Hematopathology Diagnosis

血液病理诊断

• 批准号: 8349313
• 负责人: Elaine Jaffe
• 金额: $ 57.4万
• 依托单位: DIVISION OF BASIC SCIENCES - NCI
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8349313
• 关键词: Acute Lymphocytic Leukemia; Acute T Cell Leukemia; Adopted; American; Area; Autoimmune Diseases; Award; B-Cell Lymphomas; B-Lymphocytes; Basic Science; Benign; Biological Markers; Blood; Case Series; Cell Differentiation process; Cell physiology; Child; Childhood; Classification; Clinical; Clinical Protocols; Clinical Research; Clinical Services; Collaborations; Communities; Consultations; Cytogenetics; Dendritic Cell Sarcoma; Dermatology; Detection; Development; Diagnosis; Diagnostic; Diagnostic Services; Disease; Education; Educational Activities; Educational process of instructing; Extranodal; Fellowship Program; Flow Cytometry; Follicular Lymphoma; Genes; Genetic; Goals; Growth; Hematologic Neoplasms; Hematology; Hematopathology; Histiocytic sarcoma; Hodgkin Disease; Hyperplasia; Immunoglobulins; Immunohistochemistry; Immunologic Deficiency Syndromes; In Situ; In Situ Hybridization; Individual; Indolent; Institutes; Institution; International; Intestines; Journals; Knowledge; Laboratories; Laboratory Technicians; Langerhans-Cell Histiocytosis; Lesion; Libraries; Lymphoblastic Leukemia; Lymphocyte Function; Lymphoid Cell; Lymphoma; Lymphomatoid Granulomatosis; Lymphoproliferative Disorders; Malignant Neoplasms; Malignant lymphoid neoplasm; Medical Oncology; Mission; Molecular; National Heart, Lung, and Blood Institute; National Human Genome Research Institute; National Institute of Allergy and Infectious Disease; Natural Killer Cells; Nature; Newly Diagnosed; Nodal; Pathogenesis; Pathologist; Pathology; Patients; Pediatric Oncology; Physicians; Physiology; Plasmacytoma; Population; Production; Productivity; Protocols documentation; Publications; Regional Cancer; Reporting; Research; Research Personnel; Research Training; Reverse Transcriptase Polymerase Chain Reaction; Risk; Sampling; Services; Staging; Surgical Pathology; T-Cell Lymphoma; T-Cell and NK-Cell Neoplasm; T-Lymphocyte; Testing; Time; Transplantation; Transplantation Immunology; Triage; Uncertainty; United States National Institutes of Health; Viral; Work; autoimmune lymphoproliferative syndrome; base; clinical Diagnosis; clinical practice; disease classification; follow-up; in vivo; laser capture microdissection; leukemia/lymphoma; lymphoid neoplasm; member; multidisciplinary; neoplastic; novel; oncology; programs; promoter; symposium; tool; transdifferentiation; translational study; young adult

The Hematopathology Section of the Laboratory of Pathology, NCI, offers expert diagnostic services in the field of hematopathology. Dr. Stefania Pittaluga, Staff Clinician, and I handle diagnostic service responsibilities equally, each rotating as the staff on service 50% of the time. However, because of the challenging nature of the material we receive for review, and obligations related to specific clinical protocols and teaching conferences, our clinical obligations extend well beyond the designated on-service time. In the past year we were responsible for more than 2700 cases (36% of all department-wide surgical pathology cases), and a 12-15% increase in service load over the past four years. Dr. Pittaluga spends at least 75% of her time on clinical service or educational activities. She oversees triage of clinical samples received by the laboratory, a time consuming activity due to the complicated and sometimes competing demands of clinical protocols. In addition to serving as a Staff Hematopathologist, she assists in supervising the Immunohistochemistry service, and does the laboratory development for new hematopathology tests that are later introduced into the routine test library. She also directs the In Situ Hybridization service. She is supported in these activities by a laboratory technician, and a Post-Baccalaureate fellow. As will be discussed below, Dr. Pittaluga is also Program Director of the Hematology Fellowship program. Her contributions to the clinical, research, and educational programs of the NIH were recognized in 2010, when she was one of a select group to receive an NIH Individual Merit Award from the NCI Director, Dr. Varmus, and the only member of the Laboratory of Pathology to be so honored. Dr. Pittaluga and I provide assistance in the diagnosis and classification of reactive and neoplastic lymphoproliferative disorders, immunodeficiency states, and diverse hematological malignancies. We provide consultative and