Morphological Subtypes Research Articles

Atrial functional mitral regurgitation: The concept has evolved, but inconsistencies still remain.

In our commentary we elucidated the fact that functional mitral regurgitation (FMR) is divided into two morphological subtypes: annular dilation with normal leaflet motion (Carpentier type I) and restricted systolic motion with left ventricular remodeling or dysfunction (Carpentier type IIIb). However, these phenotypes show some degree of overlap and there are currently no distinctive diagnostic cut-off values, therefore they may represent a continuum of the same disease. Moreover, correct left chambers quantification is critical for differentiating between atrial FMR and ventricular FMR. Three-dimensional echocardiography can quantify better leaflet areas, lengths, and closing angles, as well as the coaptation index, by eliminating geometric assumptions and integrating tethering of all leaflet surface and annular area enlargement. Also, It is expected that the use of artificial intelligence solutions and the deployment of automated onboard software that requires no or limited human input will stimulate wider clinical use of three-dimensional echocardiography in left chambers quantification.

Immunolocalization of CD1a expressing dendritic cells in sinonasal polyposis

ABSTRACT Sinonasal polyps are benign projections of edematous nasal mucosa lined by respiratory epithelium. Langerhans cells (LCs) belonging to the dendritic cell family located in respiratory epithelium are involved in antigen presentation and maintenance of local immunological homeostasis. This study aims to elucidate the morphology and distribution of CD1a positive LCs in normal nasal mucosa and compare the same with polypoid nasal mucosa by immunohistochemistry. Normal nasal mucosa (n = 20) was obtained from patients who underwent septoplasty for deviated nasal septum. Polypoid nasal mucosa (n = 22) was obtained from patients with chronic rhinosinusitis (CRS) or allergic fungal rhinosinusitis who underwent excision of nasal polyps. The tissues obtained were processed for immunohistochemistry and stained with CD1a-EP80 Rabbit monoclonal antibody. In the tissues studied, CD1a positive LCs were observed in both the epithelium and lamina propria. Different morphological subtypes of LCs were noted in the epithelium. The cells were distributed adjacent to walls of subepithelial capillaries and cysts. The median number of CD1a positive LCs was significantly higher in polypoid category (13.5 per mm2) as compared with normal nasal mucosa (2.5per mm2) (p = .001). Presence of CD1a positive LCs in polypoid nasal mucosa hints at a critical immunological role in the etiopathogenesis of nasal polyps.

Molecular subtyping of gastric cancer according to ACRG using immunohistochemistry – Correlation with clinical parameters

BackgroundGastric cancer (GC) is a very heterogenous disease necessitating further stratification for prognostic and therapeutic aspects. Based on the recommendation of The Asisan Cancer Research Group (ACRG) recently established four molecular subtypes (MSI, MSS/EMT, MSS/TP53+, MSS/TP53-) which require molecular expression analysis. The technology required for comprehensive molecular analysis is expensive and not applicable for routine diagnostics. Thus, in this study we established a classification system utilizing immunohistochemistry and morphology-based analyses as surrogate markers in order to reproduce the ACRG molecular subtypes of gastric cancer. To clarify the clinical relevance of the novel classification system, we performed a correlation with established clinical parameters. MethodsThe study cohort consisted of 189 patients with GC (UICC III and IV). Using immunohistochemistry, the following markers were analysed: MLH1, MSH2, MSH6, PMS2 (as a surrogate for microsatellite status), p53, SOX9. We assessed tumor budding as a surrogate for EMT to distinguish between MSS/EMT and MSS/non-EMT groups. ResultsImmunohistochemical and morphologic subtyping classified cases as follows: 10% MSI, 35% MSS/EMT, 16% MSS/TP53 + and 39% MSS/TP53–. Subtypes significantly correlated with the Lauren classification, tumor stage, venous invasion and SOX9 expression (p < .05). There was no significant correlation between molecular subtype and lymph node growth pattern. ConclusionWe propose a simple algorithm for molecular subtyping of GC using universally available immunohistochemistry, which correlates with clinical parameters and is cost-effective and applicable in diagnostic routine. This classification might prospectively help to determine patient prognosis, optimize patient care and homogenize patient cohorts for clinical trials.

