TY - JOUR
T1 - Did I Miss It? Discovering Hidden Coexisting Hematological Neoplasms
T2 - A Single Institutional Review of 100 Collision Tumors
AU - Himchak, Evan
AU - Marks, Etan
AU - Shi, Yang
AU - Wang, Yanhua
N1 - Publisher Copyright:
© 2018, © The Author(s) 2018.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - A collision tumor is defined as two histologically distinct tumor types identified at the same anatomic site. Hematolymphoid proliferative disorders (HLPDs), which coincide with non-hematological neoplasms, can mimic an immune response and can easily be overlooked as an immune reaction to a solid organ neoplasm, especially when low grade. In order to avoid a delay in the diagnosis of a HLPD during the workup for a non-hematological neoplasm, we identified a cohort of 100 cases with a HLPD diagnosis during the initial workup and treatment of a non-hematological neoplasm, or vice versa. Among the 100 collision tumors, the most common non-hematological neoplasms associated with a HLPD were from the colon (17%), breast (15%), and prostate (12%). The most commonly identified HLPDs were chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; 18%), diffuse large B-cell lymphoma (17%), follicular lymphoma (14%), marginal zone lymphoma (10%), acute myeloid leukemia (8%), and classical Hodgkin lymphoma (5%). Interestingly, in this cohort 5% of the low-grade HLPDs, all of them CLL/SLL, were missed at initial sign-out and subsequently required an addendum report. The other 95% of cases were reviewed or signed out by a hematopathologist before the report was finalized for the non-hematological neoplasm. In summary, high-grade hematological malignancies are less likely to be missed; however, low-grade coexisting HLPDs can be overlooked as a reactive immune response to a solid organ neoplasm. Therefore, it is important to keep in mind the existence of collision low-grade HLPDs before assuming the lymphoid infiltrates as an immunological response.
AB - A collision tumor is defined as two histologically distinct tumor types identified at the same anatomic site. Hematolymphoid proliferative disorders (HLPDs), which coincide with non-hematological neoplasms, can mimic an immune response and can easily be overlooked as an immune reaction to a solid organ neoplasm, especially when low grade. In order to avoid a delay in the diagnosis of a HLPD during the workup for a non-hematological neoplasm, we identified a cohort of 100 cases with a HLPD diagnosis during the initial workup and treatment of a non-hematological neoplasm, or vice versa. Among the 100 collision tumors, the most common non-hematological neoplasms associated with a HLPD were from the colon (17%), breast (15%), and prostate (12%). The most commonly identified HLPDs were chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL; 18%), diffuse large B-cell lymphoma (17%), follicular lymphoma (14%), marginal zone lymphoma (10%), acute myeloid leukemia (8%), and classical Hodgkin lymphoma (5%). Interestingly, in this cohort 5% of the low-grade HLPDs, all of them CLL/SLL, were missed at initial sign-out and subsequently required an addendum report. The other 95% of cases were reviewed or signed out by a hematopathologist before the report was finalized for the non-hematological neoplasm. In summary, high-grade hematological malignancies are less likely to be missed; however, low-grade coexisting HLPDs can be overlooked as a reactive immune response to a solid organ neoplasm. Therefore, it is important to keep in mind the existence of collision low-grade HLPDs before assuming the lymphoid infiltrates as an immunological response.
KW - carcinoma
KW - collision tumor
KW - leukemia
KW - lymphoma
KW - sarcoma
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U2 - 10.1177/1066896917752862
DO - 10.1177/1066896917752862
M3 - Article
C2 - 29320898
AN - SCOPUS:85042093614
SN - 1066-8969
VL - 26
SP - 296
EP - 305
JO - International Journal of Surgical Pathology
JF - International Journal of Surgical Pathology
IS - 4
ER -