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Perinatal pulmonary hemorrhage (PH) is a condition characterized by blood loss via the respiratory tract with an approximate incidence of 0.1% in all newborns. The histologic characteristics of the lung in PH are not well characterized, and we hypothesized that pulmonary maldevelopment such as pulmonary hypoplasia may contribute to PH. In addition, we sought to find any correlations with placental pathology. Retrospective study of fetal and neonatal autopsies with diagnosis of PH was performed between the years from 2009 to 2015. Autopsy reports, placental pathology reports, and hematoxylin and eosin sections of the lung were reviewed. Of the 17 cases which were identified meeting inclusion criteria, PH ranged from mild (<5% in each lung) to severe (>75% in both lungs). PH involved >50% of both lungs in 6 cases. Pulmonary hypoplasia was designated in 7 of 17 (41.17%) cases with PH. Pulmonary hypoplasia and/or persistence of intra-acinar arterioles was seen in 13 of 17 (76.4%) cases. No specific placental pathology was seen universally in the cases of PH, but either maternal or fetal vascular malperfusion was noted in 14 of 17 (82%) cases. Our data suggest a high prevalence of pulmonary maldevelopment, such as pulmonary hypoplasia and persistence of intra-acinar arterioles, in cases with PH. Although no specific placental pathology is seen in PH, maternal and fetal vascular pathology is common.

Background: Anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALCL) is a rare T-cell neoplasm, accounting for approximately 3% of adult non-Hodgkin lymphomas. Although NPM1 is the most common fusion partner with ALK, many others have been described, necessitating break-apart FISH studies for confirmation of the diagnosis. TNF receptor-associated factor 1 (TRAF1) is a rare ALK partner that is thought to confer a worse prognosis in patients. We describe the utility of next-generation sequencing (NGS) RNA analysis in detection of this uncommon ALK partner. Case Description: A 42-year-old male with cervical lymphadenopathy presented for excisional biopsy. Following a tissue diagnosis of ALCL, ALK+, RNA from the biopsy was extracted from Formalin-fixed paraffin-embedded (FFPE) tissue and prepared for Anchored Multiplex PCR using the Archer ® FusionPlex ® v2 assay, which employs unidirectional gene-specific primers using NGS to detect novel or unknown gene partners. Results: Histologic evaluation of the excised lymph node showed atypical cells, including "horseshoe/kidney"-shaped nuclei. Neoplastic cells were immunoreactive against CD30, ALK (diffuse, cytoplasmic), CD2, CD4, granzyme B, and TIA-1. A diagnosis of ALCL, ALK+ was made. The pattern of ALK immunostaining suggested a non-NPM1-associated ALK translocation pattern, prompting further investigation. NGS fusion analysis showed a translocation involving exon 7 of TRAF1 and exon 20 of ALK. Conclusion: ALK positivity suggests an overall favorable prognosis of ALCL as compared to ALK-negative cases. However, in the rare published cases of TRAF1-ALK, an aggressive clinical course has been observed, which may reflect the aggressive propensity of this particular fusion, as these cases appear to be refractory to standard chemotherapy and also to the first generation ALK inhibitors. This study highlights the