The five phenotypes of tricuspid regurgitation: insight from cluster analysis of clinical and echocardiographic variables

Abstract Funding Acknowledgements Type of funding sources: None. Background Tricuspid regurgitation (TR) is a prevalent valvular lesion with three broad morphologic subtypes: primary due to intrinsic pathology of the valve or subvalvular apparatus; secondary due to pulmonary hypertension; and isolated TR associated with chronic atrial fibrillation. The complex pathophysiological, clinical and echocardiographic features between these subtypes require further investigation. Purpose We aimed to identify the different phenotypes of TR using cluster analysis, and determine differences (if present) in clinical outcomes associated with these phenotypes. Methods We included 13611 patients with ≥ moderate TR, either primary or secondary, in the final analyses. The demographic, clinical and echocardiographic data of these patients were evaluated using Ward’s minimum variance cluster analysis including a total of 38 variables. Survival analysis for all-cause mortality was performed using the Kaplan-Meier method, and groups were compared using the log-rank test. Results The mean age of patients was 72.5 ± 13.4 years, 7590 (56%) were females. The clustering identified 5 distinct phenotypes. Cluster 1 represented "low-risk TR" with lesser severity likely related to chronic atrial fibrillation. This cluster had less severe TR, normal sized right ventricle and fewer comorbidities. Clusters 2-5 represented "higher severity TR", "TR associated with lung disease", "TR associated with coronary artery disease and ischemic cardiomyopathy" and "TR associated with chronic kidney disease" respectively (Figure 1). Cluster 1 had the best overall survival, followed by clusters 2, 3 and 4, and lastly cluster 5, with the worst outcome (Figure 2). Conclusions Cluster analysis identifies 5 phenotypically distinct novel subgroups of TR with differences in all-cause mortality. This phenotype-based classification improves our understanding of interaction of different co-morbidities with this complex valve lesion and can inform clinical decision making. Abstract Figure. Cluster Dendrogram Abstract Figure. Kaplan-Meier survival curves

Reduced Plasmacytoid Dendritic Cell Output Is Associated With High Risk in Low-grade Myelodysplastic Syndrome.

Reduced Plasmacytoid Dendritic Cell Output Is Associated With High Risk in Low-grade Myelodysplastic Syndrome.

Differential expression of CK7, CK20, CDX2 in intestinal and pancreatobiliary types of preriampullary carcinoma.

Incidence of periampullary carcinoma is low, approximately 0.5-2% of all gastrointestinal malignancies. Histologic subtyping has a prognostic bearing. The purpose of this study is to differentiate periampullary carcinomas based on immunohistochemistry (IHC) by using cytokeratin 7 (CK7), cytokeratin 20 (CK20), caudal type homeobox 2 (CDX2). To analyze the usefulness of IHC as single/panel of markers that included CK7, CK20, and CDX2. This was a prospective study done from January 2017 to September 2018. A total 50 pancreaticoduodenectomy specimens were evaluated and classified as intestinal (INT) and pancreaticobiliary (PB) types based on their morphological and immunohistochemical features, respectively. The morphologic subtypes, expression of IHC markers were correlated with different histologic parameters. Chi-square test was used to study the association between different IHC markers with histologic parameters. Probability (P) values <0.05 were regarded as statistically significant. The expression of CK7, CK20, CDX2 were studied in 50 cases to classify them as INT and pancreatobiliary subtypes. CK7 has high sensitivity (88.2%), CDX2 has high specificity (96.4%), CK20+/CDX2+ has both high sensitivity (94.2 percent) and specificity (89.2 percent) in differentiating INT from pancreatobiliary subtypes. The morphologic subtypes showed correlation with two variables (tumor grade, pathologic T stage). CK20 and CK20/CDX2 expression showed a positive correlation with tumor grade, pathologic T staging, and lymphovascular invasion. In conclusion, morphological classification can significantly discriminate histologic types, IHC plays a moderate role. However, the combined expression of CK20 and CDX2 is helpful in subtyping.

