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  1. Article ; Online: How I investigate difficult cells at the optical microscope.

    Zini, Gina

    International journal of laboratory hematology

    2020  Volume 43, Issue 3, Page(s) 346–353

    Abstract: Blood cell morphological identification on the peripheral blood and bone marrow films remains a cornerstone for the diagnosis of hematological neoplasms to be integrated with immunophenotyping, molecular genetics, and histopathology. Although ... ...

    Abstract Blood cell morphological identification on the peripheral blood and bone marrow films remains a cornerstone for the diagnosis of hematological neoplasms to be integrated with immunophenotyping, molecular genetics, and histopathology. Although standardization is still far from being achieved, with high interobserver variability, in recent years, several classification approaches, from the 1976 FAB to the 2016 WHO classification, have provided hematologists with detailed morphological descriptions for a large number of diseases. Counting blasts and detecting dysplastic specimens are two cornerstones of morphological diagnosis. This review deals with identifying difficult cells, with particular reference of those with relevant diagnostic implications.
    MeSH term(s) Animals ; Blood Cells/pathology ; Blood Cells/ultrastructure ; Bone Marrow Cells/pathology ; Bone Marrow Cells/ultrastructure ; Bone Marrow Diseases/diagnosis ; Bone Marrow Diseases/pathology ; Cell Nucleus/pathology ; Hematologic Neoplasms/diagnosis ; Hematologic Neoplasms/pathology ; Humans ; Leukemia/diagnosis ; Leukemia/pathology ; Microscopy/methods
    Language English
    Publishing date 2020-12-20
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2268590-X
    ISSN 1751-553X ; 1751-5521 ; 0141-9854
    ISSN (online) 1751-553X
    ISSN 1751-5521 ; 0141-9854
    DOI 10.1111/ijlh.13437
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: ICC-2022 versus WHO-2022 classification systems for acute leukemias and myeloid neoplasms: The perspective from two classical morphologists.

    Zini, Gina / Bennett, John M

    American journal of hematology

    2023  Volume 98, Issue 8, Page(s) E209–E211

    MeSH term(s) Humans ; Leukemia/genetics ; Myeloproliferative Disorders ; Acute Disease ; World Health Organization ; Leukemia, Myeloid, Acute/genetics
    Language English
    Publishing date 2023-05-22
    Publishing country United States
    Document type Letter
    ZDB-ID 196767-8
    ISSN 1096-8652 ; 0361-8609
    ISSN (online) 1096-8652
    ISSN 0361-8609
    DOI 10.1002/ajh.26963
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Coronavirus disease 2019 (COVID-19): Focus on peripheral blood cell morphology.

    Zini, Gina / d'Onofrio, Giuseppe

    British journal of haematology

    2022  Volume 200, Issue 4, Page(s) 404–419

    Abstract: Numerous studies have shown peculiar morphological anomalies in COVID-19 patients' smears. We searched all the peer-reviewed scientific publications that explicitly reference the cytomorphological alterations on peripheral blood smears of patients with ... ...

    Abstract Numerous studies have shown peculiar morphological anomalies in COVID-19 patients' smears. We searched all the peer-reviewed scientific publications that explicitly reference the cytomorphological alterations on peripheral blood smears of patients with COVID-19. We extracted data from sixty-five publications (case reports, patient group studies, reviews, and erythrocyte morphology studies). The results show that frequent alterations concern the morphology of lymphocytes (large lymphocytes with weakly basophilic cytoplasm, plasmacytoid lymphocytes, large granular lymphocytes). Neutrophils display abnormal nuclei and cytoplasm in a distinctive cytomorphological picture. Besides a left shift in maturation, granulations can be increased (toxic type) or decreased with areas of basophilia. Nuclei are often hyposegmented (pseudo-Pelger-Huёt anomaly). Apoptotic or pycnotic cells are not uncommon. Monocytes typically have a large cytoplasm loaded with heterogeneous and coalescing vacuoles. Platelets show large and giant shapes. The presence of erythrocyte fragments and schistocytes is especially evident in the forms of COVID-19 that are associated with thrombotic microangiopathies. Such atypia of blood cells reflects the generalized activation in severe COVID-19, which has been demonstrated with immunophenotypic, molecular, genetic, and functional methods. Neutrophils, in particular, are involved in the pathophysiology of hyperinflammation with cytokine storm, which characterizes the most unfavorable evolution.
    MeSH term(s) Humans ; COVID-19/complications ; Pelger-Huet Anomaly/etiology ; Neutrophils/metabolism ; Monocytes/metabolism ; Killer Cells, Natural
    Language English
    Publishing date 2022-10-06
    Publishing country England
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 80077-6
    ISSN 1365-2141 ; 0007-1048
    ISSN (online) 1365-2141
    ISSN 0007-1048
    DOI 10.1111/bjh.18489
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Diagnostics and Prognostication of Myelodysplastic Syndromes.