collaborative services to physicians in the NCI, as well as to physicians studying patients with hematolymphoid disorders in other institutes, in particular NIAID, NHLBI, NHGRI, and NIAMSD. We cosponsor a monthly multidisciplinary case review conference discussing diagnostic or management problems in lymphoma, and in addition regularly present at conferences sponsored by NCI clinical branches (Pediatric Oncology, Medical Oncology, Dermatology, Experimental Transplantation & Immunology), and by NIAID, NHLBI, and NHGRI. We serve as Associate Investigators on more than 40 clinical protocols being conducted in the NCI and other NIH institutes. These protocols frequently mandate specialized testing to characterize the biological markers relevant to the particular study. In collaboration with other service units (Specialized Diagnostics, Cytogenetics, Flow Cytometry), we utilize a variety of diagnostic tools. The Section also provides in situ hybridization services for detection of Epstein Barr viral (EBV) sequences, and other diagnostic and experimental targets. We receive more than 2200 cases in consultation each year. Recent studies have highlighted the importance of secondary review for the diagnosis and proper treatment of patients with lymphoma.1, 2 Because of the demands that the consultation service places on our time, we try to restrict consultations to difficult or challenging cases. Many cases are submitted by other academic institutions, based on diagnostic uncertainty, or because of differences of opinion among several institutions. We regularly refuse to accept consultations that we regard to be of a routine nature, and recommend that such cases be sent to routine reference laboratories. We frequently make novel observations based on this unique clinical practice, and a number of publications have emanated from case material originally reviewed in consultation. Thus, I believe our clinical work enhances, rather than detracts, from our academic productivity. In many instances consultation cases are submitted to us based on prior publications from our laboratory. These cases contribute to our research mission, as they help us to expand our knowledge of rare entities, and characterize these disorders. Specific examples and the relevant publications are discussed under other projects. However, among them they include in situ follicular lymphoma,3 pediatric marginal zone lymphomas, 4, 5 NK-cell enteropathy,6 histiocytic sarcomas arising in B-cell or T-cell malignancies,7-9 and plasmacytomas with production of IgA.10 1. Proctor IE, McNamara C, Rodriguez-Justo M, Isaacson PG, Ramsay A. Importance of Expert Central Review in the Diagnosis of Lymphoid Malignancies in a Regional Cancer Network. J Clin Oncol 2011. 2. Jaffe ES. Centralized Review Offers Promise for the Clinician, the Pathologist, and the Patient With Newly Diagnosed Lymphoma. J Clin Oncol 2011. 3. Cong P, Raffeld M, Teruya-Feldstein J, Sorbara L, Pittaluga S, Jaffe ES. In situ localization of follicular lymphoma: description and analysis by laser capture microdissection. Blood 2002;99:3376-82. 4. Taddesse-Heath L, Pittaluga S, Sorbara L, Bussey M, Raffeld M, Jaffe ES. Marginal zone B-cell lymphoma in children and young adults. The American journal of surgical pathology 2003;27:522-31. 5. Rizzo KA, Streubel B, Pittaluga S, et al. Marginal zone lymphomas in children and the young adult population; characterization of genetic aberrations by FISH and RT-PCR. Mod Pathol 2010;23:866-73. 6. Mansoor A, Pittaluga S, Beck PL, Wilson WH, Ferry JA, Jaffe ES. NK-cell enteropathy: a benign NK-cell lymphoproliferative disease mimicking intestinal lymphoma: clinicopathologic features and follow-up in a unique case series. Blood 2011;117:1447-52. 7. Feldman AL, Minniti C, Santi M, Downing JR, Raffeld M, Jaffe ES. Histiocytic sarcoma after acute lymphoblastic leukaemia: a common clonal origin. The lancet oncology 2004;5:248-50. 8. Feldman AL, Berthold F, Arceci R, et al. Clonal relationship between precursor T-lymphoblastic leukaemia/lymphoma and Langerhans-cell histiocytosis. Lancet Oncology 2005;6:435-7. 9. Feldman AL, Arber DA, Pittaluga S, et al. Clonally related follicular lymphomas and histiocytic/dendritic cell sarcomas: evidence for transdifferentiation of the follicular lymphoma clone. Blood 2008;111:5433-9. 10. Shao H, Xi L, Raffeld M, et al. Nodal and extranodal plasmacytomas expressing immunoglobulin a: an indolent lymphoproliferative disorder with a low risk of clinical progression. The American journal of surgical pathology 2010;34:1425-35.

