The edition · Pathology
Marrow cellularity in fibrotic myelofibrosis, and TRBC1 before clonality testing in cutaneous T-cell lymphoma
A multicentre marrow series links cell depletion in MF-3 to high-risk mutations and shorter survival; a 665-biopsy cohort supports a TRBC1-first workup for suspected mycosis fungoides.
The edition in brief
An eleven-institution Bone Marrow Pathology Group study of 241 patients with advanced fibrotic myelofibrosis found that cell-depleted marrows carried more ASXL1, U2AF1, EZH2 and MPL mutations, more osteosclerosis, worse blood counts and shorter overall survival than cellular marrows. A multicentre colorectal cancer study classified 10,410 non-metastatic lymph nodes on H&E as stimulated, unstimulated or depleted with high reproducibility, and a model built on those subtypes added prognostic information in external validation. A review sets out the current subdivision of high-grade follicular cell-derived thyroid carcinoma and the diagnostic traps in anaplastic carcinoma. The practice-changer is a 665-biopsy cohort with paired TCR clonality testing: TRBC1 immunohistochemistry reached 85.8% sensitivity and 79.8% specificity, polytypic staining effectively excluded clonality, and the authors propose TRBC1 first with reflex molecular testing only for borderline or discordant cases.
Cell-depleted marrow in MF-3 myelofibrosis marks higher-risk disease
Report cellularity and osteosclerosis explicitly in MF-3 myelofibrosis trephines, since depletion tracks with high-risk mutations and shorter survival.
Non-metastatic lymph nodes in colorectal cancer carry prognostic information on H&E
H&E morphology of non-metastatic nodes may refine colorectal cancer prognosis, but it is not ready for routine reporting.
High-grade thyroid carcinoma: the categories between differentiated and anaplastic
Name high-grade thyroid carcinoma categories explicitly and plan biomarker testing early in suspected anaplastic carcinoma.
What makes a trephine adequate for fibrosis grading
Grade marrow fibrosis only on an adequate trephine, using reticulin in haematopoietic areas, and say so when the core falls short.
TRBC1 immunohistochemistry first for suspected cutaneous T-cell lymphoma
Consider TRBC1 immunohistochemistry first in suspected cutaneous T-cell lymphoma, reserving TCR clonality testing for borderline or discordant cases.
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