cases had circulating PDC populations in blood. None of the cases met clinical or pathologic criteria for BPDCN. Morphologic review was available for four acute leukemia cases and demonstrated either nodular or interstitial infiltrates of PDCs. All cases had an aggressive clinical course, and three cases had FLT3 ITD mutation. CONCLUSIONS These cases demonstrate that high grade MNs, in particular AML, can exhibit PDC differentiation, with or without monocytic differentiation, in a manner distinct from MPDMN or BPDCN. The existence of MNs with immature PDC proliferations suggests that there is a broader spectrum of PDC-associated neoplasms than currently recognized. © 2019 International Clinical Cytometry Society.
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Affiliation(s)
- Fatima Hamadeh
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amad Awadallah
- Department of Pathology, University Hospitals of Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Howard J Meyerson
- Department of Pathology, University Hospitals of Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rose C Beck
- Department of Pathology, University Hospitals of Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio
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12
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Jialal I, Pahwa R, Beck RC, Schmotzer CL. Therapeutic Monoclonal Antibodies and the Value of the Free Light Chain Assay in Myeloma. Am J Clin Pathol 2018; 150:468-469. [PMID: 30184092 DOI: 10.1093/ajcp/aqy110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ishwarlal Jialal
- Section of Clinical Chemistry VA Medical Center Mather, CA
- California Northstate University College of Medicine Elk Grove, CA
| | | | - Rose C Beck
- School of Medicine Case Western Reserve University Cleveland, OH
| | - Christine L Schmotzer
- Department of Pathology University Hospitals of Cleveland Medical Center Cleveland, OH
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13
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Tang F, Malek E, Math S, Schmotzer CL, Beck RC. Interference of Therapeutic Monoclonal Antibodies With Routine Serum Protein Electrophoresis and Immunofixation in Patients With Myeloma: Frequency and Duration of Detection of Daratumumab and Elotuzumab. Am J Clin Pathol 2018; 150:121-129. [PMID: 29901687 DOI: 10.1093/ajcp/aqy037] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES We investigated the frequency and pattern of detection of therapeutic monoclonal antibodies (t-mAbs) daratumumab and elotuzumab by routine serum protein electrophoresis (SPE) and immunofixation (IF) in treated patients with myeloma. METHODS Detection of t-mAb was assessed in 22 patients by retrospective review of SPE/IF ordered prior to, during, and after 26 individual courses of therapy. RESULTS t-mAb was distinguishable from M-protein in 16 of 26 courses, with daratumumab detected in nine of nine and elotuzumab in six of seven patients. t-mAb was detected on first follow-up SPE/IF in 12 patients, with earliest detection 7 days after therapy initiation and latest detection 70 days after therapy. t-mAb persisted throughout induction therapy in most patients, with loss of detection during maintenance daratumumab. CONCLUSIONS When distinguishable from M-protein, t-mAbs are detectable in 93% of treated patients as soon as 7 days after the initial dose and are consistently observed throughout induction therapy, warranting increased monitoring and careful interpretation of SPE/IF.
