Citations

Abstract Objective The successful diagnosis and classification of lymphoid neoplasms in blood and bone marrow is the responsibility of the practicing pathologist. This guide provides a general “roadmap” for this process, from initial case recognition to final classification. Methods The integration of hematologic, morphologic, immunophenotypic, and genetic features for the full spectrum of precursor and mature B-cell, T-cell, and natural killer–cell neoplasms that typically manifest in blood and bone marrow is included. Results Classification systems for lymphoid neoplasms provide criteria for pathologists to render a diagnosis that is optimal for patient care, treatment, and outcome prediction. Conclusions This guide provides diagnostic strategies for lymphoid neoplasms encountered in blood and bone marrow specimens using both the International Consensus Classification and the World Health Organization fifth edition classification systems. Key tips are provided for each entity along with testing requirements, differential diagnosis, nonneoplastic mimics, and other unique features based on the experience of the Bone Marrow Pathology Group members.

Abstract Objective Despite exponential growth in artificial intelligence (AI) research for laboratory medicine and pathology, a significant gap exists between model development and clinical AI implementation. This article introduces a structured framework, the Clinical AI Readiness Evaluator (CARE), to bridge this gap and support the responsible adoption of AI in clinical laboratory settings. Methods Building upon the Machine Learning Technology Readiness Levels framework, we developed CARE specifically for the clinical laboratory environment by incorporating health care–specific requirements, regulatory considerations, and workflow integration needs. This framework was iteratively refined through practical application across diverse AI use cases within laboratory medicine and pathology. Results The CARE framework provides a systematic approach to AI development and implementation through 8 component workstreams: clinical use case, data, data pipeline, code, clinical user experience, clinical technology infrastructure, clinical orchestration, and regulatory compliance. Unlike generic AI frameworks, CARE distinguishes itself by emphasizing both health care and laboratory workflow integration, regulatory requirements, ethical considerations, and comprehensive validation for clinical contexts. The framework accommodates both internally developed models and commercial AI solutions, providing clear guidance through technology readiness levels and structured review processes. Conclusions The CARE framework addresses the unique challenges of implementing AI in laboratory medicine and pathology by providing a comprehensive roadmap from initial concepts through clinical deployment and maintenance. This article, the first in a series of 4, establishes the foundational AI lifecycle framework, while subsequent articles will explore data documentation, ethical AI considerations, and governance structures. By adopting this structured approach, laboratories can responsibly harness AI’s potential to enhance diagnostic accuracy and operational efficiencies and, ultimately, improve patient care.

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare diffuse parenchymal lung disease representing 3% of all interstitial lung diseases. PLCH occurs either as part of multi-system Langerhans cell histiocytosis (LCH) or an isolated disease of the lung. Isolated involvement of lungs is observed in approximately 50–70% of LCH cases and the age of onset peaks between 20 and 40 years without gender difference. Cigarette smoking is the only identified environmental risk factor. PLCH is characterized by Langerhans cell infiltrates that in general are in a bronchiolocentric distribution. Pulmonary lesions can occur after chronic systemic disease or are an initial sign of disease. The aims of this study are to (1) report five rare cases of PLCH in adults; (2) discuss the relationship of PLCH with interstitial lung fibrosis; (3) provide a concise review of PLCH epidemiology, pathophysiology, diagnosis, treatment, and prognosis to improve the knowledge of PLCH by pneumologists and internal medicine physicians.

Abstract Background and Objectives Lucid episodes (LEs) in people living with late-stage dementia have been reported anecdotally. However, how this seemingly unexpected phenomenon is experienced by family caregivers is less known. Focusing on the two most common groups of informal caregivers, spouses and adult children, this study examined variability in family caregivers’ experiences with LEs—whether they exhibit differential appraisals of and responses to LEs. Research Design and Methods Using a sample of former/bereaved and current family caregivers from UsAgainstAlzheimer’s A-LIST, we conducted an online survey of spouse and child caregivers (N = 387). We conducted semistructured interviews among a subset of caregivers who witnessed a LE (n = 22). Results Overall, child caregivers were more likely to witness a LE than spouse caregivers. Among former/bereaved caregivers who witnessed a LE (n = 139), spouses were likely to report nonverbal communication during LEs, appraise LEs more negatively, and make changes in care decisions, such as end-of-life planning and financial decisions, compared to adult children. Among current caregivers who witnessed a LE (n = 80), spouses often reported no special circumstances preceding LEs, whereas children linked LEs to friend/family visits. No significant differences were found in positive and negative appraisals of LEs between current spouse and child caregivers. Content analysis of qualitative interviews revealed the contexts underlying these differences. Discussion and Implications Differences between spouses and adult children in their experiences with LEs are related to their different caregiving contexts, including relationship history, living arrangements, expectations, motivations, and caregiving resources.

