Developing a standardized approach for assessing mast cells and eosinophils on tissue biopsies: A Work Group Report of the AAAAI Allergic Skin Diseases Committee

Zimmermann, Nives; Abonia, J. Pablo; Dreskin, Stephen C.; Akin, Cem; Bolton, Scott M.; Happel, Corinne S.; Geller, Mário; Larenas‐Linnemann, Désiree; Nanda, Anil; Peterson, Kathryn A.; Wasan, Anita N.; Wechsler, Joshua B.; Zhang, Simin; Bernstein, Jonathan A.

doi:10.1016/j.jaci.2021.06.030

Cited by 13 publications

(6 citation statements)

References 152 publications

(240 reference statements)

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“…Until such data are forthcoming, there remains no good evidence to justify pathologists to performing mast cell counts in the work-up of patients with suspected MCAS, a view also reflected in a recent set of clinical guidelines. 25 Functional Disorders (Chronic Diarrhoea Without an Identifiable Cause, 'Mastocytic Enterocolitis,' Irritable Bowel Syndrome, and Others)…”

Section: Mast Cell Activation Syndromementioning

confidence: 99%

“…Larger controlled studies are required to determine with more certainty whether or not a clinically useful cutoff for mast cell density exists that would support a diagnosis of MCAS. Until such data are forthcoming, there remains no good evidence to justify pathologists to performing mast cell counts in the work‐up of patients with suspected MCAS, a view also reflected in a recent set of clinical guidelines 25 …”

Section: Mast Cell Activation Syndromementioning

confidence: 99%

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Mast cell evaluation in gastrointestinal biopsies: should we be counting? A critical review and practical guide for the surgical pathologist

2023

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Mast cells are residents of the tubular gastrointestinal (GI) tract, where they play an important role in host defence and other vital functions. Dysregulation of mast cells has been implicated in the pathogenesis of several neoplastic, inflammatory, and functional disorders, some of which may manifest with GI symptoms. Surgical pathologists must therefore confront when and how to evaluate GI biopsies for mast cells, and whether such decisions should be based on morphologic criteria, clinical context, or direct request from clinical colleagues. The pathologist's role in evaluation of mast cell infiltrates is best defined in the diagnosis of systemic mastocytosis, where the utility of morphologic assessment coupled with ancillary studies is well established. In contrast, in nonneoplastic mast cell disorders such as mast cell activation syndrome, irritable bowel syndrome, or so-called 'mastocytic enterocolitis', a role for histopathology, if any, is controversial. Despite this, pathologists have seen a sharp increase in requests for mast cell quantification in the latter setting, despite these requests not being supported by published evidence. Moreover, what constitutes a 'normal' number of mast cells in a luminal GI biopsy is not well established. As a result, there is considerable variation in how these requests are handled in practice. This review evaluates and summarizes the published evidence relating to mast cell evaluation in endoscopic GI biopsies in various clinical scenarios, with a goal of providing practical, evidence-based guidance for the surgical pathologist when approached with requests for mast cell quantification in GI biopsies.

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Section: Mast Cell Activation Syndromementioning

confidence: 99%

Section: Mast Cell Activation Syndromementioning

confidence: 99%

Mast cell evaluation in gastrointestinal biopsies: should we be counting? A critical review and practical guide for the surgical pathologist

2023

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“…It is also worth noting that accumulations of tissue MCs can also be detected in various inflammatory disorders or genetic conditions. [43][44][45][46][47][48]…”

Section: Laboratory Valuesmentioning

confidence: 99%

Refined Treatment Response Criteria for Indolent Systemic Mastocytosis Proposed by the ECNM-AIM Consortium

Pyatilova

Akin

Álvarez‐Twose

et al. 2022

The Journal of Allergy and Clinical Immunology: In Practice

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“…However, an MC count of > 75-100/mm 2 is suggested to be abnormal, dependent on the location of the biopsy. [12][13][14] Recently, an MC percentage of > 40% was also demonstrated to be specific for CM, next in specificity to the distribution of MC in skin. 15 Expression of aberrant MC markers might also be related to certain subtypes.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies showed a wide range of MC density in lesional skin. However, an MC count of > 75–100/mm 2 is suggested to be abnormal, dependent on the location of the biopsy 12–14 . Recently, an MC percentage of > 40% was also demonstrated to be specific for CM, next in specificity to the distribution of MC in skin 15 .…”

Section: Introductionmentioning

confidence: 99%

Histopathological characteristics are instrumental to distinguish monomorphic from polymorphic maculopapular cutaneous mastocytosis in children

Hermans

Pasmans

Arends

et al. 2022

Clin Experimental Derm

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Background Mastocytosis is characterized by the accumulation of mast cells (MCs) in the skin or other organs, and can manifest at any age. A significant number of paediatric mastocytosis cases persist after puberty. In particular, monomorphic maculopapular cutaneous mastocytosis (mMPCM) is often persistent and associated with systemic mastocytosis. However, clinical differentiation of MPCM from polymorphic (p)MPCM can be difficult. Aim To identify histopathological features that can help to distinguish mMPCM from other subtypes of paediatric mastocytosis. Methods This was a retrospective study using skin biopsies from patients with any subtype of mastocytosis. The localization and density of the MC infiltrate, MC morphology and expression of aberrant markers were evaluated and correlated with clinical characteristics. Results In total, 33 biopsies were available for evaluation from 26 children [(10 with mMPCM, 5 with mastocytoma, 3 with diffuse cutaneous mastocytosis (DCM), 8 with pMPCM)] and 7 adults with MPCM. The MC number was increased in all patients, but was higher in children than adults (P < 0.01). The presence of mMPCM was associated with sparing of the papillary dermis from MC infiltration, whereas MC density in the papillary dermis was highest in pMPCM and DCM (P < 0.01). The positive predictive value of the presence of a reticular MC infiltrate for mMPCM was 72.7% (95% CI 51.4–87.0), and the negative predictive value was 83.3% (95% CI 42.2–97.2). There were no relevant differences in the expression of CD2, CD25 or CD30 between the different subtypes. Conclusion Skin histopathology might enhance the phenotypical differentiation of mMPCM from other subtypes in children, thereby increasing the accuracy of one's prognosis.

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Developing a standardized approach for assessing mast cells and eosinophils on tissue biopsies: A Work Group Report of the AAAAI Allergic Skin Diseases Committee

Cited by 13 publications

References 152 publications

Mast cell evaluation in gastrointestinal biopsies: should we be counting? A critical review and practical guide for the surgical pathologist

Mast cell evaluation in gastrointestinal biopsies: should we be counting? A critical review and practical guide for the surgical pathologist

Refined Treatment Response Criteria for Indolent Systemic Mastocytosis Proposed by the ECNM-AIM Consortium

Histopathological characteristics are instrumental to distinguish monomorphic from polymorphic maculopapular cutaneous mastocytosis in children

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