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Affiliation(s)
- Felicia Tang
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Ehsan Malek
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Hematology/Oncology, University Hospitals of Cleveland Medical Center, Cleveland, OH
| | - Susan Math
- Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, OH
| | - Christine L Schmotzer
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, OH
| | - Rose C Beck
- School of Medicine, Case Western Reserve University, Cleveland, OH
- Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, OH
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14
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Affiliation(s)
- Felicia Tang
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Christine Schmotzer
- Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
| | - Rose C. Beck
- Department of Pathology, University Hospitals of Cleveland Medical Center, Cleveland, Ohio
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15
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Richardson ET, Shukla S, Nagy N, Boom WH, Beck RC, Zhou L, Landreth GE, Harding CV. ERK Signaling Is Essential for Macrophage Development. PLoS One 2015; 10:e0140064. [PMID: 26445168 PMCID: PMC4596867 DOI: 10.1371/journal.pone.0140064] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/20/2015] [Indexed: 11/25/2022] Open
Abstract
Macrophages depend on colony stimulating factor 1 (also known as M-CSF) for their growth and differentiation, but the requirements for intracellular signals that lead to macrophage differentiation and function remain unclear. M-CSF is known to activate ERK1 and ERK2, but the importance of this signaling pathway in macrophage development is unknown. In these studies, we characterized a novel model of Erk1-/-Erk2flox/floxLyz2Cre/Cre mice in which the ERK2 isoform is deleted from macrophages in the background of global ERK1 deficiency. Cultures of M-CSF-stimulated bone marrow precursors from these mice yielded reduced numbers of macrophages. Whereas macrophages developing from M-CSF-stimulated bone marrow of Erk2flox/floxLyz2Cre/Cre mice showed essentially complete loss of ERK2 expression, the reduced number of macrophages that develop from Erk1-/-Erk2flox/floxLyz2Cre/Cre bone marrow show retention of ERK2 expression, indicating selective outgrowth of a small proportion of precursors in which Cre-mediated deletion failed to occur. The bone marrow of Erk1-/-Erk2flox/floxLyz2Cre/Cre mice was enriched for CD11b+ myeloid cells, CD11bhi Gr-1hi neutrophils, Lin- c-Kit+ Sca–1+ hematopoietic stem cells, and Lin- c-Kit+ CD34+ CD16/32+ granulocyte-macrophage progenitors. Culture of bone marrow Lin- cells under myeloid-stimulating conditions yielded reduced numbers of monocytes. Collectively, these data indicate that the defect in production of macrophages is not due to a reduced number of progenitors, but rather due to reduced ability of progenitors to proliferate and produce macrophages in response to M-CSF-triggered ERK signaling. Macrophages from Erk1-/-Erk2flox/floxLyz2Cre/Cre bone marrow showed reduced induction of M-CSF-regulated genes that depend on the ERK pathway for their expression. These data demonstrate that ERK1/ERK2 play a critical role in driving M-CSF-dependent proliferation of bone marrow progenitors for production of macrophages.
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Affiliation(s)
- Edward T. Richardson
- Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
- Medical Scientist Training Program, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Supriya Shukla
- Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Nancy Nagy
- Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - W. Henry Boom
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
- Center for AIDS Research, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Rose C. Beck
- Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Lan Zhou
- Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - Gary E. Landreth
- Department of Neurosciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Clifford V. Harding
- Department of Pathology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
- Division of Infectious Diseases and HIV Medicine, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
- Center for AIDS Research, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
- * E-mail:
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Abstract
The use of natural killer (NK) cells as cell therapy against acute leukemia is an active area of investigation. The optimal source of cytotoxic NK cells for therapeutic use is presently unknown. With funds from the National Blood Foundation, the author's lab has developed in vitro culture systems that use the Notch receptor ligand Delta4 for the differentiation and expansion of functional NK cells from CD34+ cord blood hematopoietic progenitor cells. These Notch-induced NK (N-NK) cells display a predominantly immature, CD56(bright) surface phenotype, with expression of activating receptors important for leukemia cell recognition and killing, but with an absence of inhibitory receptors that bind major histocompatibility complex (MHC) class I, making them free of restriction by self-MHC. They are capable of directly killing hematopoietic tumor cell lines and primary leukemia cells in vitro. Thus, cytotoxic, HLA-independent N-NK cells may represent a novel cell therapy for hematopoietic malignancy.
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Affiliation(s)
- Rose C Beck
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.
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Procop GW, Beck RC, Pettay JD, Kohn DJ, Tuohy MJ, Yen-Lieberman B, Prayson RA, Tubbs RR. JC virus chromogenic in situ hybridization in brain biopsies from patients with and without PML. ACTA ACUST UNITED AC 2006; 15:70-3. [PMID: 16778586 DOI: 10.1097/00019606-200606000-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC polyoma virus. Electron microscopy and immunohistochemistry are the traditional methods of confirming the presence of the virus in brain biopsies from these patients. We studied the brain biopsies from 7 patients with PML and 6 patients without PML with chromogenic in situ hybridization (CISH) for the JC polyoma virus using a commercially available probe. The biopsies from the patients with the PML cases were proven to contain the JC polyoma virus by traditional and molecular methods. The CISH findings were compared with the known state of infection. All (7/7) of the biopsies from patients with PML were positive for the presence of polyoma virus by CISH, whereas the biopsies from patients without PML were uniformly negative. CISH seems to be a useful tool for the detection of the JC virus in brain biopsies from patients with PML, and is more accessible because a commercial probe is available.