    Zini, Gina

    Annals of laboratory medicine

    2017  Volume 37, Issue 6, Page(s) 465–474

    Abstract: MDS are a heterogeneous and complex group of clonal hematological neoplasms arising from a hematopoietic stem cell, and characterized by ineffective hematopoiesis, resulting in increased apoptosis in the bone marrow and peripheral cytopenia, which ... ...

    Abstract MDS are a heterogeneous and complex group of clonal hematological neoplasms arising from a hematopoietic stem cell, and characterized by ineffective hematopoiesis, resulting in increased apoptosis in the bone marrow and peripheral cytopenia, which involves one or more lineages. Epigenetic changes are reported as 'founder' mutations in the case of MDS. Its incidence in the general population has been reported as five new MDS diagnoses per 100,000 people. It affects men more frequently than it does women, and its incidence increases with age. The diagnostic classification, now in use, is the one of the World Health Organization, revised in August 2016. It recognizes six distinct entities in addition to a provisional entity of childhood. In most of the cases, diagnosis is based on the morphologic quantitative and qualitative evaluation of the peripheral blood and bone marrow using basic hematological techniques. Bone marrow biopsy and flow cytometric immunophenotyping also offer support for further diagnostic elucidation, while cytogenetics and molecular genetics are presently fully integrated into prognostication, treatment processes, and decision-making.
    Language English
    Publishing date 2017-11
    Publishing country Korea (South)
    Document type Journal Article ; Review
    ZDB-ID 2677441-0
    ISSN 2234-3814 ; 2234-3806
    ISSN (online) 2234-3814
    ISSN 2234-3806
    DOI 10.3343/alm.2017.37.6.465
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Cytomorphology of normal, reactive, dysmorphic, and dysplastic megakaryocytes in bone marrow aspirates.

    Zini, Gina / Viscovo, Marcello

    International journal of laboratory hematology

    2021  Volume 43 Suppl 1, Page(s) 23–28

    Abstract: This paper aims to emphasize the importance of applying international consensus guidelines to detect qualitative and quantitative abnormalities of megakaryocytes on smears of bone marrow aspirates (BMA) for a shared and harmonized diagnostic path between ...

    Abstract This paper aims to emphasize the importance of applying international consensus guidelines to detect qualitative and quantitative abnormalities of megakaryocytes on smears of bone marrow aspirates (BMA) for a shared and harmonized diagnostic path between different laboratories. Careful evaluation of megakaryocytes on BMA smears represents a cornerstone in the diagnosis of most clonal and nonclonal hematological diseases. Images associated with the detailed morphologic description of normal, reactive, abnormal, and dysplastic megakaryocytes are also reported together with examples of similar cells that, if not promptly identified, can lead to a morphological misdiagnosis.
    MeSH term(s) Biopsy, Needle ; Bone Marrow/pathology ; Bone Marrow Cells/cytology ; Bone Marrow Cells/pathology ; Diagnosis, Differential ; Histocytochemistry/methods ; Humans ; Megakaryocytes/cytology ; Megakaryocytes/pathology ; Microscopy/methods ; Thrombopoiesis
    Language English
    Publishing date 2021-07-19
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2268590-X
    ISSN 1751-553X ; 1751-5521 ; 0141-9854
    ISSN (online) 1751-553X
    ISSN 1751-5521 ; 0141-9854
    DOI 10.1111/ijlh.13536
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Book: Morphology of the blood

    D'Onofrio, Giuseppe / Zini, Gina

    1998  

    Author's details Giuseppe d'Onofrio ; Gina Zini
    Language English
    Size XII, 383 S. : zahlr. Ill.
    Publisher Butterworth -Heinemann
    Publishing place Oxford u.a.
    Publishing country United States
    Document type Book
    HBZ-ID HT009121317
    ISBN 0-7506-4055-3 ; 978-0-7506-4055-8
    Database Catalogue ZB MED Medicine, Health

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  7. Article: La morfologia: una fase cruciale nella diagnosi delle sindromi mielodisplastiche.

