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Hematopathology Pearls
Da Zhang
CHAPTER 1:
Hematopoiesis and Hematology Testing
Hematopoiesis and Blood Cells
The Sequence of Hematopoietic Cell Maturation
Erythrocytes
Neutrophils
The Left and Right Shift of Granulocytes
Eosinophils
Basophils and Mast Cells
Monocytes
T-lymphocytes
B-lymphocytes
Natural Killer Cells (NK Cells)
Hematology Testing
Anticoagulant Agents Used for Peripheral Blood Cell Counts
Terminology and Important Calculations
CHAPTER 2:
Disorders of Red Blood Cells
Anemia
Microcytic Anemia (MCV<80 fL)
Normocytic Anemia (MCV 80-100 fL)
Hypochromic/Microcytic Anemia
Iron Deficiency
Sideroblastic Anemias
Anemia of Chronic Disease
Anemia Associated with AIDS
Anemia Associated with Chronic Renal Failure
Anemia Associated with Lead Poisoning
Megaloblastic Anemias
Causes of Megaloblastic Anemia
Anemia Associated with Chronic Alcoholism
Aplastic Anemia and Hypoplastic Anemia (Table 2-3)
Pure Red Blood Cell Aplasia
Inherited Pure Red Blood Cell Aplasia
Acquired Pure Red Blood Cell Aplasia
Anemia Related to Hemolysis
Hereditary Erythrocyte Membrane Defects
Hereditary Spherocytosis
Hereditary Elliptocytosis
Hereditary Erythrocyte Disorders due to Deficiencies of the Glycolytic Pathway
Anemia Associated with Hemoglobinopathies
Sickle Cell Disease and other β-chain Mutation Hemoglobinopathies (Table 2-7)
Thalassemia
Hereditary Persistence of Fetal Hemoglobin
Methods Used for the Evaluation of Hemoglobinopathies
Disorders Related to Heme Synthesis and Iron Overload
Porphyrias
Other Anemia-related Syndromes
Paroxysmal Nocturnal Hemoglobinuria (PNH)
Diagnosis
Congenital Dyserythropoietic Anemia (Table 2-12)
Autoimmune Hemolytic Anemia
CHAPTER 3:
Disorders of Platelets and Coagulation Factors
Coagulation Factors
Coagulation Factors Production
Vitamin K-dependent Coagulation Factors
Coagulation Tests
The Natural Inhibitors of Coagulation
Fibrinolytic System
Inherited Coagulation Disorders
Acquired Coagulation Disorders
Liver Disease and Vitamin K Deficiency
Disseminated Intravascular Coagulopathy (DIC)
Antibodies to Coagulation Factors (Inhibitors to Coagulation Factors)
Lupus Anticoagulant Antibody
Criteria for the Laboratory Diagnosis of the Lupus Anticoagulant
Acquired Hemophilia A
Primary Amyloidosis
Nephrotic Syndrome
Hodgkin Lymphoma
Platelets and von Willebrand Factor
Thrombocytopenia
Causes:
Von Willebrand Disease
Additional Platelet Disorders
Abnormalities of Platelet Glycoprotein Adhesion Receptors
Platelet Storage Pool Disorder
Hereditary Thrombotic Disorders and Anticoagulant Therapy Monitoring (Table 3-11)
Unfractionated Heparin and Low-Molecular-Weight Heparin (LMWH)
Warfarin
CHAPTER 4:
Disorders of Nonneoplastic White Blood Cells
Neutrophil Disorders
Neutrophilia and Neutropenia
Neutrophilia
Neutropenia
Functional Defects of Neutrophils
Degranulation Abnormalities
Adhesion Abnormalities
Disorders of Decreased Cell Migration Response
Disorders of Microbicidal Activity
Hereditary Conditions Associated with Abnormal Neutrophil Morphology (Table 4-4)
Pelger-Huët Anomaly
May-Hegglin Anomaly
Alder-Reilly Anomaly
Myelokathexis
Eosinophilia
Basophilia
Monocytosis
Causes of Reactive Monocytosis