A0066 - How important are morphologic subtypes on the prognosis of surgically treated non-metastatic papillary renal cell carcinoma? An analysis from a contemporary multi-institutional database

A0066 - How important are morphologic subtypes on the prognosis of surgically treated non-metastatic papillary renal cell carcinoma? An analysis from a contemporary multi-institutional database

Quantifying corneal immune cells from human in vivo confocal microscopy images: Can manual quantification be improved with observer training?

Manually quantifying immune cells (ICs), commonly considered dendritic cells, in the corneal epithelium from in vivo confocal microscopy (IVCM) images can be influenced by observer bias. This study sought to evaluate the repeatability of manual IC quantification. Cell counts were first performed for 184 non-overlapping IVCM images by a single observer. Quantifications were undertaken to establish the total cell numbers per image, and the numbers of three cell morphological subtypes: mature ICs (with elongated dendrites), immature ICs (with short- or non-discernible dendrites) and globular cells (with large bodies and no visible dendrites). Cell counts were then repeated by the same observer, and independently undertaken by a second observer. Prior to these counts, both observers undertook an agreement ‘training’ process to define IC appearance and delineate the morphological subtypes.Total IC counts demonstrated excellent intra- and inter-observer reliability (intraclass correlation coefficients (ICC) > 0.90). Bland-Altman plots showed that interobserver measurement bias increased as a function of the total IC number in the image prior to consensus training. For total IC counts after the observer training process, there was no significant interobserver measurement bias. For IC morphological subtypes, there was a positive relationship between the mean inter-observer difference and average cell count for mature ICs and globular cells, but not immature ICs.In conclusion, higher variability in manual corneal IC counts exists when more cells are present in an IVCM image. Implementing an observer training process reduced inter-observer variability and minimised systematic measurement error.

Myxoid liposarcoma of small bowel presenting with intussusception and obstruction: A case report

Gastrointestinal liposarcomas are extremely rare with the most common reported morphological subtype being dedifferentiated liposarcoma and well-differentiated liposarcoma. These tumors are rarely diagnosed preoperatively and diagnosis is only confirmed on histopathological analysis. Treatment of gastrointestinal liposarcomas consists of surgical excision with widely negative margins followed by post-operative irradiation and close follow-up. We report an exceedingly rare case of myxoid liposarcoma of the small bowel (ileum) presenting with an unusual presentation with intussusception and intestinal obstruction. A 42-year-old male presented to the emergency department with features of intestinal obstruction. Contrast-enhanced computed tomography abdomen revealed ileo-ileal intussusception with an endoluminal soft-tissue lesion at the leading edge. The patient was taken for surgical intervention and the involved segment of the bowel along with the lesion was resected and re-anastomosis done. Histological sections of the mass along with immunohistochemistry suggested the pathological diagnosis of myxoid liposarcoma.

Brain metastases originating in breast cancer: clinical-pathological analysis and immunohistochemical profile.

