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Published on: November 4, 2016
Plasmacytoid dendritic cells in the setting of myeloid neoplasms: Diagnostic guide to challenging pathologic
1Department of Pathology, University of Rochester Medical Center, Rochester, New York, USA.
Insights
This study outlines three key ways plasmacytoid dendritic cells (pDCs) appear with myeloid neoplasms, aiding diagnosis. It proposes a classification system for these pDC-related myeloid neoplasms.
Area of Science:
- Hematology
- Immunology
- Pathology
Background:
- Plasmacytoid dendritic cells (pDCs) have complex associations with myeloid neoplasms.
- Accurate classification of these conditions is crucial for patient management.
Purpose of the Study:
- To describe three main pathologic presentations of pDCs in myeloid neoplasms.
- To provide a diagnostic algorithm for classifying pDC-related myeloid neoplasms.
- To clarify and standardize nomenclature for pDC states in myeloid neoplasms.
Main Methods:
- Review of clinical practice cases involving pDCs and myeloid neoplasms.
- Description of pathologic features for each presentation.
- Development of a diagnostic algorithm based on observed presentations.
Main Results:
- Identification of three presentations: mature pDC expansion (e.g., CMML), pDC differentiation (e.g., AML), and association with BPDCN.
- Discussion of AML with pDC-like phenotype.
- Establishment of a proposed diagnostic algorithm.
Conclusions:
- A structured approach to classifying pDC-associated myeloid neoplasms is presented.
- The proposed algorithm aims to improve diagnostic accuracy and consistency.
- Clarifying nomenclature is essential for understanding the biology of pDCs in myeloid malignancies.
Abstract:
In this article, we describe three broad pathologic presentations of plasmacytoid dendritic cells (pDCs) that may be encountered in clinical practice, in which an association between pDCs and myeloid neoplasms is identified: (1) myeloid neoplasms with mature pDC expansion, most commonly seen in chronic myelomonocytic leukaemia (CMML); (2) myeloid neoplasms with pDC differentiation, in which pDCs show a spectrum of maturation from early immature pDCs to mature forms, most commonly seen in acute myeloid leukaemia (AML); (3) myeloid neoplasms associated with blastic plasmacytoid dendritic cell neoplasm (BPDCN), either stemming from the same precursor or representing an independent clonal process. Additionally, we also discuss AML with pDC-like phenotype, in which myeloblasts show immunophenotypic features that may mimic those seen in pDCs. Using these presentations, we provide a diagnostic algorithm for appropriate pathologic classification, while attempting to clarify and homogenize nomenclatures pertaining to different biologic states of pDCs.