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Affiliation(s)
- Gary W Procop
- Division of Pathology and Laboratory Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA.
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18
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Beck RC, Wlodarski M, Gondek L, Theil KS, Tuthill RJ, Sobeck R, Bolwell B, Maciejewski JP. Efficient identification of T-cell clones associated with graft-versus-host disease in target tissue allows for subsequent detection in peripheral blood. Br J Haematol 2005; 129:411-9. [PMID: 15842666 DOI: 10.1111/j.1365-2141.2005.05472.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Graft-versus-host disease (GVHD) causes severe morbidity and mortality in allogeneic haematopoietic stem cell transplantation (HSCT) because of destruction of recipient tissues by donor alloreactive T cells. We hypothesized that GVHD-specific T-cell clones are expanded within affected tissue of HSCT patients and can also be detected in blood at the time of active disease. A multiplex polymerase chain reaction (PCR) was used to amplify T-cell receptor (TCR) variable beta (VB) chain rearrangements in skin biopsies from eight allogeneic HSCT patients. Molecular analysis of the complementarity-determining region 3 (CDR3) of amplified products defined expanded, potentially disease-associated 'clonotypes' and enabled the design of clonotype-specific PCR assays. We detected immunodominant clones in seven of eight GVHD-positive skin biopsies. In serial skin biopsies from the same patient, the identical clone was found in each biopsy. In a patient who underwent two successive HSCTs from different donors, distinct clones were identified for each engraftment. Using clonotypic PCR assays, individual tissue-derived clones could be identified in peripheral blood samples obtained during active GVHD. We hypothesize that clonotypic sequences derived from target tissue can serve as markers for GVHD and may have utility in diagnosis and monitoring response to therapy, as well as enable future therapies targeted against pathogenic clones.
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Affiliation(s)
- Rose C Beck
- The Experimental Hematology and Hematopoiesis Section, Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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19
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Beck RC, Kohn DJ, Tuohy MJ, Prayson RA, Yen-Lieberman B, Procop GW. Detection of polyoma virus in brain tissue of patients with progressive multifocal leukoencephalopathy by real-time PCR and pyrosequencing. ACTA ACUST UNITED AC 2004; 13:15-21. [PMID: 15163004 DOI: 10.1097/00019606-200403000-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We evaluated 2 methods, a LightCycler PCR assay and pyrosequencing for the detection of the JC polyoma virus (JCV) in fixed brain tissue of 10 patients with and 3 control patients without progressive multifocal leukoencephalopathy (PML). Nucleic acid extraction was performed after deparaffinization and proteinase K digestion. The LightCycler assay differentiates the BK virus (BKV), JCV, and SV40 using melt curve analysis. Conventional PCR was used with the same primers to generate products for pyrosequencing. Two sequencing primers were used that differentiate the polyoma viruses. Seven of 11 biopsies (1 patient had 2 biopsies) with PML were positive for JCV by real-time PCR and/or PCR/pyrosequencing. Three of 4 remaining biopsies were positive by real-time PCR but had melting points between JCV and SV40. The 4 specimens that were negative or atypical by LightCycler PCR were positive by traditional PCR, but 1 had an amplicon of lower molecular weight by gel electrophoresis. These were shown to represent JCV by at least 1 of the 2 pyrosequencing primers. The biopsies from patients without PML were PCR negative. Both the LightCycler and pyrosequencing assays are useful for confirming JCV in brain biopsies from patients with PML, but variant JCVs may require supplementary methods to confirm JCV infection.