The incidence of brain metastases (BMs) originating in breast cancer (BC) is increasing due to advances in imaging techniques, which can detect such events early, and due to new therapies that can ensure longer survival. We performed a retrospective study on patients with BMs originating in BC and receiving surgical treatment in Neurosurgery Clinics of Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, from January 2018 to December 2019. We identified 10 consecutive patients who underwent a craniotomy for a BMs originating in a BC (either for diagnostic purpose or with therapeutic intent). Clinicopathological data were collected from the electronic medical record and included the patient demographics (age at diagnosis of their BM), morphological characteristics of BM [location, cytopathological features, histopathological (HP) subtype, and immunohistochemical features, i.e., cytokeratin 5/6 (CK5/6), mammaglobin, estrogen receptor (ER), progesterone receptor (PR), and Ki67 labeling index (LI)], and time from BC diagnosis to BM diagnosis. Ninety percent of patients were in their sixth and seventh decades of life, with a median age of 57.9 years (47–65 years). Median time from BC diagnosis to BM was 34.42 months. Fifty percent of BMs were located in the parietal lobes, and 70% of all cases have multiple (≥2) BMs. All cases (100%) had a cytopathological examination, showing a hypercellular pattern, with poorly cohesive clusters of mild or pleomorphic cells, with nuclei with homogeneously distributed fine granular chromatin membrane, and with small or enlarged and irregular nucleoli. The dominant histopathology was invasive breast carcinoma of no special type (IBC-NST) (70%), but we also identified specific subtypes, i.e., tubular carcinoma (TC) (20%) and invasive micropapillary carcinoma (IMPC) (10%). Correlating location with HP subtypes of BMs from BC, IBC-NST and IMPC were located mostly in parietal lobes, and TC developed only in the occipital lobe. We found three patterns of immunostaining: (i) CK5/6 +/-, mammaglobin+, ER+, PR-, which was much more characteristic for IBC-NST; (ii) CK5/6-, mammaglobin+, ER-, PR-, being identified in tubular breast carcinoma; (iii) CK5/6 +/-, mammaglobin-, ER-, PR-, which were revealed by invasive micropapillary breast carcinoma. Our study revealed the fact that BMs originating in BC show heterogeneity of hormone receptor status, although morphologically there is not so much diversity. We also found a very variable Ki67 LI, which correlated especially with the morphological subtype.

Morphological and immunohistochemical characterization and molecular classification of spontaneous mammary gland tumors in macropods.

Mammary gland neoplasms in macropods are uncommonly reported, and the morphological and immunohistochemical characteristics are incompletely described. The goal of this study was to describe the morphologic features of macropod mammary neoplasms and to determine the molecular subtypes of mammary carcinomas using a panel of antibodies against estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (Her-2), p63, smooth muscle actin (SMA), and epidermal growth factor receptor (EGFR). Biopsy and necropsy specimens were examined from 21 macropods with mammary tumors submitted to Northwest ZooPath from 1996 to 2019. In accordance with the histologic classification of canine mammary tumors proposed by Goldschmidt and colleagues, tubulopapillary (2), tubular (10), and comedo-carcinomas (2), adenoma (1), lobular hyperplasia (3), fibroadenomatous hyperplasia (1), and mastitis (2) were diagnosed. Red kangaroos (Osphranter rufus) were most commonly diagnosed with mammary carcinomas (79% of all carcinomas). Seven carcinomas had lymphovascular invasion and 2 also had pulmonary metastases. Six of these 7 carcinomas were classified as grade 3. Immunohistochemistry (IHC) for all antibodies was performed on 9/14 carcinomas, and partial IHC was performed for 3 cases. All 12 carcinomas were immunoreactive for PR, 5 for ER, 9 for EGFR, and none for Her-2. Five of the 9 mammary carcinomas with complete IHC data were classified as luminal A subtype, and 4 were normal-like subtype. Accurate classification of mammary tumors in macropods based on morphology, immunohistological characteristics, and molecular subtype may be helpful in guiding clinical management, prognosis, and potential therapeutic targets.

Imaging mimickers of cholangiocarcinoma: a pictorial review.

Cholangiocarcinoma (CCA) is the second most common primary hepatobiliary malignancy and presents as three separate morphological subtypes; namely mass-forming, periductal-infiltrating, and intraductal-growing patterns. Each of these subtypes have distinct imaging characteristics, as well as a variety of benign and malignant mimics, making accurate diagnosis of CCA on imaging challenging. Whilst histopathological examination is required to arrive at a definitive diagnosis, it is still important for radiologists to be cognizant of these entities and provide reasonable differential diagnoses, as these potentially have a large impact on patient management. This pictorial essay illustrates the three morphological subtypes of CCA, as well as some important mimics for each subtype, that are encountered in clinical practice.

Skin and Mucosal Manifestations in NEMO Syndrome: A Case Series and Literature Review.