Causes of Neoplastic Monocytosis
Benign Lymphocytosis
Causes of Benign Lymphocytosis
Diagnosis and Differential Diagnosis
Lymphocytopenia
Causes of Lymphocytopenia
Hemophagocytic Lymphohistiocytosis (HLH)
CHAPTER 5:
Normal Lymph Node, Thymus and Lymphoid Hyperplasia
Normal Lymph Node—Function and Structure
Major Functions
Structure
Normal Thymus—Function and Structure
Major Functions
Structure
Predominant Patterns and Etiology of Reactive Lymph Node Hyperplasia
Follicular Hyperplasia
Paracortical Hyperplasia
Medulla/Sinuses—Distended Sinuses
Lymph Nodes with Necrosis (High-Grade B-cell lymphoma should be Ruled Out First)
Lymph Node with Granuloma
Highlighted Topics
Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman Disease)
Progressive Transformation of Germinal Centers
Vascular Transformation of Sinuses
Bacillary Angiomatosis
Kaposi's Sarcoma of Lymph Node
Castleman's Disease
Dermatopathic Lymphadenopathy
Kimura Lymphadenopathy (Kimura Disease)
Kikuchi Disease
CHAPTER 6:
Spleen
Normal Spleen Function and Structure
Major Functions
Structures
Indication for Splenectomy
Causes of Splenic Reactive Follicular Hyperplasia
Splenic Lymphomas
Hematopoietic Neoplasms that may Involve Spleen
Myeloproliferative Disorders
Lymphoproliferative Disorders
Others
Splenic B-cell Marginal Zone Lymphoma
Splenic Diffuse Red Pulp Small B-cell Lymphoma (WHO 2008 Splenic B-cell Lymphoma/Leukemia, Unclassifiable, Provisional Entity)
Hepatosplenic T-cell Lymphoma
Other Lymphomas that may Involve Spleen
CHAPTER 7:
Myelodysplastic Syndromes
Myelodysplastic Syndromes (MDS)
Myelodysplastic/Myeloproliferative Neoplasms (MDS/MPN)
CMML
WHO Diagnostic Criteria for CMML
Diagnostic Criteria for CMML 1 and CMML 2
Atypical Chronic Myeloid Leukemia
MDS in Children
Juvenile Myelomonocytic Leukemia (JMML)
WHO Diagnostic Criteria for JMML
Prognosis of JMML
Myelodysplastic Syndrome/Myeloproliferative Neoplasm, Unclassifiable (MDS/MPN, U)
Myeloproliferative Neoplasms
Chronic Myelogenous Leukemia (CML)
Chronic Phase of CML
Accelerated Phase CML Diagnostic Criteria
Blast Phase (Acute Leukemia Phase) Diagnostic Criteria
Leukocyte Alkaline Phosphatase (LAP) Score and MPN
Differential Diagnosis of Chronic Phase CML
Chronic Neutrophilic Leukemia
WHO Diagnostic Criteria for Chronic Neutrophilic Leukemia
Polycythemia Vera
WHO Diagnostic Criteria for Polycythemia Vera
WHO Diagnostic Criteria for Post-polycythemic Myelofibrosis
Primary Myelofibrosis
Essential Thrombocythemia and Thrombocytosis
WHO Criteria for Essential Thrombocythemia (Diagnosis Requires Meeting all Four Criteria)
Causes of Thrombocytosis
Chronic Eosinophilic Leukemia, Not Otherwise Specified (CEL, NOS)
Mastocytosis
WHO Classification of Mastocytosis
Myeloid and Lymphoid Neoplasms with Eosinophilia and Abnormalities of PDGFA, PDGFRB or FGFR1
Myeloid and Lymphoid Neoplasms with PDGFA Rearrangement
Myeloid Neoplasms with PDGFB Rearrangement
Myeloid and Lymphoid Neoplasms with FGFR1 Abnormalities
Myeloproliferative Neoplasm, Unclassifiable
CHAPTER 8:
Acute Myeloid Leukemia
WHO Classification and Prognosis
WHO Classification of AML
Cytochemical Stains Used in Lineage Identification (Table 8-1)
Prognosis
Detection of Minimal Residual Disease