    Zini, Gina

    Recenti progressi in medicina

    2014  Volume 105, Issue 3, Page(s) 104–109

    Abstract: Diagnosis and classification of myelodysplastic syndromes (MDS) are based on the integration of morphology, immunophenotype, histology, genetics and molecular analysis. The role of cytomorphology in this context, however, remains fundamental and ... ...

    Title translation Morphology: a critical phase in the diagnosis of myelodysplastic syndromes.
    Abstract Diagnosis and classification of myelodysplastic syndromes (MDS) are based on the integration of morphology, immunophenotype, histology, genetics and molecular analysis. The role of cytomorphology in this context, however, remains fundamental and preliminary to the application of the other methods. The first modern classification of MDS, originally published by the FAB (French-American-British) Group in 1985, was based on the recognition of five different diagnostic categories. The more recent 2008 WHO classification of hematopoietic neoplasms has widened and modified the FAB approach, by including seven different cytomorphological entities and decreasing the threshold of the blast cell percentage to 19% for the discrimination of MDS from acute myeloid leukemias. In addition, chronic myelomonocytic leukemia is now included in the new group or MDS/myeloproliferative neoplasms. Finally, precise quantitative and qualitative criteria are provided, with the aim to improve microscope method standardization.
    MeSH term(s) Cytodiagnosis/methods ; Diagnosis, Differential ; Humans ; Microscopy/methods ; Myelodysplastic Syndromes/classification ; Myelodysplastic Syndromes/diagnosis ; World Health Organization
    Language Italian
    Publishing date 2014-03
    Publishing country Italy
    Document type English Abstract ; Journal Article
    ZDB-ID 138266-4
    ISSN 0034-1193
    ISSN 0034-1193
    DOI 10.1701/1434.15870
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Diagnostic Testing for Differential Diagnosis in Thrombotic Microangiopathies

    Zini, Gina / De Cristofaro, Raimondo

    Turkish journal of haematology : official journal of Turkish Society of Haematology

    2019  Volume 36, Issue 4, Page(s) 222–229

    Abstract: Thrombotic microangiopathies (TMAs) are multiple disease entities with different etiopathogeneses, characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA) with schistocytosis, variable symptoms including fever, and multi-organ failure ...

    Abstract Thrombotic microangiopathies (TMAs) are multiple disease entities with different etiopathogeneses, characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA) with schistocytosis, variable symptoms including fever, and multi-organ failure such as mild renal impairment and neurological deficits. The two paradigms of TMAs are represented on one hand by acquired thrombotic thrombocytopenic purpura (TTP) and on the other by hemolytic uremic syndrome (HUS). The differential diagnosis between these two paradigmatic forms of TMA is based on the presence of either frank renal failure in HUS or a severe deficiency (<10%) of the zinc-protease ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) in TTP. ADAMTS13 is an enzyme involved in the proteolytic processing of von Willebrand factor (vWF), and its deficiency results in formation of high-molecular-weight vWF-rich microthrombi in the environment of the microvasculature. The presence of these ultra-large vWF multimers in the microcirculation can recruit platelets, promoting multi-organ ischemic lesions. The presence of ADAMTS13 activity at >10% could rule out the presence of a TTP form. However, it is often difficult to differentiate either a TTP or HUS clinical scenario presenting with typical symptoms of TMA. There are in fact several additional diagnoses that should be considered in patients with ADAMTS13 activity of >10%. Widespread inflammation with endothelial damage and adverse reactions to drugs play a central role in the pathogenesis of several forms of TMA, and in these cases, the differential diagnosis should be directed at the underlying disease. Hence, a correct etiologic diagnosis of TMA should involve a critical illness, cancer-associated TMA, drug-induced TMA, and hematopoietic transplant-associated TMA. A complete assessment of all the possible etiologies for TMA symptoms, including acquired or congenital TTP, will allow for a more accurate diagnosis and application of a more appropriate treatment.
    MeSH term(s) Diagnostic Tests, Routine/methods ; Humans ; Thrombotic Microangiopathies/diagnosis ; Thrombotic Microangiopathies/epidemiology ; Thrombotic Microangiopathies/pathology
    Language English
    Publishing date 2019-07-24
    Publishing country Turkey
    Document type Journal Article ; Review
    ZDB-ID 2185903-6
    ISSN 1308-5263 ; 1300-7777
    ISSN (online) 1308-5263
    ISSN 1300-7777
    DOI 10.4274/tjh.galenos.2019.2019.0165
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Digital morphology in hematology diagnosis and education: The experience of the European LeukemiaNet WP10.