To characterize the skin and mucosal findings of NEMO syndrome. Retrospective review of clinical characteristics from a cohort of two families with mutations in IKBKG (the NEMO-encoding gene). A literature review identified 86studies describing 192 patients with IKBKG mutations whose data were also included. Single center with literature review. Patients with mutations in IKBKG from our center and reported in the literature. Skin and mucosal characteristics of patients with NEMO syndrome. In addition to ectodermal dysplasia and recurrent infections, male patients had findings of ichthyosis, palmoplantar keratoderma, and inflammatory skin diseases. Both male and female patients had mucocutaneous ulcers and slow-to-heal chronic wounds. In combination with patients from the literature, 59% (85/144) of males had ectodermal dysplasia with anhidrosis (EDA) features, and 8% and 10% (12/144; 6/63) of males and females had dental findings, respectively. 4% (6/144) of males and 32% (20/63) of females had mucocutaneous ulcers. Ichthyosis/xerosis was present in 15% of males (21/144) but only 2% (1/63) females. Similarly, 13% (18/144) of male patients presented with dermatitis while this was reported in only 2% (1/63) of females. Our results both confirm and expand upon the known spectrum of mucocutaneous findings in NEMO syndrome. Further genetic studies are needed to correlate specific mutations to clinical and morphologic subtypes.

Morphological and syntactic identification of clauses of universal concession in British National Corpus

The article investigates morphological and syntactic organization of English sentences of universal concession in modern English fiction dramatic, prose and verse texts of the British National Corpus. In the context of the studied sentences identification with the semantics of concessive action, the main attention is focused on generalization of morphological and syntactic characteristics of universal sentences of concession with the verification of their statistical data implementation in the modern English corpus. It has been found out that in the fiction texts of the British National Corpus English sentences of universal concession are actualized in four syntactic types of sentences: in simple, compound, complex, and cohesive types, where the concessive action clause is introduced by various types of conjunctions such as though, even though, although; in any case, in spite of; yet … (al)though etc. with / without punctuation for the cohesive type. Morphological features of means of syntactic connection are defined in three types of clauses of concession with hypotactic, paratactic, cohesive conjunction coherence in the morphological configuration as: “simple means of connection – conjunctions or adverbs”, “complex or composite means of connection – prepositional phrases”, “correlative means of connection – correlative conjunctions or disjuncts”. Seven basic morphological and syntactic subtypes of English sentences of universal concession have been identified with the syntactic description of models of concessive clauses as: finite / non-finite -ed (-ing) participial / non-finite to infinitive / nominative / prepositional / adjective / adverb clause of concession. In order to identify the structural semantic grid of the studied sentences, taking into account the corpus analysis in terms of the semantic marking tagging with the collocation [+1 Right] to the right of the conjunction of the universal concession, the quantitative indicators of nine structural and semantic types of concessive clauses are determined and calculated in the adjustment of the concessive conjunction with any verb, noun, adjectival, adverbial, conjunctive, prepositional, pronominal categorical phrase, as well as the agreement with any article and punctuation.

Diffuse large B-cell lymphoma and new insights into its pathobiology and implication in treatment.

The most common non-Hodgkin lymphoma (NHL) subtype is diffuse large B-cell lymphoma (DLBCL). It accounts for roughly 30% of all cases of NHL affecting both nodal and extra nodal sites. There are molecular subtypes of DLBCL, germinal centre subtype (GCB), and activated B-cell (ABC), based on gene expression profiling (GEP), in accumulation to distinct morphological and clinicopathological subtypes. To prognosticate patients, the International Prognostication Index (IPI) and its variants are used. In ABC type DLBCL, limited stage disease is treated with a combination of abbreviated systemic chemotherapy (three cycles) and field radiation therapy. Although advanced stage disease is treated with a full course of chemotherapy as well as novel agents (Bortezomib, Ibrutinib, Lenalidomide). In this review study, we looked at the role of multiple aspects of genetic and microenvironment changes which have effects in DLBCL tumours.