Detection of Inversion 16: PCR or FISH
Detection of t(8;21): PCR or FISH
Detection of t(15;17): PCR or FISH
Detection of NPM-1 and FLT-3 Mutations: PCR
AML with Recurrent Genetic Abnormalities
AML with t(8;21)(q22;q22)
AML with Eosinophils inv(16)(p13;q22) or t(16;16)(p13;q22)
Acute Promyelocytic Leukemia (APL) with t(15;17)(q22;q12)
AML with t(9;11)(q22;q23) MLLT3-MLL
AML with t(6;9)(p23;q34) DEK-NUP214
AML with inv(3)(q21q26.2) or t(3;3)(q21;q26.2) RPN1-EVI1
AML (Megakaryoblastic) with t(1;22)(p13;q13) RBM15-MKL1
AML with Gene Mutations
AML with Myelodysplasia Related Changes
Therapy-related Myeloid Neoplasms (t-AML, t-MDS, t-MDS/MPN)
AML Not Otherwise Categorized
AML with Minimal Differentiation (FAB Subtype M0)
AML without Maturation (FAB Subtype M1)
AML with Maturation (FAB Subtype M2)
Acute Myelomonocytic Leukemia (AMML, FAB Subtype M4)
Acute Monoblastic and Monocytic Leukemia (FAB Subtype M5)
Acute Erythroid Leukemia (FAB Subtype M6)
Acute Megakaryoblastic Leukemia (FAB Subtype M7)
Acute Basophilic Leukemia
Acute Panmyelosis with Myelofibrosis
Myeloid Sarcoma
Myeloid Proliferations Related to Down Syndrome (Trisomy 21)
Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDC)
Acute Leukemias of Ambiguous Lineage
CHAPTER 9:
Acute Lymphoblastic Leukemia/Lymphoma, Mature T- and B-cell Leukemias
Acute Lymphoblastic Leukemia/Lymphoma (ALL)
WHO Classification of Precursor Lymphoid Neoplasms
B-ALL
B-lymphoblastic Leukemia/Lymphoma with Recurrent Genetic Abnormalities
t(9;22)(q34;q11.2)
t(v;11q23) MLL Rearranged
t(1;19)(q23;p13.3)
t(12;21)(p13;q22)
t(5;14)(q31;q32)
T Acute Lymphoblastic Leukemia/Lymphoma
Differential Diagnosis of ALL
Hematogones and B-ALL
Reactive Lymphocytosis
Aplastic Anemia
Acute Myeloid Leukemia
Burkitt Leukemia/Lymphoma
Blastic Mantle Cell Lymphoma
Metastatic Small Cell Tumor
Mature B-cell Leukemia
Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)
B-cell Prolymphocytic Leukemia (B-PLL)
Hairy Cell Leukemia
Mature T-cell Leukemia and Natural Killer Cell-Large Granular Lymphocyte Leukemia (NK-LGLL)
Classification
T-cell Prolymphocytic Leukemia (T-PLL)
T-cell Large Granular Lymphocytic Leukemia (T-LGLL)
NK-Large Granular Lymphocytes Leukemia
Aggressive NK-cell Leukemia
Adult T-cell Leukemia/Lymphoma
Sézary Syndrome
CHAPTER 10:
Non-Hodgkin Lymphomas, Plasma Cell Neoplasms and Histiocytic/Dendritic Cell Neoplasms
Non-Hodgkin Lymphomas
Mature B-cell Lymphomas with Small to Medium Sized Lymphocytes
Lymphoplasmacytic Lymphoma
Nodal Marginal Zone Lymphoma
Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue Type
Follicular Lymphoma
Mantle Cell Lymphoma
Diffuse Large B-cell Lymphoma (DLBCL)
Diffuse Large B-cell Lymphoma (DLBCL), Not Otherwise Specified
DLBCL Morphological Variants
DLBCL Subtypes
B-cell Lymphoma, Unclassifiable with Features Intermediate between DLBCL and Burkitt Lymphoma
B-cell Lymphoma, Unclassifiable with Features Intermediate between DLBCL and Classical Hodgkin Lymphoma (CHL)
Burkitt Lymphoma
Mature T-cell and Natural Killer (NK) Cell Neoplasm
Extranodal NK/T-cell Lymphoma, Nasal Type
Enteropathy Associated T-cell Lymphoma (EATL)
Subcutaneous Panniculitis-like T-cell Lymphoma
Mycosis Fungoides