    Zini, Gina / Barbagallo, Ombretta / Scavone, Fernando / Béné, Marie C

    International journal of laboratory hematology

    2022  Volume 44 Suppl 1, Page(s) 37–44

    Abstract: Hematological diagnostics is based on increasingly precise techniques of cellular and molecular analysis. The correct interpretation of the blood and bone marrow smears observed under an optical microscope still represents a cornerstone. Precise ... ...

    Abstract Hematological diagnostics is based on increasingly precise techniques of cellular and molecular analysis. The correct interpretation of the blood and bone marrow smears observed under an optical microscope still represents a cornerstone. Precise quantitative and qualitative cytomorphological criteria have recently been codified by up-to-date guidelines for diagnosing hematopoietic neoplasms. Morphological analysis has found formidable support in digital reproduction techniques, which have simplified the circulation of images for educational or consultation purposes. From 2007 to 2019, the Working Group WP10 of European LeukemiaNet (ELN) used, in annual exercises, digital images to support training in cytomorphology and verify harmonization and comparability in the interpretation of blood and bone marrow smears. We describe the design, development, and results of this program, which had 741 participants in-person or remotely, to which 2055 questions were submitted regarding the interpretation of cytomorphological images. We initially used circulation and presentation of digital microphotographs and then introduced a virtual microscopy (VM). Virtual slides were obtained using a whole slide imaging technique, similar to the one largely used in histopathology, to produce digitized scans of consecutive microscopic fields and reassembles them to obtain a complete virtual smear by stitching. Participants were required to identify cells in labeled fields of view of the virtual slides to obtain a morphological diagnosis. This work has demonstrated substantial improvements in diagnostic accuracy and harmonization with the VM technique. Between-observer concordance increased from 62.5% to 83.0%. The integrity of the digitalized film image, which provides a general context for cell abnormalities, was the main factor for this outcome.
    MeSH term(s) Hematology ; Humans ; Image Processing, Computer-Assisted/methods ; Microscopy/methods
    Language English
    Publishing date 2022-09-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2268590-X
    ISSN 1751-553X ; 1751-5521 ; 0141-9854
    ISSN (online) 1751-553X
    ISSN 1751-5521 ; 0141-9854
    DOI 10.1111/ijlh.13908
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Case of metastatic melanoma in bone marrow smear.

    Frioni, Filippo / Za, Tommaso / D'alò, Francesco / Zini, Gina

    International journal of laboratory hematology

    2022  Volume 44, Issue 6, Page(s) 976–977

    MeSH term(s) Humans ; Bone Marrow/pathology ; Melanoma/diagnosis ; Melanoma/pathology ; Skin Neoplasms/diagnosis ; Skin Neoplasms/pathology ; Neoplasms, Second Primary
    Language English
    Publishing date 2022-04-05
    Publishing country England
    Document type Case Reports
    ZDB-ID 2268590-X
    ISSN 1751-553X ; 1751-5521 ; 0141-9854
    ISSN (online) 1751-553X
    ISSN 1751-5521 ; 0141-9854
    DOI 10.1111/ijlh.13835
    Database MEDical Literature Analysis and Retrieval System OnLINE

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