Mixed Invasive Ductal and Lobular Carcinoma of the Breast (IDC-L): Rare Morphological Subtype

Mixed Invasive Ductal and Lobular Carcinoma of the Breast (IDC-L): Rare Morphological Subtype

Symptomatic Hallux Valgus Deformities and 1st Tarsometatarsal Joint Morphology

Category:Bunion; Midfoot/ForefootIntroduction/Purpose:The pathogenesis of the hallux valgus deformity is still poorly understood. Consistent observations of the 1st tarsometatarsal (TMT) joint as the CORA of hallux valgus raises questions about pathology associated with that joint. Mason and Tanaka studied the 1st TMT joint in cadaveric specimens in 2012, observing three morphological subtypes to the 1st cuneiform articular surface. They noted that specimens with hallux valgus had either a unifacet (37%) or bifacet (63%) appearance, where normal feet had a trifacet appearance. This observation suggests that these bony differences may be responsible for 'instability' that generates the metatarsal deviation into varus, and thus the development of hallux valgus. If true, surgical corrections for hallux valgus deformity should address this TMT joint pathology.Methods:This study was designed to correlate the morphological differences of the TMT joint with symptomatic hallux valgus patients who are seeking surgery. The hypothesis was that the hallux valgus patients would show a majority unifacet and bifacet morphology and have an inclination towards unifacet in younger patients and patients with a larger deformity. The cohort of patients who are in the registered longitudinal study Align3D had their TMT joints harvested in a standard fashion as part of their surgical treatment. These specimens were analyzed for the number of facets by the surgeon at the time of their surgical procedure. This cohort therefore only includes symptomatic hallux valgus patients and eliminates hallux valgus associated with metatarsus adductus. Standard weight-bearing x-rays taken pre-operatively were analyzed for severity of deformities. Functional and Patient Reported Outcome measures were obtained pre-operatively and post-operatively.Results:In this study we observed 143 specimens. Unifacet was observed in 116 specimens (81.1%), bifacet was observed in 26 specimens (18.2%), and trifacet was observed in 1 specimen. Neither X-Ray findings, age, nor Functional Scores suggested a trend in severity in relation to morphological type. Mason & Tanaka's cadaveric study was limited in some respects because of the hardening effect of formaldehyde preservations. Their study represented an elderly population, mean age 86 years, whereas this study represented a much younger population, mean age 40.6, in which patients were able to participate in both X-Ray and clinical scoring. To the best of our knowledge, this is the first time that morphology of the TMT joint has been studied in symptomatic hallux valgus patients who underwent surgery.Conclusion:Symptomatic hallux valgus deformities are associated with a higher likelihood of having a unifacet morphology than previously reported in cadavers (81.1% vs 37%). This morphology may predispose patients to decreased stability resulting in more symptomatic deformity. The number of facets does not seem to correlate with severity of deformity on X-Ray evaluation, nor does it correlate with age. However, the younger age group in our study as compared to Mason and Tanaks's study suggests that morphological differences may even be congenital, leading to later development of deformity.

Increment of the incidence of glioblastoma following decrease in the incidence of brain tumors in 2000-2020: a population-based registry study

Prevalence and dynamics of certain morphological variants of neuroglial brain malignancies (ICD-10 C71) are unknown in the Russian Federation. To assess the incidence of neuroglial brain malignancies in 2000-2020 considering individual records of morphologically verified cases in the cancer registry of the Arkhangelsk region. We analyzed overall and age-adjusted incidence of neuroglial brain malignancies in 2000-2020 considering morphological subtypes of tumor. Incidence of morphologically verified glioblastoma was assessed in detail taking into account gender, age and place of residence. Segmented regression analysis was used to assess the dynamics and significance of linear trends. In total, there were 1699 brain malignancies for the period from 2000 to 2020. Morphological verification was obtained in 1289 (76%) patients including 467 (27%), 92 (5%) and 307 (18%) ones with glioblastoma, anaplastic G3 glioma and G2 glioma, respectively. Percentage of glioblastoma and anaplastic gliomas increased from 23.4% and 3.9% in 2000 to 55.3% and 9.2% in 2020, respectively. Age-adjusted incidence for the entire C71 group decreased from 5.2 to 3.2 cases per 100,000 after 2015 (annual decline 7.1%). However, incidence of glioblastoma monotonously increased from 1.0 to 2.1 per 100,000 (annual increment 6.2%). Incidence was similar in men and women. Age-adjusted incidence was 50-70% higher among rural population. Significant increase (>2 times) in the incidence of glioblastoma was found over the past twenty years. Probably, it is associated with improved diagnosis and registration of this disease. In-depth analysis of morbidity and survival of patients with rare neuroglial tumors is required.

