Медичний факультет

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    Парвовирусная инфекция В19V: обзор литературы. Часть 1
    (ЖУРНАЛ "АКТУАЛЬНА ІНФЕКТОЛОГІЯ" ТОМ 7, 2019) Потий В.В.; Кириенко В.Т.; Зайцев И.А.; Нестерук Е.С.
    В статье представлены современные сведения о различных аспектах проблемы парвовирусной инфекции. На основании анализа данных литературы описаны этиология, эпидемиология, пути передачи инфекции, особености патогенеза у взрослого человека и фетальной парвовирусной инфекции. Представлены клинические проявления основных форм заболевания.
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    Скрининг и ранняя диагностика гепатоцеллюлярной карциномы
    (Актуальная инфектология., 2019) Потий В. В.; Грушкевич В. В.; Зайцев И. А.; Кириенко В. Т.
    Приведены факторы риска развития гепатоцеллюлярной карциномы (ГЦК), современные положения о возможностях скрининга и ранней диагностики ГЦК с использованием лучевых методов визуализации, неинвазивных серологических маркеров. Определены категории пациентов, подлежащие скринингу ГЦК, и алгоритм обследования.Представлены современные положения о возможностях скрининга и ранней диагностики гепатоцеллюлярной карциномы с использованием лучевых методов визуализации, неинвазивных серологических и иммуногистохимических маркеров, а также показания и возможности морфологического исследования очаговых образований печени у пациентов из группы риска.
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    Possible strategies for the implementation of WHO program on the elimination of hepatitis C in Ukraine by 2030.
    (Journal of Education, Health and Sport., 2019) Potii V.; Zaytsev I.; Kiriienko V.
    The article describes the model of natural history of hepatitis C virus the use of which makes it possible to assess the dynamics of the infected population from 2015 to 2030 in natural history and under the influence of the strategies of antiviral therapy, namely, the changes in the number of infected populations, the progression of the diseases, patients’ proportion with different stages of fibrosis and also the mortality which is associated with final stages of liver disease. In addition, there are estimated data on the number of the patients that are subject to annual diagnosing for treatment in accordance with specific therapy strategies which is necessary to achieve the results provided by the WHO program for the elimination of hepatitis C virus in Ukraine by 2030.
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    USE OF INTERACTIVE TEACHING METHODS IN TEACHING HYGIENE AND OCCUPATIONAL SAFETY BY STUDENTS OF MEDICAL UNIVERSITIES
    (2019-11-19) Baieva Olena Viktorivna; Zelentsova Svitlana Mikolaivna; Slobodian Angelina Ivanivna
    This article deals with the main principles for the use of interactive methods in the study of Hygiene and Occupational health and safety in medical higher education institutions
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    ІННОВАЦІЙНІ ПІДХОДИ ДО ВИКЛАДАННЯ СОЦІАЛЬНОЇ МЕДИЦИНИ, ОРГАНІЗАЦІЇ ТА ЕКОНОМІКИ ОХОРОНИ ЗДОРОВ’Я В МЕЖАХ КРЕДИТНО-МОДУЛЬНОЇ СИСТЕМИ ЯК ОДИН З АСПЕКТІВ ДЕРЖАВНОГО УПРАВЛІННЯ ТА ЗБЕРЕЖЕННЯ ГРОМАДСЬКОГО ЗДОРОВ’Я
    (Видавничий дім «Гельветика», 2019-11-25) Коваленко О.О.
