Acute Leukemia Immunohistochemistry: A Systematic Diagnostic Approach

2008 ◽  
Vol 132 (3) ◽  
pp. 462-475
Author(s):  
Randall J. Olsen ◽  
Chung-Che Chang ◽  
Jennifer L. Herrick ◽  
Youli Zu ◽  
Aamir Ehsan
Keyword(s):  
Flow Cytometry ◽  
Relevant Literature ◽  
General Strategy ◽  
Acute Leukemias ◽  
Fixed Tissue ◽  
Genetic Studies ◽  
Therapeutic Implications ◽  
Formalin Fixed Tissue ◽  
Diagnosis And Classification

Abstract Context.—The diagnosis and classification of leukemia is becoming increasingly complex. Current classification schemes incorporate morphologic features, immunophenotype, molecular genetics, and clinical data to specifically categorize leukemias into various subtypes. Although sophisticated methodologies are frequently used to detect characteristic features conferring diagnostic, prognostic, or therapeutic implications, a thorough microscopic examination remains essential to the pathologic evaluation. Detailed blast immunophenotyping can be performed with lineage- and maturation-specific markers. Although no one marker is pathognomonic for one malignancy, a well-chosen panel of antibodies can efficiently aid the diagnosis and classification of acute leukemias. Objective.—To review important developments from recent and historical literature. General immunohistochemical staining patterns of the most commonly encountered lymphoid and myeloid leukemias are emphasized. The goal is to discuss the immunostaining of acute leukemias when flow cytometry and genetic studies are not available. Data Sources.—A comprehensive review was performed of the relevant literature indexed in PubMed (National Library of Medicine) and referenced medical texts. Additional references were identified in the reviewed manuscripts. Conclusions.—Immunophenotyping of blasts using an immunohistochemical approach to lymphoid and myeloid malignancies is presented. Initial and subsequent additional antibody panels are suggested to confirm or exclude each possibility in the differential diagnosis and a general strategy for diagnostic evaluation is discussed. Although the use of immunohistochemistry alone is limited and evaluation by flow cytometry and genetic studies is highly recommended, unavoidable situations requiring analysis of formalin-fixed tissue specimens arise. When performed in an optimized laboratory and combined with a careful morphologic examination, the immunohistochemical approach represents a useful laboratory tool for classifying various leukemias.

scholarly journals Tissue flow cytometry immunophenotyping in the diagnosis and classification of non-Hodgkin's lymphomas: A retrospective evaluation of 1,792 cases

2013 ◽  
Vol 84B (2) ◽  
pp. 82-95 ◽  
Author(s):  
Anna Demurtas ◽  
Alessandra Stacchini ◽  
Sabrina Aliberti ◽  
Luigi Chiusa ◽  
Roberto Chiarle ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Retrospective Evaluation ◽  
Diagnosis And Classification ◽  
Hodgkin's Lymphomas

Hematopathological Concepts and Controversies in the Diagnosis and Classification of Myelodysplastic Syndromes

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 199-204 ◽  
Author(s):  
James W. Vardiman
Keyword(s):  
Bone Marrow ◽  
Myelodysplastic Syndromes ◽  
Who Classification ◽  
Diagnostic Dilemma ◽  
Genetic Studies ◽  
Diagnostic Uncertainty ◽  
Diagnostic Problems ◽  
Diagnosis And Classification

Abstract Although the diagnosis and classification of most cases of the myelodysplastic syndromes (MDS) is usually accomplished without difficulty, a minority of cases may pose diagnostic problems. In many cases the diagnostic dilemma can be solved by adhering to basic guidelines recommended for evaluation of patients suspected of having MDS, and in particular to the quality of the blood and bone marrow specimens submitted for morphologic, immunophenotypic and genetic studies. In other cases, such as patients who have hypocellular MDS or MDS with fibrosis, the criteria for making a diagnosis may be difficult if not impossible to apply, and in still others the diagnostic uncertainty is because the minimal criteria necessary to establish the diagnosis of MDS are not always clearly stated. In this review, some of these diagnostic problems are addressed and some general guidelines for resolving them are suggested. In addition, data are presented that illustrate that the WHO classification offers a valuable tool in the diagnosis and classification of MDS.

scholarly journals Multifaceted Approach to the Diagnosis and Classification of Acute Leukemias

