p53 immunohistochemistry discriminates between pure erythroid leukemia and reactive erythroid hyperplasia

Journal of Hematopathology - 2021
Christina Alexandres1, Basma Basha2, Rebecca King3, Matthew T. Howard3, Kaaren K. Reichard3
1Mayo Clinic Alix School of Medicine, Rochester, MN, USA
2Division of Hematopathology, Sidra Medicine, Doha, Qatar
3Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic College of Science and Medicine, 200 1st Street, Hilton 8-00C, Rochester, MN, 55905, USA

Tóm tắt

Abstract

Pure erythroid leukemia (PEL) is a rare, aggressive subtype of acute myeloid leukemia with a poor prognosis. The diagnosis of PEL is often medically urgent, quite challenging, and is typically a diagnosis of exclusion requiring meticulous distinction from non-neoplastic erythroid proliferations, particularly florid erythroid hyperplasia/regeneration. Given the frequency of TP53 mutations in the molecular signature of PEL, we hypothesize that differential p53 expression by immunohistochemistry (IHC) may be useful in distinguishing PEL versus non-neoplastic erythroid conditions. We performed p53 IHC on 5 normal bone marrow, 46 reactive erythroid proliferations, and 27 PEL cases. We assessed the positivity and intensity of nuclear staining in pronormoblasts and basophilic normoblasts using a 0–3+ scale with 0 being absent (with internal positive controls) and 3 being strong nuclear positivity. A total of 26/27 PEL cases showed strong, uniform, diffuse intense staining by the neoplastic pronormoblasts versus 0/5 and 0/46 normal and reactive controls, respectively. The control cases show various staining patterns ranging from 0 to 3+ in scattered erythroid precursor cells. Uniform, strong p53 positivity is unique to PEL and discriminates this entity from a benign erythroid mimic. Thus, p53 IHC may be a useful marker in urgent medical cases to assist in the confirmation of a malignant PEL diagnosis while awaiting the results of additional ancillary studies such as cytogenetics.

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Journal of Hematopathology

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