    У статті здійснена характеристика одного з основних аспектів державного управління, а саме підготовки майбутнього кадрового потенціалу держави. Розвиток суспільства і навчально-виробничих технологій диктує свої вимоги щодо фахово та інформаційно освічених, комунікабельних спеціалістів, здатних вести діалог на рівних із колегами і пацієнтами заради досягнення мети збереження здоров’я та якості життя своїх підопічних. Наведено приклади застосування методів і прийомів технології розвитку критичного мислення та аналізу ситуацій. Також описано результати використання модифікованої методики аналізу ситуацій (на базі методики С. Терно, 2011) для формування та розвитку у студентів-медиків критичного мислення та аналітичних здібностей. Представлені результати впровадження інтерактивних методів навчання, а саме «аналіз ситуації» та «метод розвитку критичного мислення». Також висвітлені нові підходи щодо досвіду у викладанні інтерактивних методів навчання дисципліни «Соціальна медицина, організація та економіка охорони здоров’я» в умовах кредитно-модульної системи як один із аспектів державного управління. Методика ґрунтується на логічному аргументованому судженні щодо змісту та форми навчальних текстів, а також самостійності, незалежності мислення від стереотипів, результатом чого є формування власної позиції щодо будь-яких текстів і ситуацій у цілому. Це дозволить розвинути організаційні здібності майбутніх лікарів, уміння планувати та економічно обґрунтовувати, організовувати, мотивувати молодший медичний персонал та контролювати його подальшу діяльність, забезпечить підготовку висококваліфікованих фахівців, здатних до самостійного виваженого прийняття рішень у різних проблемних ситуаціях. За проведеним аналізом щодо порушеної проблематики зроблено висновок про те, що першочерговим завданням державної політики в галузі освіти, й підготовки магістрів зокрема, має стати запровадження нових та сучасних інтерактивних методів викладання із ключовою роллю держави у цьому процесі. Доведено, що розроблення нових сучасних навчальних програм є важливою платформою для підготовки студентів-медиків
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    Epidemiological and preventive aspects of Hepatitis C virus infection in Ukraine
    (Boston: Primedia eLaunch, 2020) Baieva O.; Kovalenko O.; Tserkovniak L.; Slobodyan A.
    Viral hepatitis is a common and dangerous infectious disease caused by various hepatitis viruses, which primarily affect human liver cells. Hepatitis C is a liver disease caused by the hepatitis C virus (HCV): the virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Analysis of materials obtained in of the official registration of cases of the Ministry of Health of Ukraine, a total of 44359 cases of HCV infection were registered in country for 7 years (2013 - 2019), including 3826 cases of Acute hepatitis C - (8 , 44 ± 0.48)% and 41483 Chronic hepatitis C - (91.56 ± 0.48)%
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    Парвовирусная инфекция В19V у беременных (обзор литературы) Часть 2
    (Актуальная инфектология, 2020) Потий В.В; Зайцев И.А.; Кириенко В.Т; Нестерук Е.С.
    В статье представлены особенности течения парвовирусной инфекции у беременных. Описаны последствия поражения плода патогеном. Освещены возможности оценки риска врожденной парвовирусной инфекции, антенатальной диагностики, интерпретации результатов лабораторных и инструментальных методов исследования. Представлены подходы к лечению, обсуждены возможности профилактики заболевания.
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    Predictive factors of pathological response to neoadjuvant chemotherapy in patients with breast cancer.
    (Journal of BUON, 2020-01) Koshyk, Olena; Ryspayeva, Dinara; Lyashenko, Andrey; Dosenko, Irina
    Purpose: To identify predictive factors connected with pathologic response in patients with breast cancer (BC) having received neoadjuvant chemotherapy (NACT). Methods: 49 patients with BC were investigated before and after treatment in this prospective research. Different chemotherapy regimes were administered. The Miller-Payne scoring system was used to assess the tumour response. The nuclear proliferation markers Ki67 and the expression of topoisomerase IIα (Topo IIα) were evaluated. Results: Six patients (12.2 %) achieved pathological complete response (pCR). Noticeable decrease of tumor cellularity was detected in all BC subtypes and pCR in the triple-negative BC (TNBC) group (p=0.007) was observed. Poorly differentiated tumors could be considered as predictive factors of pCR (p=0.07). Ki67 appeared to be a predictive marker of achieving pCR (p<0.001) with a threshold of 28% (AUC=0.89, 95% CI 0.75-0.96). The additional factor of reaching pCR was operable BC (p=0.04). The expression level of Topo IIα (p=0.50) and using different regimens of NACT (p=0.97) did not influence pCR achievement. Conclusion: To sum it up, poorly differentiated carcinomas with high cellularity in the primary tumor, TNBC, Ki 67 with a threshold above 28% and operable BC can be considered as early predictors of reaching pCR.