2000 ◽  
Vol 46 (8) ◽  
pp. 1252-1259 ◽  
Author(s):  
Robert W McKenna
Keyword(s):  
Treatment Protocol ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Remission Induction ◽  
Prognostic Information ◽  
Acute Leukemias ◽  
Multifaceted Approach ◽  
New Therapeutic Approaches ◽  
Diagnosis And Classification

Abstract Until recently, the diagnosis and classification of acute myeloid (AML) and acute lymphoblastic (ALL) leukemias was based almost exclusively on well-defined morphologic criteria and cytochemical stains. Although most cases can be diagnosed by these methods, there is only modest correlation between morphologic categories and treatment responsiveness and prognosis. The expansion of therapeutic options and improvement in remission induction and disease-free survival for both AML and ALL have stimulated emphasis on defining good and poor treatment response groups. This is most effectively accomplished by a multifaceted approach to diagnosis and classification using immunophenotyping, cytogenetics, and molecular analysis in addition to the traditional methods. Immunophenotyping is important in characterizing morphologically poorly differentiated acute leukemias and in defining prognostic categories of ALL. Cytogenetic and molecular studies provide important prognostic information and are becoming vitally important in determining the appropriate treatment protocol. With optimal application of these techniques in the diagnosis of acute leukemias, treatment strategies can be more specifically directed and new therapeutic approaches can be evaluated more effectively.

scholarly journals Flow cytometry in the diagnosis and classification of malignant lymphoma and leukemia

Cancer ◽  
1982 ◽  
Vol 50 (6) ◽  
pp. 1122-1135 ◽  
Author(s):  
Lawrence W. Diamond ◽  
Bharat N. Nathwani ◽  
Henry Rappaport
Keyword(s):  
Flow Cytometry ◽  
Malignant Lymphoma ◽  
Diagnosis And Classification

scholarly journals EPIDEMIOLOGICAL AND IMMUNOPHENOTYPIC CHARACTERIZATION OF ACUTE MYELOID LEUKEMIAS

2017 ◽  
Vol 12 (4) ◽  
pp. 234-239
Author(s):  
Tatiana Cristina ENACHE ◽  
◽  
Ana-Maria VLĂDĂREANU ◽  
Horia BUMBEA ◽  
Minodora ONISÂI ◽  
...  
Keyword(s):  
Residual Disease ◽  
Lymphocytic Leukemia ◽  
Acute Leukemias ◽  
Hematopoietic Stem ◽  
Myeloid Leukemias ◽  
Diagnosis And Classification ◽  
Insufficiency Syndrome ◽  
Acute Myeloid

Acute leukemias are a group of hematopoietic stem cell malignancies characterized by the proliferation and accumulation of immature cell (blasts) clones that associate medullary insufficiency syndrome (anemia, neutropenia, thrombocytopenia). Depending on the origin of the malignant clone, two major categories of acute leukemias are: acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML). Studies show an annual incidence of acute leukemias in European adults of 5-6 cases per 100,000 people with an increase in over 70 years of age, reaching an incidence of about 15-20 / 100,000 people. Of the total acute myeloid leukemias, 20% occur in children and 80% are among adults. Diagnosis of acute leukemias is based on the recognition of morphological, cytochemical, immunophenotypic, cytogenetic and molecular biology changes. Immunophenotyping plays a major role in the diagnosis and classification of acute leukemias, in differentiation of acute myeloid and lymphocytic leukemias and in detection of minimal residual disease.

Utility of Flow Cytometry Immunophenotyping for the Diagnosis and Classification of Lymphoma in Community Hospital Clinical Needle Aspiration/Biopsies

2000 ◽  
Vol 124 (12) ◽  
pp. 1792-1799 ◽  
Author(s):  
James D. Siebert ◽  
Lori M. Weeks ◽  
Larry W. List ◽  
John W. Kugler ◽  
James A. Knost ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
B Cell ◽  
Community Hospital ◽  
Paraffin Section ◽  
Large Cell ◽  
Needle Aspiration ◽  
Cancer Center ◽  
Surgical Biopsy ◽  
Diagnosis And Classification

