Fortis Memorial Research Institute

Bone marrow sampling [including bone marrow aspirate (BMA), trephine biopsy touch imprint (BMI), and the bone marrow trephine biopsy (BMBx)] is a very important test in the diagnosis and/or follow-up monitoring of both hematological and many non-hematological conditions. A synoptic report for BMA/BMI cytology aims to bring homogeneity in reporting among pathologists/laboratory hematologists/hematopathologists across academic and practicing centres, and ensure completeness in communicating with clinicians with actionable suggestions. The essence of such reporting format is to bring out the accuracy in reporting that will incorporate treating physician/hematologist’s perspective, essential patient related clinical information gathered and documented during bone marrow sampling, careful interpretation of freshly prepared and stained peripheral blood smear (PBS) morphology, recent complete blood count parameters, and meticulous evaluation of hematopoietic and non-hematopoietic elements in the bone marrow. The integrated PBS-BMA-BMI report should be made available in a time bound manner maintaining reasonable turnaround time. It should be clear and comprehensive, and every attempt should be made to offer preliminary vital diagnostic information regarding the underlying disease process wherever possible; suggest requisite routine and/or specialized ancillary testing; and finally guide the treating physician for further plan of patient management. The BMA-BMI reporting should be followed-up with that of BMBx, preferably, by the same reporting personnel. This ICH-ISHBT taskforce consensus document on BMA and BMI synoptic reporting intends to address the above issues, bring out homogeneity, and improve the quality of patient care at par with national and international standards.

Colorectal cancer (CRC) is one of the most molecularly heterogeneous malignancies, with complexity that extends far beyond traditional histopathological classifications. The consensus molecular subtypes (CMS) established in 2015 brought a marked advancement in the taxonomy of CRC, consolidating six classification systems into four novel subtypes, which focus on vital gene expression patterns and clinical and prognostic outcomes. However, nearly a decade of clinical experience with CMS classification has revealed fundamental limitations that underscore the inadequacy of any single classification system for capturing the full spectrum of CRC biology. The inherent challenges of the current paradigm are multifaceted. In the CMS classification, mixed phenotypes that remain unclassifiable constitute 13% of CRC cases. This reflects the remarkable heterogeneity that CRC shows. The tumor budding regions reflect the molecular shift due to CMS 2 to CMS 4 switching, causing further heterogeneity. Moreover, the reliance on bulk RNA sequencing fails to capture the spatial organization of molecular signatures within tumors and the critical contributions of the tumor microenvironment. Recent technological advances in spatial transcriptomics, single-cell RNA sequencing, and multi-omic integration have revealed the limitations of transcriptome-only classifications. The emergence of CRC intrinsic subtypes that attempt to remove microenvironmental contributions, pathway-derived subtypes, and stem cell-based classifications demonstrates the field's recognition that multiple complementary classification systems are necessary. These newer molecular subtypes are not discrete categories but biological continua, thus highlighting that the vast molecular landscape is a tapestry of interlinked features, not rigid subtypes. Multiple technical hurdles cause difficulty in implementing the clinical translation of these newer molecular subtypes, including gene signature complexity, platform-dependent variations, and the difficulty of getting and preserving fresh frozen tissue. CMS 4 shows a poor prognostic outcome among the CMS subtypes, while CMS 1 is associated with poor survival in metastatic cases. However, the predictive value for definitive therapy remains subdued. Looking forward, the integration of artificial intelligence, liquid biopsy approaches, and real-time molecular monitoring promises to enable dynamic, multi-dimensional tumor characterization. The temporal and spatial complexity can only be captured by complementary molecular taxonomies rather than a single, unified system of CRC classification. Such an approach recognizes that different clinical questions - prognosis, treatment selection, resistance prediction - may require different molecular lenses, each optimized for specific clinical applications. This editorial advocates for a revolutionary change from pursuing a single "best" classification system toward a diverse approach that welcomes the molecular mosaic of CRC. Only through such comprehensive molecular characterization can we hope to achieve the promise of precision oncology for the diverse spectrum of patients with CRC.

Core-binding factor acute myeloid leukemia (CBF-AML) is traditionally classified as a favorable-risk subtype; however, outcomes in the Indian context have not mirrored this biological advantage. Relapse rates approaching 40

Introduction Sarcopenia is a generalized disorder of skeletal muscle associated with adverse outcomes in older adults. With advancing age, the ability to overcome adverse outcomes reduces as measured by reduced intrinsic capacity (IC). Therein lies an underlying pathophysiological relationship between sarcopenia and IC. Our study aimed to explore the association between IC and sarcopenia in healthcare-seeking older adults in India. Materials and methods We conducted a cross-sectional study at a tertiary care hospital in New Delhi, India. One hundred and thirty older adults (90 men and 40 women) aged 65 years attended outpatient department services. Sarcopenia was diagnosed as per the Asian Working Group for Sarcopenia (AWGS) 2019 consensus criteria. IC was evaluated as the sum of five domains defined by the World Health Organization (WHO), namely, cognition, sensory (self-reported vision and hearing), locomotion, vitality (nutrition), and psychological. The IC composite score was calculated by summing of scores of all five domains, with a higher score representing lower IC. Results The mean age of patients was 70.8±5.8 years. Twenty-six patients (20%) had sarcopenia. Sarcopenic patients were older, less physically active, had a similar incidence of chronic comorbidities, and had significant polypharmacy as compared to non-sarcopenic patients; 73% of total patients had impairment in at least one domain of IC. Cognition, locomotion, sensory, vitality, and psychological domains were impaired in 26%, 48%, 65%, 52% and 44% of total patients, respectively. The median IC composite score was 2 in non-sarcopenic patients, while the sarcopenic patients had a median IC score of 3.5, showing significantly reduced IC. After multivariable analysis, sarcopenic patients had significantly higher impairment in locomotion and vitality domains of IC. Conclusion This study showed that lower IC is associated with sarcopenia. Vitality and locomotion domains are strongly associated with sarcopenia. This study is consistent with hypotheses of shared underlying pathophysiology from prior literature, and hence, sarcopenia and IC should be discussed together while diagnosing and managing an older adult in the Integrated Care for Older People (ICOPE) protocol.