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    Hashimoto's thyroiditis attenuates progression of papillary thyroid carcinoma: deciphering immunological links
    (Heliyon, 2020-01-08) Sulaieva, Oksana; Seleznov, Oleksii; Shapochka, Dmytro
    Although some studies have investigated the clinicopathologic relationships between papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT), there is still no clear understanding of differences in tumor immune microenvironment for PTC with coexisting HT and HT effect on PTC progression. The aim of this study was to clarify immune-mediated mechanisms of coexisting HT, which might influence PTC progression. 30 patients with histologically confirmed conventional-type PTC and 30 patients with PTC and coexisting HT were enrolled in the study. To analyze the role of immune-mediated links between PTC and HT, immunohistochemical investigation was conducted to count the number of different immune cells including T-cytotoxic cells (CD8), plasma cells (CD138), Treg cells (FOXP3), mast cells (MCT), and M2 macrophages (CD163). It was shown that despite the high number of immune cells in the intact thyroid tissues of PTC patients with coexisting HT there were no significant differences in M2 macrophages, mast cells and Treg counts inside PTC with or without HT. PTC with HT was associated with a higher number of CD8+ cells (P < 0.001) reflecting the ability of immune system to generate and recruit T-cytotoxic cells in tumor area, which can explain the protective effect of HT on PTC progression. Lymph node metastases development was associated with an increased number of mast cells, M2 macrophages and Treg along with a decreased plasma cells count regardless of coexisting HT. However, we did not find significant differences in T-cytotoxic cells quantity in node-positive and node-negative patients with or without HT, which encourages further investigation of immune escape mechanisms in PTC.
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    Молекулярні підтипи м’язово-інвазивного раку сечового міхура
    (Праці Наукового товариства імені Шевченка. Медичні науки., 2020-04-15) Сулаєва, Оксана; Селезньов, Олексій; Шапочка, Дмитро
    Проаналізовано сучасний стан питання про молекулярні підтипи м’язово-інвазивного раку сечового міхура (МІ-РСМ), їхні ключові біомаркери та рекомендовані підходи до лікування. Відомо кілька варіантів молекулярних класифікацій РСМ, враховуючи версії медичного коледжу Бейлора (BCM), Університету Північної Кароліни (UNC), Центру раку МД Андерсона (MDA), проєкту Атлас генома раку (TCGA) ікласифікацію Лунда (Швеція). Сьогодні розроблена консенсусна міжнародна класифікація молекулярних підтипів МІ-РСМ, яка не тільки поглибила розуміння біології РСМ, а й виявила взаємозв’язок певних геномних порушень з конкретними морфологічними підтипами та клінічним перебігом РСМ. Молекулярні класифікації МІ-РСМ допомагають не тільки прогнозувати перебіг пухлинного процесу, а й стратифікувати пацієнтів за ймовірною відповіддю на хіміотерапію та імунотерапію. Однак впровадження молекулярної класифікації РСМ в клінічну практику має певні обмеження та потребує проведення валідаційних досліджень.
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    Combined effects of probiotic and chondroprotector during osteoarthritis in rats.