Inherited platelet disorders (IPDs) are a group of rare conditions affecting platelet number, function, or both. Clinical manifestations vary widely, from asymptomatic cases to patients with severe bleeding, syndromic features, or early-onset blood cancers. Some are diagnosed due to family history. Early and accurate diagnosis—through both clinical and molecular evaluation—is essential for effective patient management and to avoid inappropriate treatments due to misdiagnosis. Genetic confirmation aids in prognosis, follow-up planning, family screening, genetic counseling, and donor selection for stem cell transplantation if required. However, diagnosing IPD is still challenging due to the disorders’ complexity and the limitations of current lab tests. This review outlines the diagnostic process for IPD and provides evidence-based, practical recommendations informed by scientific literature and clinical experience.

Introduction: Robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (PLND) represents the gold standard surgical treatment for high-risk localized prostate cancer. PLND carries the risk of lymphocele formation, which can lead to complications such as deep vein thrombosis (DVT), infection, and voiding dysfunction. Many techniques have been described to minimize lymphocele formation, yet no method has seen widespread use or been described as sutureless. The objective of this study is to describe the novel, sutureless peritoneal window (PWIN) technique and assess its efficacy in lymphocele prophylaxis for extended PLND. Methods: This was a retrospective review of patients with high-risk prostate cancer undergoing RARP with extended PLND by a single surgeon from 2018 to 2024. PLND was carried out in the usual manner with bipolar cautery. PWIN technique is performed by excising a 3 × 5 cm PWIN over the lymphadenectomy bed to maintain lymphatic communication with the abdominal cavity. The primary outcome was a comparison between the incidence of symptomatic lymphoceles (SLs) with PWIN vs standard technique. SLs were defined as lymphoceles presenting with pain, DVT, voiding dysfunction, or infectious symptoms. Patients with asymptomatic lymphoceles were excluded. Results: Our study included 199 patients who underwent RARP with extended PLND. There were 46 patients (23.1%) in the standard approach group and 153 patients (76.9%) in the PWIN group. We identified 5/46 (10.9%) SLs in the standard technique, which were significantly higher than the 3/153 (2.0%) observed in the PWIN group (p = 0.017). There was no difference between the standard and PWIN cohorts regarding symptomology or treatment of their lymphocele. Conclusion: This study describes a novel, sutureless PWIN technique that significantly decreases SL after extended PLND. This technique offers a practical, time-efficient, and cost-effective alternative for lymphocele prevention. Future prospective studies are warranted to validate these findings.

Background: During the COVID-19 pandemic, increased use of telehealth expanded access to health care for older adults. Many clinicians and health systems adjusted workflows and realized that certain competencies are needed to fully engage older adults in telehealth services. This scoping review evaluates the approaches needed to educate clinicians about providing telehealth services to older adults. Methods: We conducted a review of studies published from January 2000 through February 2024 by using the 6-stage scoping review process. Searches of PubMed/MEDLINE and five other databases included the concept areas of competencies, telehealth delivery of mental health services, and older adults. Results: We initially identified 813 articles, of which 89 were eligible for full-text review and 15 met our inclusion criteria. Most studies included training participants about the use of telehealth but without formal curricular interventions or evaluations and lacked details about topics, materials, methods, or outcomes. Telehealth training was general and focused primarily on the use of technology and telepresence, although not specifically for older adults. Three themes were identified from the studies: the role of teams and interprofessional education, the importance of training for clinicians and older patients, and adaptations to improve telehealth delivery for older adults. Conclusions: Individual and institutional competencies are needed to guide educational goals and outcome measures related to telehealth services for older adults. The use of telehealth specifically for older adults may require adaptation to clinical practice and delivery, adjustments to workflow, development of clinician skills, and promotion of interprofessional teamwork.

Background and purpose New Zealand White Rabbits are a useful preclinical model for neurovascular research. Inducing right common carotid artery aneurysms in New Zealand White Rabbits gives researchers the ability to test neurovascular devices in vivo. This study takes advantage of archived angiograms to obtain vascular measurements of interest for future research in rabbit models. Methods Rabbit angiograms from endovascular studies conducted in-house between 2005 and 2024 were analyzed using ImageJ at points of interest along the thoracic and abdominal aorta. Using scale references, the diameters of various New Zealand White Rabbit (2.5–3.5 kg) arteries were measured for aneurysm models and controls. Anatomic vascular variations were categorized and recorded. Results Measurable artery diameters at 39 points of interest were recorded for 170 female New Zealand White Rabbits. Type 1 vascular anatomy was the most common rabbit aortic arch, characterizing 85% of identifiable rabbit anatomies in this study. Conclusion By making these measurements available, this study simplifies future neurovascular studies, allowing for vasculature to be selected by size depending on the application. Additionally, the study offers insight into the relationship between elastase-induced aneurysms and surrounding vasculature size and draws size comparisons between some key arteries of interest.