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Acute Leukemia Immunohistochemistry: A Systematic Diagnostic Approach

机译：急性白血病免疫组织化学：一种系统的诊断方法

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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.
机译：背景：白血病的诊断和分类正变得越来越复杂。当前的分类方案结合了形态学特征，免疫表型，分子遗传学和临床数据，以将白血病具体地分类为各种亚型。尽管复杂的方法学经常用于检测赋予诊断，预后或治疗意义的特征，但彻底的显微镜检查对于病理学评估仍然至关重要。详细的胚细胞免疫表型可以使用谱系和成熟特异性标志物进行。尽管没有一种标志物可代表一种恶性肿瘤，但精心挑选的抗体组可以有效地帮助急性白血病的诊断和分类。目的：回顾近期和历史文献中的重要发展。强调了最常见的淋巴样和髓样白血病的一般免疫组织化学染色模式。目的是讨论在没有流式细胞术和遗传学研究的情况下急性白血病的免疫染色。数据来源：对PubMed（国家医学图书馆）索引的相关文献和参考医学文献进行了全面审查。在审稿中还确定了其他参考文献。结论：使用免疫组织化学方法对淋巴样和髓样恶性肿瘤进行胚细胞免疫分型。建议最初和随后的其他抗体组以确认或排除鉴别诊断中的每种可能性，并讨论了诊断评估的一般策略。尽管仅单独使用免疫组织化学是有限的，并且强烈建议通过流式细胞仪和遗传研究进行评估，但不可避免的情况需要分析福尔马林固定的组织标本。当在优化的实验室中进行并结合仔细的形态学检查时，免疫组织化学方法代表了用于分类各种白血病的有用实验室工具。

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    《Archives of Pathology & Laboratory Medicine》 |2008年第3期|p.462-475|共14页
  • 作者

    Randall J Olsen Chung-Che Chang Jennifer L Herrick Youli Zu Aamir Ehsan;

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    Randall J. Olsen, MD, PhD, Chung-Che Chang, MD, PhD, Jennifer L. Herrick, MD, Youli Zu, MD, PhD, Aamir Ehsan, MDAccepted for publication May 21, 2007.From the Department of Pathology, The Methodist Hospital, Houston, Tex (Drs Olsen, Chang, and Zu), the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn (Dr Herrick), and the Department of Pathology, University of Texas Health Science Center, San Antonio (Dr Ehsan).The authors have no relevant financial interest in the products or companies described in this article.Corresponding author: Youli Zu, MD, PhD, Department of Pathology, The Methodist Hospital, 6565 Fannin St, M227, Houston, TX 77030 (e-mail: yzu@tmhs.org).,;

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