    (Panminerva Medica, 2020-06) Sulaieva, Oksana; Korotkyi, Oleksandr; Dvorshchenko, Kateryna; Falalyeyeva, Tetyana
    Background: Osteoarthritis (OA) is a joint affection, defined by articular cartilage demolition, risks of which rise with age. The aim of this study was to compare the efficacy of chondroitin sulfate (CS) course and multistrain live probiotic (LP) administered alone or in combination on the expression of TLR-2, TLR-4, TNF-α and NF-κB in articular cartilage, subchondral bone and synovial membrane during OA in rats. Methods: OA was induced in male rats by injecting monoiodoacetate (MIA) in right hind knee. Therapeutic groups received 3 mg/kg of chondroprotector (ChP) CS for 28 days and/or 140 mg/kg of LP diet for 14 days. The expression of TLR-2, TLR-4, TNF-α and NF-κB in articular cartilage, subchondral bone and synovial membrane were determined with immunohistochemical staining kits (Thermo Fisher Scientific). Results: It was established that MIA injection is associated with long-term structural changes in joint tissues that corresponded to OA-like features and associated with activation of pathogen-recognizing molecules and proinflammatory signaling pathways expression. Separate therapy with ChP and probiotics slightly decreased OA score limiting cell death and subchondral bone resorption. However, these changes were not associated with a significant decrease in TLR-2, TLR-4, NF-kB and TNF-α expression. On the other hand, the combination of ChP and LP treatment significantly decreased OA score. This correlated with a decrease in TLR-2, TLR-4, NF-kB and TNF-α expression in chondrocytes and synovial cells. Conclusions: The outcomes of our research prove that ChPs amplify the positive action of LPs in OA attenuation.
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    Mechanisms of the Impact of Hashimoto Thyroiditis on Papillary Thyroid Carcinoma Progression: Relationship with the Tumor Immune Microenvironment.
    (Endocrinology and metabolism (Seoul, Korea), 2020-06-24) Sulaieva, Oksana; Chernenko, Olena; Selesnov, Oleksiy
    Background: The relationship between Hashimoto thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains uncertain. We assessed the impact of HT on the tumor immune microenvironment (TIME) in PTC. Methods: Thirty patients with PTC (group 1) and 30 patients with PTC and HT (group 2) were enrolled in this pilot study. The distribution and number of CD8+ lymphocytes, plasma cells (CD138+), regulatory T cells (forkhead box P3 [FOXP3+)], mast cell tryptase (MCT+), and M2 macrophages (CD163+) were evaluated. To test the hypothesis that HT impacts PTC development via signal transducer and activator of transcription 6 (STAT6) activation and M2 macrophage polarization, we investigated STAT6 expression in tumor and stromal cells. We also evaluated vascular endothelial growth factor (VEGF) expression by lymph node metastasis (LNM) status. Results: TIME showed significant between-group differences. Group 1 patients demonstrated immune desert or immune-excluded immunophenotypes, while an inflamed phenotype with more CD8+ cells (P<0.001) predominated in group 2. Immune-excluded TIME was associated with the highest LNM rate. In PTC, LNM was associated with more numerous CD163+ cells. Moreover, LNM in group 1 was associated with increased numbers of mast cells peritumorally and FOXP3+ cells intratumorally and peritumorally. Group 2 demonstrated higher STAT6 but not higher VEGF expression in tumor cells. High VEGF expression was associated with LNM regardless of HT status. Conclusion: Concomitant HT impacted PTC signaling via STAT6 and TIME by increasing the number of CD8+ cells. LNM is associated with increases in CD163+ cells and VEGF expression in PTC, whereas HT affected LNM through different mechanisms.
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    Digital Marketing as an Innovative Communication Tool in the Health Tourism System
    (2020-08) Baiev V. V.; Baieva O. V.; Bakhov I. S.; Antonenko I. Y.; Melnyk I. L.
    The article examines the essence of internet marketing and digital marketing in the context of their role in the system of integrated marketing communications in the field of health tourism. The leading sites of companies working in the field of health tourism are analyzed. The use of modern digital marketing technologies, in particular crowd marketing and its basic tools in the field of health tourism, is investigated
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    ВИКОРИСТАННЯ ХУДОЖНЬОЇ ЛІТЕРАТУРИ ПРИ ВИКЛАДАННІ ДИСЦИПЛІН «БІОЕТИКА» ТА «ЕТИКА» У ВИЩИХ МЕДИЧНИХ НАВЧАЛЬНИХ ЗАКЛАДАХ
    (Scientific Publishing Center “Sci-conf.com.ua”, 2020-08-19) Зеленцова Світлана Миколаївна
    У статті йде мова про можливості та методи використання художніх творів про медицину та лікарів при викладанні дисциплін етика та біоетика у медичних університетах. Надані приклади аналізу змісту творів та їх застосування. Визначені виховні та світоглядні потенціали використання такого виду робіт при проведенні навчального заняття
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    EWSR1-PATZ1-rearranged sarcoma: a report of nine cases of spindle and round cell neoplasms with predilection for thoracoabdominal soft tissues and frequent expression of neural and skeletal muscle markers.