NCI病理学实验室的血液病理学科提供血液病理学领域的专家诊断服务。Stefania Pittaluga医生，临床医生，和我平等地承担诊断服务职责，每人轮流担任50%的服务时间。然而，由于我们收到的材料具有挑战性，以及与特定临床协议和教学会议相关的义务，我们的临床义务远远超出了指定的在职时间。在过去的一年里，我们处理了2700多例病例（占全科室外科病理病例的36%），在过去的四年里，服务负荷增加了12-15%。Pittaluga博士将至少75%的时间用于临床服务或教育活动。她负责监督实验室收到的临床样本的分诊，这是一项耗时的活动，因为临床协议的要求很复杂，有时还会相互竞争。除了作为一名工作人员血液病理学家，她还协助监督免疫组织化学服务，并为新的血液病理学测试进行实验室开发，这些测试后来被引入常规测试库。她还指导原位杂交服务。在这些活动中，她得到了一名实验室技术员和一名学士学位后研究员的支持。正如下面将要讨论的，Pittaluga博士也是血液学奖学金项目的项目主任。她对NIH的临床、研究和教育项目的贡献在2010年得到认可，当时她是获得NCI主任Varmus博士颁发的NIH个人优异奖的精选小组之一，也是病理学实验室唯一获得如此荣誉的成员。Pittaluga博士和我在反应性和肿瘤性淋巴增生性疾病、免疫缺陷状态和各种血液恶性肿瘤的诊断和分类方面提供帮助。我们为NCI的医生以及其他机构（特别是NIAID、NHLBI、NHGRI和NIAMSD）研究血淋巴疾病患者的医生提供咨询和协作服务。我们每月共同主办一次多学科病例回顾会议，讨论淋巴瘤的诊断或管理问题，此外，我们还定期出席由NCI临床分支（儿科肿瘤学、内科肿瘤学、皮肤病学、实验移植与免疫学）以及NIAID、NHLBI和NHGRI主办的会议。我们在NCI和其他NIH研究所进行的40多个临床方案中担任副研究员。这些方案通常要求进行专门的测试，以表征与特定研究相关的生物标志物。我们与其他服务单位（专业诊断、细胞遗传学、流式细胞术）合作，利用各种诊断工具。该科还提供原位杂交服务，用于检测eb病毒（EBV）序列，以及其他诊断和实验目标。我们每年接受超过2200例的咨询。最近的研究强调了二次复查对淋巴瘤患者的诊断和适当治疗的重要性。1,2由于咨询服务对我们时间的要求，我们尽量将咨询限制在困难或具有挑战性的情况下。许多病例是由其他学术机构提交的，基于诊断的不确定性，或者因为几个机构之间的意见分歧。我们通常拒绝接受我们认为属于常规性质的咨询，并建议将此类病例送到常规参考实验室。我们经常根据这种独特的临床实践做出新的观察，许多出版物来自最初在咨询中审查的病例材料。因此，我相信我们的临床工作提高而不是减损了我们的学术生产力。在许多情况下，咨询病例是根据我们实验室先前的出版物提交给我们的。这些病例有助于我们的研究任务，因为它们帮助我们扩大对罕见实体的了解，并确定这些疾病的特征。具体的例子和相关的出版物将在其他项目中讨论。然而，其中包括原位滤泡性淋巴瘤，3例儿童边缘带淋巴瘤，4,5例nk细胞肠病，6例b细胞或t细胞恶性肿瘤引起的组织细胞肉瘤，7-9和产生IgA的浆细胞瘤。10 1。李建军，李建军，李建军，等。专家中心评价在淋巴细胞恶性肿瘤诊断中的作用。临床肿瘤学杂志，2011。2. Jaffe ES。集中审查为临床医生、病理学家和新诊断的淋巴瘤患者提供了希望。临床肿瘤学杂志，2011。3. 王晓明，王晓明，王晓明，王晓明，王晓明。滤泡性淋巴瘤的原位定位：激光捕获显微解剖的描述和分析。血2002;99:3376 - 82。4. 塔德斯-希思L， Pittaluga S, Sorbara L, Bussey M, Raffeld M, Jaffe ES。儿童和年轻人的边缘带b细胞淋巴瘤。美国外科病理杂志2003；27:522-31。5. Rizzo KA, Streubel B, Pittaluga S，等。儿童和青年人群的边缘区淋巴瘤；利用FISH和RT-PCR鉴定遗传畸变。现代病理杂志2010；23:866-73。6. Mansoor A, Pittaluga S, Beck PL, Wilson WH, Ferry JA, Jaffe ES。nk细胞性肠病：一种类似肠淋巴瘤的良性nk细胞淋巴增生性疾病：临床病理特征和独特病例系列的随访。血2011;117:1447-52。7. Feldman AL, Minniti C, Santi M, Downing JR, Raffeld M, Jaffe ES。急性淋巴细胞白血病后组织细胞肉瘤：一种常见的克隆起源。柳叶刀肿瘤学2004；5:48 -50。8. 张建军，张建军，张建军，等。前体t淋巴细胞白血病/淋巴瘤与朗格汉斯细胞组织细胞增多症的克隆关系。柳叶刀肿瘤学2005；6:43 35-7。9. Feldman AL, Arber DA, Pittaluga S，等。克隆相关滤泡性淋巴瘤和组织细胞/树突状细胞肉瘤：滤泡性淋巴瘤克隆转分化的证据。血2008;111:5433-9。10. 邵辉，席磊，Raffeld M，等。表达免疫球蛋白a的淋巴结和结外浆细胞瘤：一种临床进展风险低的惰性淋巴增生性疾病。美国外科病理杂志2010；34:1425-35。