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Affiliation(s)
- Rose C Beck
- Division of Pathology and Laboratory Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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20
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Beck RC, Stahl S, O’Keefe CL, Maciejewski JP, Theil KS, Hsi ED. Detection of Mature T-Cell Leukemias by Flow Cytometry Using Anti–T-Cell Receptor VβAntibodies. Am J Clin Pathol 2003. [DOI: 10.1309/835b04qxgnnfnrju] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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21
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Beck RC, Stahl S, O'Keefe CL, Maciejewski JP, Theil KS, Hsi ED. Detection of mature T-cell leukemias by flow cytometry using anti-T-cell receptor V beta antibodies. Am J Clin Pathol 2003; 120:785-94. [PMID: 14608907 DOI: 10.1309/835b-04qx-gnnf-nrju] [Citation(s) in RCA: 14] [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] [Indexed: 10/26/2022] Open
Abstract
A broad array of antibodies directed against the variable (V) region of the T-cell receptor (TCR) beta (V beta) chain has become available in a directly conjugated multicolor format that permits assessment of 19 of 25 V beta families, covering 70% of the normal circulating T-cell repertoire. These antibodies were used to detect expanded T-cell populations in 43 peripheral blood samples submitted for suspected T-cell malignancy. Of 43 samples, 27 were diagnosed as follows: T-cell large granular lymphocyte leukemia, 14 samples; Sézary syndrome, 4 samples; T-cell prolymphocytic leukemia, 5 samples; or T-cell non-Hodgkin lymphoma or T-cell lymphoproliferative disorder not otherwise specified, 4 samples. The remaining 16 samples were determined to be nonneoplastic. All samples were diagnosed before assessment with anti-V beta flow cytometry. By using a cutoff of 1.6 times the upper limit of normal range (ULN) to define malignant restriction of V beta use, pathologic restriction of V beta use was found directly or indirectly in all 27 samples carrying a diagnosis of malignancy and directly in 2 of 16 samples without a diagnosis of malignancy. TCR gene rearrangement studies were used to confirm V beta flow cytometry results. By using a cutoff of 1.6 times the ULN for the detection of malignancy, the antibody panel had a diagnostic sensitivity of 89% for direct detection of pathologic V beta restriction and a specificity of 88%, making it useful for rapid diagnosis of T-cell leukemia.
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Affiliation(s)
- Rose C Beck
- Division of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA
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22
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Beck RC, Tubbs RR, Hussein M, Pettay J, Hsi ED. Automated colorimetric in situ hybridization (CISH) detection of immunoglobulin (Ig) light chain mRNA expression in plasma cell (PC) dyscrasias and non-Hodgkin lymphoma. Diagn Mol Pathol 2003; 12:14-20. [PMID: 12605031 DOI: 10.1097/00019606-200303000-00002] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immunohistochemistry (IHC) is frequently used to detect plasma cell (PC) or B cell monoclonality in histologic sections, but its interpretation is often confounded by background staining. We evaluated a new automated method for colorimetric in situ hybridization (CISH) detection of clonality in PC dyscrasias and small B cell lymphomas. Cases of PC dyscrasia included multiple myeloma (MM; 31 cases), plasmacytoma (seven cases), or amyloidosis (one case), while cases of lymphoma included small lymphocytic (three cases), marginal zone (four cases), lymphoplasmacytic (three cases), and mantle cell lymphomas (three cases). Tissue sections were stained for kappa and lambda light chains by IHC and for light chain mRNA by automated CISH using haptenated probes. Twenty-eight of 31 MM cases had detectable light chain restriction by IHC. Thirty of 31 MM cases demonstrated light chain restriction by CISH, including 2 cases with uninterpretable IHC and one case of nonsecretory myeloma, which was negative for light chains by IHC. Seven of 7 plasmacytoma cases had detectable light chain restriction by CISH, including one case of nonsecretory plasmacytoma in which IHC was noninformative. Automated CISH demonstrated monoclonality in 9 of 13 cases of B cell non-Hodgkin lymphoma and had a slightly higher sensitivity than IHC (6 of 13 cases), especially in cases of lymphoplasmacytic and marginal zone lymphoma. Overall, there were no discrepancies in light chain restriction results between IHC, CISH, or serum paraprotein analysis. Automated CISH is useful in detecting light chain expression in paraffin sections and appeared superior to IHC for light chain detection in PC dyscrasias and B cell non-Hodgkin lymphomas, predominantly due to lack of background staining.