    (Modern Pathology, 2020-10-04) Koshyk, Olena; Michal, Michael; Rubin, Brian P; Agaimy, Abbas
    The knowledge of clinical features and, particularly, histopathological spectrum of EWSR1-PATZ1-rearranged spindle and round cell sarcomas (EPS) remains limited. For this reason, we report the largest clinicopathological study of EPS to date. Nine cases were collected, consisting of four males and five females ranging in age from 10 to 81 years (average: 49 years). Five tumors occurred in abdominal wall soft tissues, three in the thorax, and one in the back of the neck. Tumor sizes ranged from 2.5 to 18 cm (average 6.6 cm). Five patients had follow-up with an average of 38 months (range: 18-60 months). Two patients had no recurrence or metastasis 19 months after diagnosis. Four patients developed multifocal pleural or pulmonary metastasis and were treated variably by surgery, radiotherapy, and chemotherapy. The latter seemed to have little to no clinical benefit. One of the four patients was free of disease 60 months after diagnosis, two patients were alive with disease at 18 and 60 months, respectively. Morphologically, low, intermediate, and high-grade sarcomas composed of a variable mixture of spindled, ovoid, epithelioid, and round cells were seen. The architectural and stromal features also varied, resulting in a broad morphologic spectrum. Immunohistochemically, the following markers were most consistently expressed: S100-protein (7/9 cases), GFAP (7/8), MyoD1 (8/9), Pax-7 (4/5), desmin (7/9), and AE1/3 (4/9). By next-generation sequencing, all cases revealed EWSR1-PATZ1 gene fusion. In addition, 3/6 cases tested harbored CDKN2A deletion, while CDKN2B deletion and TP53 mutation were detected in one case each. Our findings confirm that EPS is a clinicopathologic entity, albeit with a broad morphologic spectrum. The uneventful outcome in some of our cases indicates that a subset of EPS might follow a more indolent clinical course than previously appreciated. Additional studies are needed to validate whether any morphological and/or molecular attributes have a prognostic impact.
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    Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countriesю
    (Cancer Cytopathology, 2020-10-27) Sulaieva, Oksana; Vigliar, Elena; Cepurnaite, Rima; Alcaraz-Mateos, Eduardo
    Background: To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported. Methods: Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach. Results: Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%). Conclusions: The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.
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    Hemostatic performance and biocompatibility of chitosan-based agents in experimental parenchymal bleeding
    (Materials Science and Engineering. C, Materials for biological applications., 2020-11-21) Sulaieva, Oksana; Deineka, Volodymyr; Pernakov, Mykola
    The uncontrolled parenchymatic bleeding is still a cause of serious complications in surgery and require new effective hemostatic materials. In recent years, numerous chitosan-based materials have been intensively studied for parenchymatic bleeding control but still require to increased safety and effectiveness. The current research is devoted to new hemostatic materials made of natural polymer (chitosan) developed using electrospinning and microwave-assisted methods. Hemostatic performance, biocompatibility, degradation, and in-vivo effectiveness were studied to assess functional properties of new materials. Chitosan-based agents demonstrated considerable hemostatic performance, moderate biodegradation pace and high biocompatibility in vitro. Using the electrospinning-made chitosan-copolymer significantly improved in vivo biocompatibility and degradation of Chitosan-based agents that provides opportunities for its implementation for visceral bleeding management. Chitosan aerogel could be effectively applied in hemostatic patch development due to high antibacterial activity but it is not recommended for visceral application due to moderate inflammatory effect and slow degradation.