Acute myeloid leukemia

BACKGROUND: Acute myeloid leukemia (AML) is a heterogeneous disease as it affects multiple lineages of hematopoietic cells. AIMS AND OBJECTIVES: This study aims to (1) evaluate the immunophenotypic findings of AML patients, (2) correlate the morphological subtypes of AML according to French–American–British classification with immunophenotypic findings, and (3) correlate the immunophenotypic findings in AML patients with findings in cytogenetic studies. MATERIALS AND METHODS: The present study was a cross sectional study. Seventy three patients with a final diagnosis of AML, whose immunophenotyping and/or cytogenetic study results were available, were included in the study. RESULTS: Twenty one (31.81%) out of 66 patients with AML aberrantly expressed lymphoid antigens. The lymphoid antigens expressed were CD7, CD19, TdT, and CD5 which were found in 13 (19.69%), 9 (13.6%), 2 (3%), and 1 (1.51%) patient, respectively. Two out of three patients with t(8;21)(q22;q22) had CD19 aberrant expression. This association was found to be statistically significant with the Fisher exact test, with a statistic value of 0.0277 (P &lt; 0.05). Co expression of two lymphoid antigens such as CD7 and CD19 was associated with monosomy 7 and was found to be statistically significant with a Fisher exact test, with a statistic value of 0.0217 (P &lt; 0.05). In our study, t(8;21) (q22;q22) was found in AML M2 and AML M1. Many of the patients in our study were diagnosed as acute leukemia by morphological evaluation and were not diagnosed as AML. However, immunophenotyping and cytogenetics helped in getting final diagnosis of such patients. CONCLUSION: In conclusion, this study highlights the importance of morphological, immunophenotypic, and cytogenetic evaluations in the diagnosis of AML.

Molecular subtyping and phylogeny of Blastocystis sp. isolated from turkey (Meleagris gallopavo) populations in Penang, Malaysi.

Most poultry farms in Malaysia preferred rearing chickens either for eggs or/and meat than turkeys. This is due to several challenges such as parasitic load and heat stress in rearing turkey. Blastocystis is one of the most common protozoan parasites infecting poultry. As no study was conducted on Blastocystis infection in turkey in Malaysia, this study aims to determine the current status, the morphological characteristics and subtyping of Blastocystis from turkey reared either in closed house or free-range system in Penang, Malaysia. It was found that the prevalence of Blastocystis sp. infection in turkeys were moderately high with 41.6% (25/60) in the closed house and 45.0% (45/100) in free-range system as infection was higher in the female turkeys with no gastrointestinal signs and symptoms. Vacuolar form was the most common form found in the in vitro culture ranged between 5 to 20 μm in diameter with a rough surface coat and undulating cell surface viewed under the scanning electron microscope. Meanwhile, the ultrastructure of the cells from turkey isolates were varies with partially expanded electron-opaque vacuoles to electron-dense in fully distended vacuoles. Interestingly, sequence analysis for 30 positive Blastocystis isolates from turkeys revealed one subtypes with three alleles namely, ST7 allele 99 (73.4%, n=22), ST7 allele 100 (23.3%, n=7) and ST7 allele 101 (3.3%, n=1). Findings from this study added to our understanding on Blastocystis infection in turkey production.