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Pathology—Patient with possible Hirschsprung disease: Case study
Published in Victoria A. Lane, Richard J. Wood, Carlos A. Reck-Burneo, Marc A. Levitt, Pediatric Colorectal and Pelvic Surgery, 2017
Victoria A. Lane, Richard J. Wood, Carlos A. Reck-Burneo, Marc A. Levitt
H + E stain: One of the principal stains in histology.Staining involves the application of hemalum, a complex formed from aluminum ions and hematein (an oxidation product of hematoxylin).Hemalum stains nuclei blue.The nuclear stain is followed by counterstaining with eosin, which colors other structures red/pink/orange.H + E staining remains the method of choice for the identification of ganglion cells.Regular biopsies for H + E slide studies require fixation of material in buffered formalin and then standard processing.
Treatment of hairy cell leukemia
Published in Expert Review of Hematology, 2020
Dai Chihara, Robert J. Kreitman
The definition of CR includes absence of morphologic evidence of HCL in both blood and bone marrow aspirate and biopsy, and near normalization of peripheral blood counts without transfusion or growth factors for at least 4 weeks: hemoglobin > 11–12 g/dL, platelets > 100/nL, and absolute neutrophil count > 1.5/nL [6,16]. Patients in CR should have regression of splenomegaly by physical exam, although incomplete regression and even residual hypersplenism can persist despite CR [29]. This may be due to residual enlargement of non-hematologic structural components of the spleen which takes longer to resolve. In Partial remission (PR) but not CR, patients may have residual disease in the bone marrow by hematoxylin and eosin (H/E) stain [6,16,30]. PR by the consensus guidelines requires near normalization of the blood count as required by CR criteria and at least 50% reduction in organomegaly and bone marrow HCL infiltration [6,31]. Several protocols besides ours accepted >50% improvement in cytopenias as sufficient for PR [16,32,33], and in these protocols resolution of cytopenias to CR criteria qualified as a ‘good PR’ [32] or hematologic remission (HR) [34–37]. Our protocols have avoided the PR requirement for >50% improvement bone marrow infiltration due to the heterogeneity of marrow infiltration in multiply relapsed HCL. Also, we try to delay post-treatment bone marrow procedures until patients meet all other criteria to confirm CR. Also, for PR, we and others required 50% or greater reduction in circulating HCL cells [14,16,38], and we do not rely on physical exam to assess splenomegaly due to lack of accuracy and objectivity. Morphologic relapse includes leukemic cells in peripheral blood and/or bone marrow biopsy by morphologic stains, while hematologic relapse involves reappearance of cytopenias. Treatment is generally considered necessary for hematologic but not morphologic relapse, due to the long period of time which usually occurs between morphologic and hematologic relapse.