Abstract Context.—Flow cytometry immunophenotyping (FC) of needle aspiration/biopsy (NAB) samples has been reported to be useful for the diagnosis and classification of lymphoma in university and cancer center–based settings. Nevertheless, there is no agreement on the utility of these methods. Objective.—To further define the utility of adjunctive FC of clinical NAB for the diagnosis and classification of lymphoma, and to determine if this approach is practicable in a routine clinical practice setting. Setting.—A community-based hospital. Methods.—Clinical NABs were submitted for adjunctive FC between June 1996 and September 1999 if initial smears were suspicious for lymphoma. Smears and cell block or needle core tissues were routinely processed and paraffin-section immunostains were performed if indicated. The final diagnosis was determined by correlating clinical and pathologic data, and the revised European-American classification criteria were used to subtype lymphomas. Results.—Needle aspiration/biopsies from 60 different patients were submitted for FC. Final diagnoses were lymphoma (n = 38), other neoplasm (n = 15), benign (n = 6), or insufficient (n = 1). For 38 lymphomas (20 primary, 18 recurrent), patients ranged in age from 32 to 86 years (mean, 62 years); samples were obtained from the retroperitoneum (n = 11), lymph node (n = 9), abdomen (n = 8), mediastinum (n = 6), or other site (n = 4); and lymphoma subtypes were indolent B-cell (n = 20; 2 small lymphocytic, 14 follicle center, 4 not subtyped), aggressive B-cell (n = 14; 3 mantle cell, 10 large cell, 1 not subtyped), B-cell not further specified (n = 2), or Hodgkin disease (n = 2). For the diagnosis of these lymphomas, FC was necessary in 20 cases, useful in 14 cases, not useful in 2 cases, and misleading in 2 cases. Thirty-two of 36 lymphoma patients with follow-up data received antitumor therapy based on the results of NAB plus FC. Conclusions.—Adjunctive FC of NABs is potentially practicable in a community hospital, is necessary or useful for the diagnosis and subtyping of most B-cell lymphomas, and can help direct lymphoma therapy. Repeated NAB or surgical biopsy is necessary for diagnosis or treatment in some cases.

Myeloid/Lymphoid Neoplasms Associated With Eosinophilia and Rearrangements of PDGFRA, PDGFRB, or FGFR1 or With PCM1-JAK2

2020 ◽  
Author(s):  
Olga Pozdnyakova ◽  
Attilio Orazi ◽  
Katalin Kelemen ◽  
Rebecca King ◽  
Kaaren K Reichard ◽  
...  
Keyword(s):  
Myeloid Leukemia ◽  
Clinical Laboratory ◽  
Myeloproliferative Neoplasms ◽  
Molecular Genetic ◽  
Lymphoblastic Lymphoma ◽  
Therapeutic Implications ◽  
Lymphoid Neoplasms ◽  
Diagnosis And Classification ◽  
T Lymphoblastic Lymphoma

Abstract Objectives To summarize cases submitted to the 2019 Society for Hematopathology/European Association for Haematopathology Workshop under the category of myeloid/lymphoid neoplasms with eosinophilia and PDGFRA, PDGFRB, or FGFR1 or with PCM1-JAK2 rearrangements, focusing on recent updates and relevant practice findings. Methods The cases were summarized according to their respective gene rearrangement to illustrate the spectrum of clinical, laboratory, and histopathology manifestations and to explore the appropriate molecular genetic tests. Results Disease presentations were heterogeneous, including myeloproliferative neoplasms (MPNs), myelodysplastic syndromes (MDSs), MDS/MPN, acute myeloid leukemia, acute B- or T-lymphoblastic lymphoma/acute lymphoblastic lymphoma (ALL/LBL), or mixed-lineage neoplasms. Frequent extramedullary involvement occurred. Eosinophilia was common but not invariably present. With the advancement of RNA sequencing, cryptic rearrangements were recognized in genes other than PDGFRA. Additional somatic mutations were more frequent in the FGFR1-rearranged cases. Cases with B-ALL presentations differed from Philadelphia-like B-ALL by the presence of an underlying MPN. Cases with FLT3 and ABL1 rearrangements could be potential candidates for future inclusion in this category. Conclusions Accurate diagnosis and classification of this category of myeloid/lymphoid neoplasms has important therapeutic implications. With the large number of submitted cases, we expand our understanding of these rare neoplasms and improve our ability to diagnose these genetically defined disorders.

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