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Affiliation(s)
- Rose C Beck
- Department of Clinical Pathology, Cleveland Clinic Foundation, Ohio 44195, USA
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23
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Abstract
Plant cell nuclei were compared with chicken erythrocyte nuclei for use as internal standards for microspectrophotometry. The amount of DNA per nucleus and the coefficient of variation for measurement of individual nuclei were determined for cells from dormant embryos of Pinus taeda and Pinus coulteri, from onion root tips and from chicken erythrocytes. The chicken erythrocytes had the least variability and thus were best suited for use as a standard. Onion root tips were least suitable, with a coefficient of variation 2 1/2 times that of erythrocytes. Although onion root tips have been used as an internal standard in other studies, their mitotic activity, in contrast with the nonreplication of DNA of mature erythrocytes, is reflected in a broad distribution of nuclei with values in the 2C-4C range. Coulter pine mature embryos were at the 3C level, whether dry or hydrated, while loblolly pine embryos were in the 2C state. This confirms previous reports. The coefficient of variability for the pine embryo cells was 1 1/2 times that of erythrocytes for nonhydrated seeds and twice the erythrocyte value for hydrated seeds. The larger 2C values for pine (26 pg for P. taeda and 17 pg for P. coulteri) are closer to values expected for many plant species than the 3 pg level of the chicken erythrocytes. Dormant P. taeda embryo cells (2C) are suggested as an alternative where the experimental material has large DNA values and/or chicken erythrocytes are difficult to procure. Large sample size is recommended for the plant materials if they are to be used as internal standards in Feulgen cytophotometry.
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Berlyn GP, Beck RC, Renfroe MH. Tissue culture and the propagation and genetic improvement of conifers: problems and possibilities. Tree Physiol 1986; 1:227-240. [PMID: 14975900 DOI: 10.1093/treephys/1.2.227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The utilization of tissue culture in the propagation and genetic improvement of conifers holds promise of many benefits including faster multiplication of selected genotypes, faster development of improved genotypes and the transfer of genes between non-fertile parents. However, many of the techniques required for the realization of this potential remain to be developed. Furthermore, genetic differentiation of cells in culture creates uncertainty as to the fidelity of reproduction by micropropagation. Aspects of the problem of nuclear DNA variation during reproduction by tissue culture are reviewed with particular reference to the genus Pinus.
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Affiliation(s)
- G P Berlyn
- Yale University School of Forestry and Environmental Studies, New Haven, CT 06511, USA
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25
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Abstract
Dual-chamber pacemakers interact with cardiac rhythms in complex ways. The resultant surface electrocardiograms (ECGs) are often very difficult to interpret. A simple and automatic diagnostic diagram is described that graphically illustrates pacemaker-heart interactions. Pacemaker operation is explained by a continuous series of lines and symbols that interconnect any sequence of paced and sensed events in both chambers. Fixed, programmable, and adaptive pacemaker timing intervals are all shown in a simple format. The pacemaker diagnostic diagram is plotted directly below the ECG to help users interpret the paced cardiac rhythm. The pacemaker diagnostic diagram is generated by software in a pacemaker programmer from: (1) telemetered real-time event markers; (2) fixed and programmable timing parameters (lower rate, AV interval, etc.); (3) pacemaker conditional logic. If this computer analysis of the telemetered event markers is not consistent with normal pacemaker operation, a specific error-message is printed. The pacemaker diagnostic diagram should be useful for instruction, pacemaker follow-up, and troubleshooting.