Primary Cutaneous CD30+ T-cell Lymphoproliferative Disorders
Peripheral T-cell Lymphoma, Unspecified (PTCL, NOS)
Angioimmunoblastic T-cell Lymphoma
Anaplastic Large Cell Lymphoma, ALK-positive
Anaplastic Large Cell Lymphoma (ALCL), ALK-negative (provisional entity in WHO 2008)
Plasma Cell Neoplasms
Classification of Plasma Cell Neoplasms
Monoclonal Gammopathy of Undetermined Significance
Diagnostic Criteria for MGUS (WHO 2008)
Diagnostic Criteria for Plasma Cell Myeloma (WHO 2008)
Variants of Plasma Cell Myeloma
Amyloidosis and Systemic Light and Heavy Chain Deposition Disease
Osteosclerotic Myeloma (POEMS Syndrome)
Cryoglobulinemia
Three Types of Cryoglobulinemia
Laboratory Evaluation
Histocytic and Dendritic Cell Neoplasms
Langerhans Cell Histiocytosis (LCH)
Histiocytic Sarcoma
Follicular Dendritic Cell Sarcoma
Interdigitating Dendritic Cell Sarcoma
CHAPTER 11:
Hodgkin Lymphoma
CHAPTER 12:
Lymphoproliferative Disorders Associated with Immunodeficiency and Post-transplantations
Primary Immune Disorders Associated with Lymphoproliferative Disorders
Wiskott-Aldrich Syndrome
Common Variable Immunodeficiency Disorder
Ataxia Telangiectasia
X-linked Lymphoproliferative Syndrome
Disorders Associated with Acquired Immunodeficiency
Lymphomas that Associated with HIV Infection
Multicentric Castleman's Disease with HIV Infection
Post-transplant Lymphoproliferative Disorder
Classification of Post-transplant Lymphoproliferative Disorders (WHO 2008)
Diagnostic Approach to PTLD
Prognosis
CHAPTER 13:
Flow Cytometry
Principles of Flow Cytometry and its Applications
Applications of Flow Cytometry
Lineage Associated Markers of Flow Cytometry Phenotyping
Interpretation Flow Cytometry Results
Flow Cytometry Study Cases
CHAPTER 14:
Molecular Pathology
Basic Concept and Terminology
Methods in Molecular Pathology
Specimen Collection
Sources of Nucleic Acid
Southern Blot
Polymerase Chain Reaction
Real Time PCR
DNA Sequencing
Protein Truncation Test
Fluorescence In Situ Hybridization
Detecting Methylation of DNA
Gene Microarray Technology (Gene Chips)
Microsatellite Instability Assays
Genetic Abnormalities and Molecular Basis of Diseases
Common Recurrent Genetic Abnormalities in Soft Tissue and Bone Tumors
Breast Tumors
CNS Tumors
Gastrointestinal Cancers
Gynecologic Tumors
Lung Tumors
Renal Tumors
Salivary Gland Tumors
Testicular Germ Cell Tumors
Thyroid Tumors
Hematopoietic Neoplasms may Contain JAK2 Mutation
Hematopoietic Neoplasms with an Increased Tyrosine Kinase Activity
Questions and Answers
Appendix
WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues (2008; 4th Ed)
MYELOPROLIFERATIVE NEOPLASMS
MYELOID AND LYMPHOID NEOPLASMS WITH EOSINOPHILIA AND ABNORMALITIES OF PDGFRA, PDGFRB OR FGFR1
MYELODYSPLASTIC/MYELOPROLIFERATIVE NEOPLASMS
MYELODYSPLASTIC SYNDROMES
ACUTE MYELOID LEUKEMIA (AML) AND RELATED PRECURSOR NEOPLASMS
Acute myeloid leukemia, NOS
ACUTE LEUKEMIA OF AMBIGUOUS LINEAGE
PRECURSOR LYMPHOID NEOPLASMS
MATURE B-CELL NEOPLASMS
MATURE T-CELL AND NK-CELL NEOPLASMS
HODGKIN LYMPHOMA
HISTIOCYTIC AND DENDRITIC CELL NEOPLASMS
POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS (PTLD)
INDEX
TOC
Index
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