A Test Utilization Approach to the Diagnostic Workup of Isolated Eosinophilia in Otherwise Morphologically Unremarkable Bone Marrow

Fang, Hong; Ketterling, Rhett P.; Hanson, Curtis A.; Pardanani, Animesh; Kurtin, Paul J.; Chen, Dong; Greipp, Patricia T.; Howard, Matthew T.; King, Rebecca; Dyke, Daniel L. Van; Reichard, Kaaren K.

doi:10.1093/ajcp/aqy064

Cited by 12 publications

(9 citation statements)

References 39 publications

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“…These cases accounted for 9% (7/77) of patients with HES in whom neither a reactive nor neoplastic cause was identified after an extensive workup (Hu et al, 2018). Reported incidences of L‐HES among patients with eosinophilia vary (Fang et al, 2018; Shi et al, 2019), depending on the patient populations screened. Seven of these patients had clinical symptoms and signs related to an eosinophilic infiltrate or eosinophil activation.…”

Section: Discussionmentioning

confidence: 99%

Lymphocytic variant of hypereosinophilic syndrome: A report of seven cases from a single institution

Wang

Thakral

et al. 2020

Cytometry Part B Clinical

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Background: Lymphocytic variant of hypereosinophilic syndrome (L-HES) is a subtype of HES driven by cytokines produced by clonal T-cells. Due to the rarity of its occurrence and challenges in diagnosis, this subtype of HES is under recognized. Methods and Results: We report seven patients with L-HES, diagnosed from a group of 136 patients who were referred to our institution for the work-up of hypereosinophilia. The clinical presentation, symptoms and signs were heterogeneous and uncharacteristic; indistinguishable from idiopathic HES. Flow cytometry immunophenotypic analysis revealed aberrant T-cells in all patients, with a Th2 immunophenotype, CD2 + CD3−CD4 + CD5 + CD7dim+/−CD8− in six of seven (86%) cases. CD10 was partially expressed in one of seven (14%) cases, and clonal TCR gene rearrangement was detected by PCR in five of seven (71%) patients. All patients were treated with corticosteroids and two of seven (29%) patients received anti-IL5 antibody therapy. With a median follow-up time of 7.5 years (2.3-14.1 years), one (11%) patient developed peripheral T-cell lymphoma 6.1 years after the initial diagnosis of L-HES and responded well to chemotherapy. All patients were alive at the last follow-up. Conclusion: In conclusion, a combination of flow cytometry immunophenotyping and molecular analysis allows the identification of aberrant T-cells, facilitating a diagnosis of L-HES in patients with eosinophilia. A correct diagnosis is essential for the proper management of these patients.

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Section: Discussionmentioning

confidence: 99%

Lymphocytic variant of hypereosinophilic syndrome: A report of seven cases from a single institution

Wang

Thakral

et al. 2020

Cytometry Part B Clinical

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“…21 Department of Pathology, Ambroise Pare Hospital, AP-HP and Versailles SQY University, Boulogne, France. 22 Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 23 Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg and Department of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…Several changes to the diagnostic criteria of CEL are introduced: (1) the time interval required to define sustained hypereosinophilia is reduced from 6 months to 4 weeks; (2) addition of requirement for both clonality and abnormal bone marrow morphology (e.g., megakaryocytic or erythroid dysplasia); and, (3) elimination of increased blasts (≥2% in peripheral blood or 5-19% in bone marrow) as an alternative to clonality. These criteria improve the distinction between CEL and entities such as idiopathic hypereosinophilic syndrome and hypereosinophilia of unknown significance [ 22 ]. As the criteria of CEL and its place relative to other disorders with eosinophilia have become well characterized, the qualifier “not otherwise specified” is no longer needed and has been omitted from the name.…”

Section: Myeloproliferative Neoplasmsmentioning

confidence: 99%

The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms

et al. 2022

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The upcoming 5th edition of the World Health Organization (WHO) Classification of Haematolymphoid Tumours is part of an effort to hierarchically catalogue human cancers arising in various organ systems within a single relational database. This paper summarizes the new WHO classification scheme for myeloid and histiocytic/dendritic neoplasms and provides an overview of the principles and rationale underpinning changes from the prior edition. The definition and diagnosis of disease types continues to be based on multiple clinicopathologic parameters, but with refinement of diagnostic criteria and emphasis on therapeutically and/or prognostically actionable biomarkers. While a genetic basis for defining diseases is sought where possible, the classification strives to keep practical worldwide applicability in perspective. The result is an enhanced, contemporary, evidence-based classification of myeloid and histiocytic/dendritic neoplasms, rooted in molecular biology and an organizational structure that permits future scalability as new discoveries continue to inexorably inform future editions.

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“…It is important to emphasize that having an unremarkable bone marrow by histology does not exclude a clonal process and necessitates further evaluation. 124 Bone marrow biopsy interpretation recommendation-mastocytosis. Although H&E can easily detect clusters of mast cells, they are not always present; thus, one should have a low threshold for using additional special stains (Giemsa) or IHC to detect mast cell-mediated disease.…”

Section: Bone Marrow Biopsy: Interpretationmentioning

confidence: 99%

“…151 Thus, in patients with HE for which bone marrow assessment does not yield a specific diagnosis, it is indicated to perform IHC for tryptase, CD117, and CD25 to assess for SM. 124 Because abnormal mast cells can be seen in both MLNeo and SM, positive IHC should be followed by further testing, including KIT mutation assessment as discussed in the ''Ancillary testing for mastocytosis'' section.…”

Section: Bone Marrow Biopsy: Interpretationmentioning

confidence: 99%

Developing a standardized approach for assessing mast cells and eosinophils on tissue biopsies: A Work Group Report of the AAAAI Allergic Skin Diseases Committee

Zimmermann

Abonia

Dreskin³

et al. 2021

Journal of Allergy and Clinical Immunology

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AAAAI Position Statements,Work Group Reports, and Systematic Reviews are not to be considered to reflect current AAAAI standards or policy after five years from the date of publication. The statement below is not to be construed as dictating an exclusive course of action nor is it intended to replace the medical judgment of healthcare professionals. The unique circumstances of individual patients and environments are to be taken into account in any diagnosis and treatment plan. The statement reflects clinical and scientific advances as of the date of publication and is subject to change.

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A Test Utilization Approach to the Diagnostic Workup of Isolated Eosinophilia in Otherwise Morphologically Unremarkable Bone Marrow

Cited by 12 publications

References 39 publications

Lymphocytic variant of hypereosinophilic syndrome: A report of seven cases from a single institution

Lymphocytic variant of hypereosinophilic syndrome: A report of seven cases from a single institution

The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms

Developing a standardized approach for assessing mast cells and eosinophils on tissue biopsies: A Work Group Report of the AAAAI Allergic Skin Diseases Committee

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