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Brillhart CA, Osberg AG, Beck RC. Heart rates of hungry or thirsty rats during sucrose presentation. Psychol Rep 1975; 36:907-10. [PMID: 1144635 DOI: 10.2466/pr0.1975.36.3.907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Heart rates were recorded from unrestrained food- or water-deprived rats ( n = 8) before, during, and after 1-min. presentations of either 2% or 16% sucrose. When sucrose was presented there were nearly identical initial increments for all four deprivation-incentive combinations, followed by an immediate decrement. Rates increased again when the solutions were removed. The results are discussed in terms of locomotor activity.
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27
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Beck RC, Nash R, Viernstein L, Gordon L. Sucrose preferences of hungry and thirsty rats as a function of duration of stimulus presentation. J Comp Physiol Psychol 1972; 78:40-50. [PMID: 5027341 DOI: 10.1037/h0032294] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
16 rats were given 23-hr. tests with each of 2 low-concentration (sweet by human report) pairs of saccharin (.05% vs .15% and .05% vs .35%) and 2 high-concentration (bitter) pairs (1.15% vs 1.25% and 1.15% vs 1.45%). All Ss were tested under each condition while on ad lib. feeding and while on a 23-hr. food deprivation schedule. Results with the 2 low-concentration pairs showed the typical deprivation-concentration interaction, greatly increased intake for the higher concentration of a pair. There was also an interaction with the “bitter” pairs, due to Ss drinking more of the 1.15% concentration when food-deprived than when non-deprived.
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Bobbitt RG, Beck RC. Semantic differential judgments of single and multiple conditioned stimuli with an aversive delay conditioning paradigm. J Exp Psychol 1971; 89:398-402. [PMID: 5567143 DOI: 10.1037/h0031171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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31
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Beck RC. Clearance of ingested sucrose solutions from the gastrointestinal tract of the rat: replication report. Psychol Rep 1969; 24:753-4. [PMID: 5809069 DOI: 10.2466/pr0.1969.24.3.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Two partial replications of a study of the dehydrating effects of ingested hypertonic sucrose solutions (Beck, 1967) are described. As in the original study, Ss drank less 37% sucrose than 18.5% but the 37% produced greater absolute as well as relative dehydration.
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Abstract
16 rats were given 30-min. 2-choice preference tests with water and Hawaiian Punch (HP) after 1, 8, 24, or 32 hr. water deprivation. Intake of HP was constant at about 13 ml under all conditions, but water intake was from 1 ml to 13 ml with increasing deprivation.
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Abstract
Rats were trained to bar press for 1 of 2 different sucrose reinforcements under a particular deprivation condition, then were extinguished under the same or a different condition. Independent groups of Ss were trained thirsty and extinguished thirsty or satiated, were trained hungry and extinguished hungry or thirsty, were trained thirsty and extinguished hungry or thirsty. Differential reinforcement effects were found only for those Ss trained under food deprivation; Ss trained while water deprived showed no reinforcement differences in training or extinction. There did appear to be drive stimulus generalization effects.
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Beck RC, Brooks CI. A test of drive stimulus theory using saline stomach loads. Psychol Rep 1967; 20:1011-4. [PMID: 6042462 DOI: 10.2466/pr0.1967.20.3.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study tested the hypothesis that the depression of barpressing following hypertonic NaCl stomach loads is due to their producing unconditioned drive stimuli. It was predicted that rats given a response-depressing load repeatedly would show less depression on successive occasions as the novel drive stimuli became conditioned to the response. The results did not support this prediction.
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Beck RC, McLean JF. Effect of schedule of reinforcement and stomach loads on bar pressing by thirsty rats. J Comp Physiol Psychol 1967; 63:530-3. [PMID: 6064403 DOI: 10.1037/h0024637] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
32 rats were used to test the deprivation-trace hypothesis of O'Kelly and Heyer (1951). In a 2 × 2 × 2 factorial design the following variables were manipulated: delay between saline injection and bar-press testing, 30 min. vs 240 min., presence or absence of food during the delay period, and schedule of reinforcement, VI-¼ min. vs VI-1 min. The only significant differences were the main effects of schedule and delay. The prediction was supported, but alternative interpretations not requiring the hypothesis were offered.
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