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- W1866803003 abstract "2721 Introduction: In majority of hematologic malignancies, morphology supplemented with immunohistochemistry (IHC) and/or flow cytometric (FCM) immunophenotyping can discriminate between a malignant and reactive lymphoproliferation. In about 10% of cases, additional ancillary studies such as T cell receptor (TCR) gamma gene rearrangement and immunoglobulin heavy chain (IgH) gene rearrangement are ordered to provide additional evidence that “suspicious” histological changes may represent a malignant process. T cell lymphomas in particular are often difficult to distinguish from atypical T cell proliferations. Our study focuses on the contribution of TCR gamma clonality assessment assay towards accurate diagnosis and staging of hematologic malignancies. Methods: From January to October 2006, 111 specimens were evaluated for TCR gamma clonality in the AP Molecular Pathology laboratory at Henry Ford Hospital. Histologic evaluation, IHC, and sometimes FCM evaluations were also performed on all cases. Specimen types were as follows: skin biopsy (74), lymph node biopsy (15), peripheral blood (7), bone marrow (5), and miscellaneous extranodal lymphoid proliferations (10). DNA was isolated and subjected to PCR amplification for TCR gene rearrangement (TCR Gamma Gene Rearrangement Assay, In Vivo Scribe, San Diego, CA). The amplified PCR products were analyzed by capillary electrophoresis. Gene rearrangement test results were correlated with other histologic and clinical features. Results: Of the111 specimens, 50 demonstrated clonal TCR gamma gene rearrangement (31 skin, 8 lymph node, 5 blood, 4 bone marrow, and 2 breast biopsy specimens). For 15 of these, all other histological, IHC and FCM (when available) findings were inconclusive. Positive gene rearrangement results prompted closer monitoring of these patients, and T cell malignancies were subsequently confirmed in most of these cases. TCR gamma gene rearrangement testing was negative in 52 cases of atypical lymphoid proliferation, confirming other histologic findings. Nine of the specimens (7 skin and 2 lymph node) gave what appeared to be false negative results. Four of these subsequently demonstrated T cell clonality when repeat biopsies were tested. Conclusion: As with many diseases with a spectrum of clinical and pathologic findings, demonstration of clonal T cell proliferation can confirm diagnosis, or help to raise suspicion of a T cell lymphoma. In cases of atypical lymphoid proliferation, negative results are highly suggestive of a reactive process. The results of this study demonstrate that, in addition to histologic diagnosis, ancillary gene rearrangement studies can further define difficult cases, especially difficult to diagnose dermatologic malignancies." @default.
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- W1866803003 date "2007-05-01" @default.
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- W1866803003 title "Significant contribution of TCR gamma gene rearrangement testing to accurate diagnosis and staging of T cell lymphomas" @default.
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