Did I Miss It? Discovering Hidden Coexisting Hematological Neoplasms: A Single Institutional Review of 100 Collision Tumors

Evan Himchak, Etan Marks, Yang Shi, Yanhua Wang

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1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalInternational Journal of Surgical Pathology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Hematologic Neoplasms
Neoplasms
B-Cell Chronic Lymphocytic Leukemia
Follicular Lymphoma
Lymphoma, Large B-Cell, Diffuse
Hodgkin Disease
Acute Myeloid Leukemia
Prostate
Lymphoma
Colon
Breast

Keywords

  • carcinoma
  • collision tumor
  • leukemia
  • lymphoma
  • sarcoma

ASJC Scopus subject areas

  • Anatomy
  • Surgery
  • Pathology and Forensic Medicine

Cite this

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title = "Did I Miss It? Discovering Hidden Coexisting Hematological Neoplasms: A Single Institutional Review of 100 Collision Tumors",
abstract = "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.",
keywords = "carcinoma, collision tumor, leukemia, lymphoma, sarcoma",
author = "Evan Himchak and Etan Marks and Yang Shi and Yanhua Wang",
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T2 - A Single Institutional Review of 100 Collision Tumors

AU - Himchak, Evan

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AU - Shi, Yang

AU - Wang, Yanhua

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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.

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