16 June 2022: Textbook Updates

We have posted updates of the following topics:

Bone marrow neoplastic > Bone marrow – plasma cell and lymphoid neoplasms > B lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities > Therapy related B ALL
by Sharon Koorse Germans, M.D., Jesse Manuel Jaso, M.D.
Topic summary: B lymphoblastic leukemia / lymphoma arising after cytotoxic or radiation therapy for a prior malignancy. No distinct morphologic or immunophenotypic features but is commonly associated with KMT2A rearrangement, del(5 / 5q), del(7 / 7q), hypodiploidy, TP53 mutation and BCR::ABL1 rearrangement. Estimated to occur in 1 – 10% of patients who receive cytotoxic / radiation therapy as primary therapy or in preparation for hematopoietic stem cell transplant. Previously mentioned cytogenetic abnormalities, as well as prior exposure to mutagenic agents, confer a worse prognosis when compared to de novo disease.

Laboratory Administration & Management of Pathology Practices > Qualifying board topics > Finance > Laboratory budgeting
by Duy K. Doan, M.D., Lewis A. Hassell, M.D.
Topic summary: Budget is a detailed plan outlining expenses (costs) and revenues (incomes); it is also called a financial plan, a map to get where we intend to go. Operational budget provides a plan of day to day expenses and revenues; capital budget provides a plan for long term upgrades and improvements. Ways of budgeting include (but are not limited to) the following: pro forma budgeting, zero based budgeting, priority based budgeting, activity based budgeting and flexible budgeting. Budget is the internal reporting tool that management uses to control expenses and make decisions; the budget variance analysis is performed periodically, at least monthly.

Lymphoma & related disorders > Mature B cell neoplasms > Large B cell lymphomas-special subtypes > Plasmablastic lymphoma
by Abhilasha Ghildyal, M.D., M.P.H., Julio Poveda, M.D.
Topic summary: Aggressive large B cell lymphoma with plasmablast / immunoblast morphologic features with plasma cell differentiation, usually in association with immunodeficiency. Predominantly occurs in extranodal sites (most common in oral cavity). Mostly occurs in adults with HIV infection or with iatrogenic immunosuppression. Prognosis is unfavorable; median survival is 6 – 12 months. Newer treatment modalities using V-EPOCH (bortezomib with etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) have shown increased survival.

Placenta > Nonneoplastic placental conditions and abnormalities > Infectious > Acute chorioamnionitis
by Andrew P. Norgan, M.D., Ph.D., Drucilla J. Roberts, M.D.
Topic summary: Acute chorioamnionitis is defined by the presence of acute inflammation (neutrophils) within the chorion or amnion (or both) of the extraplacental membranes or chorionic plate (maternal inflammatory response [MIR]), with or without acute inflammatory cell extravasation from the umbilical cord vasculature or chorionic plate vessels (fetal inflammatory response [FIR]). More common in younger, nulliparous women. Unfavorable factors: necrotizing chorioamnionitis; fetal inflammatory response. Treatment: maternal and neonatal antibiotic therapy.

Stains & CD markers > Cytokeratin AE1 / AE3
by Mieke R. Van Bockstal, M.D., Ph.D.
Topic summary: Mixture of 2 different clones of anticytokeratin (CK) monoclonal antibodies (AE1 and AE3), which functions as a broad spectrum cytokeratin marker. Immunoreactivity is observed in epithelia and most carcinomas (i.e., tumors of epithelial origin), with cytoplasmic and membranous positivity. Used to confirm or rule out epithelial nature of tissue, tumors or components of tumors; as such, usually not performed as a standalone immunohistochemical analysis but rather used as part of a panel of immunohistochemical stains to avoid misinterpretation.

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