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Starry Sky Pattern in Hematopoietic Neoplasms: A Review of Pathophysiology and Differential Diagnosis

Dy-Ledesma, Janelyn L. MD; Khoury, Joseph D. MD; Agbay, Rose Lou Marie C. MD; Garcia, Mar MD; Miranda, Roberto N. MD; Medeiros, L. Jeffrey MD

doi: 10.1097/PAP.0000000000000127
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The starry sky pattern is a distinctive histologic feature wherein a rapidly proliferating hematolymphoid neoplasm contains scattered histiocytes with abundant pale cytoplasm in a background of monomorphic neoplastic cells. The cytoplasm of these histiocytes typically contains cellular remnants, also known as tingible bodies, incorporated through active phagocytosis. Although common and widely recognized, relatively little is known about the pathophysiological underpinnings of the starry sky pattern. Its resemblance to a similar pattern seen in the germinal centers of secondary follicles suggests a possible starting point for understanding the molecular basis of the starry sky pattern and potential routes for its exploitation for therapeutic purposes. In this review, we discuss the historical, pathophysiological, and clinical implications of the starry sky pattern.

*Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX

Department of Pathology, Hospital del Mar, Barcelona, Spain

The authors have no funding or conflicts of interest to disclose.

Reprints: Joseph D. Khoury, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, MS-072, Houston, TX 77030 (e-mail: jkhoury@mdanderson.org). All figures can be viewed online in color at www.anatomicpathology.com.

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