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    Utility of NKX3.1 immunohistochemistry in the differential diagnosis of seminal vesicles versus prostatic tissue in needle biopsy.
    (Annals of Diagnostic Pathology, 2020-12) Slisarenko, Maryna; Pitra, Tomas; Pivovarcikova, Kristyna; Alaghehbandan, Reza
    NKX3.1 is considered a reliable immunohistochemical marker of prostatic origin with high specificity and sensitivity. However, NKX3.1 positivity has been described in other neoplastic and non-neoplastic tissues, such as mesenchymal chondrosarcoma, sex-cord stromal tumors, rete testis adenocarcinoma, lobular and ductal carcinoma of the breast, salivary glands, peribronchial submucosal glands, and Sertoli cells. We analyzed expression of two antibodies (mono and polyclonal) of NKX3.1 in a total of 63 non-neoplastic seminal vesicles. We used 52 resection materials (12 seminal vesicles without prostatic adenocarcinoma, 26 seminal vesicles with prostatic adenocarcinoma infiltration, and 14 cases of seminal vesicles infiltrated by urothelial carcinoma) and 11 prostatic core needle biopsies with incidentally sampled fragment of seminal vesicles. In all cases, tissues from seminal vesicles were completely negative for NKX3.1, despite using polyclonal and monoclonal NKX3.1 antibodies, and regardless of the detection system utilized (diaminobenzidine (DAB) versus alkaline phosphatase (AF)). However, prostatic adenocarcinoma was negative in several cases (n = 6), when AF detection system was used. Reaction with DAB was strong and robust in all cases. Based on our data, we can recommend NKX3.1 as a negative immunohistochemical marker of seminal vesicles.
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    Molecular Profiling of Salivary Oncocytic Mucoepidermoid Carcinomas Helps to Resolve Differential Diagnostic Dilemma With Low-grade Oncocytic Lesions.
    (The American Journal of Surgical Pathology, 2020-12) Koshyk, Olena; Skálová, Alena; Agaimy, Abbas; Stanowska, Olga
    Oncocytic mucoepidermoid carcinoma (OMEC) is a rare but diagnostically challenging variant of mucoepidermoid carcinoma (MEC). OMEC is notable for differential diagnostic considerations that are raised as a result of overlap with other benign and low-grade oncocytic salivary gland tumors. Diffuse and strong immunoreactivity of p63 protein may be useful in distinguishing OMEC from its mimics. However, focal p63 staining can be present in benign oncytomas. Presence of mucin-containing cells, mucinous cystic formation, and foci of extravasated mucin are considered a hallmark of MEC. True mucocytes may be, however, very few and hardly discernable in OMECs. Recent evidence has shown that most MECs harbor gene fusions involving MAML2. A retrospective review of archived pathology files and the authors' own files was conducted to search for "low-grade/uncertain oncocytic tumor," "oncocytoma," and "oncocytic carcinoma" in the period from 1996 to 2019. The tumors with IHC positivity for p63 and/or p40, and S100 negativity, irrespective of mucicarmine staining, were tested by next-generation sequencing using fusion-detecting panels to detect MAML2 gene rearrangements. Two index cases from consultation practice (A.S. and A.A.) of purely oncocytic low-grade neoplasms without discernible mucinous cells showed a CRTC1-MAML2 fusion using next-generation sequencing, and were reclassified as OMEC. In total, 22 cases of oncocytic tumors, retrieved from the authors' files, and from the Salivary Gland Tumor Registry, harbored the MAML2 gene rearrangements. Presence of mucocytes, the patterns of p63 and SOX10 immunopositivity, and mucicarmine staining were inconsistent findings. Distinguishing OMEC devoid of true mucinous cells from oncocytoma can be very challenging, but it is critical for proper clinical management. Diffuse and strong positivity for p63 and visualization of hidden mucocytes by mucicarmine staining may be misleading and does not always suffice for correct diagnosis. Our experience suggests that ancillary studies for the detection of MAML2 rearrangement may provide useful evidence in difficult cases.