Ginell Post, MD, PhD

Neoplastic micro-follicles (CD10) in a predominantly diffuse FL involving inguinal LN. CD23+ and lack of IgH-BCL-2. NGS: mut CREBBP, KMT2D (MLL2), STAT6 D419G & TNFRSF14 loss (del1p36). #hemepath #lymphoma #lymsm

The most common clinical presentation of this rare hematopoietic malignancy is a cutaneous lesion. #hemepath #dermpath

Child with left neck mass and polyclonal hypergammaglobulinemia. #hemepath

Child with lethargy and a skin rash. #hemepath

@lbsmithmd @ClinChemMD Techs put cell count (%) into “other” cells with a comment that characterization requires pathologist review.

@GPostMDPHD @ClinChemMD Do techs call before diff is verified or does it wait? We have to verify diff and do a report but techs call with “prelim” critical value.

How should we conceptualize blasts as critical values? Unlike potassium or PT/PTT, these require pathologist confirmation. Curious to know how others approach this #hemepath #hematology #medtwitter

@lbsmithmd @ClinChemMD First time occurrence of “blasts” requires pathologist review/confirmation before differential cell count is released. At our children’s hospital, technicians preliminary classify as “other” cells.

@ClinChemMD And is 1% blasts critical? Hardly in many situation. Newborns, premies, kids recovering from chemo. I think waiting to confirm it leads to less confusion.

A cytopenic patient with spindle cell lesion diffusely involving the bone marrow. Strongly ERG-positive. Dx: Angiosarcoma. BM angiosarcoma are more often metastasis, with spleen to be one of the common sites for primary lesion. PMID: 15462503, 30627296

@codarra Hematopathology.

I actually really like dermatopathology. A lot more than I thought I would! So much so that I'm now considering a fellowship?? #dilemma #toomanytochoose

#hemepath #pathology Ah, a simple uninspired surgical sign out. Just this hammertoe left and I can leave e…. auggghhh! Subsequent serum showed 3.3 g/dL monoclonal IgM kappa.

Don't think I can find a more classic smear than this for hairy cell leukemia.

Young child with failure to thrive, developmental delay, steatorrhea. Smear shows acanthocytes- thorn cells - a helpful clue to establishing the rare diagnosis of abetalipoproteinemia.

Follicular hyperplasia and beautiful monocytoid B-cells after #Covid_19 vaccine. #hematology #hemepath #pathology

Elderly male with anemia #hemepath #ASH_imagebank @ASH_hematology @gvencut1 Pic courtesy: Nomusa Mashigo; Robert Kingsley Lohlun; Keshanya Moodley

Today we had this smear and Dr. @ChrisTormey3 taught me that these are also called Pince-nez cells. Appreciating how steampunk they look now🥸#hemepath #PathTwitter #pathology

Blood Work: A case of lymphocytic variant hypereosinophilic syndrome in an elderly patient ow.ly/2u8Y50Dg1Dx

What is the microorganism depicted below, extensively involving the bone marrow and the peripheral blood? #pathboards #hemepath #micropath (Marrow aspirate and blood smear, Wright-Giemsa; marrow core, H&E) 📸 credit: @NedaWickEdPath

In summary, whenever you see immunoblastic morphology (prominent central nucleoli) consider the ddx provided. ALK + LBCL can be misdiagnosed as carcinoma (can have Keratins) or undiff neoplasm. Good panel includes CD20, CD138, LCA, EBER, ALK, CD30, HHV8.

Don't let this zebra fool you! On low power it may look like myelofibrosis, but closer inspection and appropriate stains confirm its true identity: metastatic angiosarcoma #hemepath #SocHemepath #SHTopics Read more: pubmed.ncbi.nlm.nih.gov/30733205/

#hemepath #hemepathMDA First time presentation of blastoid mantle cell lymphoma in peripheral blood.

Circulating mantle cell lymphoma. Leukemic phase of MCL is more commonly seen in SOX11 negative cases. The blastoid morphology is also a mimicker for AML.