Hematology

Which Slides and Reports Does a BPDCN Second Opinion Need?

At a Glance

For a BPDCN second opinion, ask the specialist center what it needs, then have your hospital securely send pathology reports, tissue blocks or slides, complete flow-cytometry data, genetic results, imaging, and recent clinical records. Do not delay urgent treatment while records are transferred.

Getting a second opinion at a specialized cancer center is a highly recommended step after a Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) diagnosis. While your written medical reports are important, specialist centers typically prefer—and often require—your actual physical biopsy materials, complete laboratory data, and raw imaging files to perform a full re-evaluation.

Important Safety Note: BPDCN is an aggressive disease that sometimes requires immediate therapy. Do not delay urgent treatment, transfusions, or hospital admissions just to gather records or wait for a second opinion. Always coordinate with your current treating hematology team; you can begin treatment while your records are being transferred.

Step 1: Call the Specialist Center First

Before you start requesting materials, call the receiving cancer center and ask to speak with their intake coordinator.

Every center has different requirements: They will tell you exactly what they need for their review.
Do not mail biological samples yourself: Your local hospital’s pathology department must securely transfer tissue blocks and slides directly to the specialist center to maintain a proper chain of custody.
Sign release forms: You will need to sign Medical Records Release forms at your local hospital and imaging centers to authorize these transfers.

Step 2: The BPDCN Second Opinion Checklist

When arranging your transfer, ask the specialist center if they need the following items. Not every patient will have (or need) every item on this list.

Category	What to Request	Why It May Be Needed
Pathology (Tissue & Blood)	• Original pathology reports • Formalin-fixed paraffin-embedded (FFPE) tissue blocks • Unstained glass slides (if blocks cannot be sent) • Original stained slides • Bone marrow core, clot sections, and aspirate smears • Peripheral blood smears	The specialist needs to look at the actual cells under a microscope ^[1]. They may also need to run their own specialized immunostains on the unstained slides or blocks.
Flow Cytometry	• Complete flow cytometry reports • Visual “dot plots” or graphs • Raw digital data files (FCS files), if requested and available	Flow cytometry measures proteins inside and on the surface of cells. BPDCN is diagnosed using a complex pattern of markers, so specialists need the full data, not just a one-paragraph summary ^[2].
Genetics & Molecular	• Next-Generation Sequencing (NGS) reports • Cytogenetic (karyotype) reports • FISH (Fluorescence in situ hybridization) reports	These tests look for chromosome changes and genetic mutations. While no single mutation proves or disproves BPDCN, this data provides important context for your prognosis and treatment planning ^[3]^[4].
Imaging	• Physical CD/DVD discs of scans (DICOM format) OR secure electronic transfer • Written radiology reports	If you had a PET/CT, CT, or MRI scan, the specialist radiologist will want to view the actual images to assess where the disease is located, not just read the summary ^[5].
Clinical Records	• Recent bloodwork (CBC with differential, LDH, chemistry panel) • Clinical notes from your hematologist/oncologist • Treatment history (any therapies already given)	Interpretation of your pathology depends heavily on your clinical timeline, symptoms, and whether a sample was taken before or after treatment.

Why Physical Materials Matter

Hematopathology—the study of blood cancers—is highly complex. In general studies of expert second opinions for various blood cancers, diagnoses are refined, updated, or changed in roughly 10% to 20% of cases ^[6]^[7]. (Note that this statistic applies broadly to hematology referrals, not your specific likelihood of a misdiagnosis).

Many local hospitals lack the specific testing required to confidently identify BPDCN. For instance, evaluating BPDCN may include checking for a combination of markers like CD4, CD56, CD123, and CD303, or running advanced tissue stains for proteins like TCF4 ^[8]^[9]. No single stain or marker is a “magic bullet” that confirms BPDCN; instead, the hematopathologist must look at the entire pattern and rule out other diseases. If your initial hospital did not have access to these specific stains, sending the actual tissue allows the specialist center to run them.

What If Materials Are Missing or Exhausted?

Sometimes a biopsy sample is too small, the tissue is exhausted (completely used up), or digital flow cytometry files are no longer saved. Do not panic, and do not cancel your appointment. Send whatever written reports and materials are available. The specialist center will review what you have and determine if a repeat biopsy or additional testing is clinically justified.

Common questions in this guide

What pathology materials should I send for a BPDCN second opinion?

Ask the receiving center whether it needs the original pathology reports, tissue blocks, unstained or stained slides, bone marrow core and clot sections, aspirate smears, and peripheral blood smears. Your local pathology department should send biological materials directly to the specialist center; do not mail them yourself.

Why are full flow-cytometry results important for BPDCN review?

BPDCN is evaluated using a pattern of proteins on and inside abnormal cells rather than one test result. The specialist may need the complete report, visual dot plots, and available raw digital files, often called FCS files, to reassess that pattern.

Which genetic test reports are useful in a BPDCN second opinion?

The center may request next-generation sequencing, chromosome or karyotype testing, and fluorescence in situ hybridization, or FISH, reports. These results do not by themselves confirm or rule out BPDCN, but they can provide context for prognosis and treatment planning.

Do I need to send scans and routine bloodwork too?

Yes. Ask whether the center wants the actual CT, PET/CT, or MRI files in DICOM format and the radiology reports, along with recent CBC with differential, LDH, chemistry results, clinical notes, and treatment history. This information helps specialists interpret the pathology in the context of your illness and prior care.

What if my biopsy tissue or digital flow data is no longer available?

Send every report and remaining material you can obtain, and keep the appointment. The specialist team can decide whether a repeat biopsy or additional testing is clinically justified; missing materials do not automatically make a review impossible.

Should I wait to start BPDCN treatment until the second opinion is complete?

No. Do not delay urgent treatment, transfusions, or hospital admission just to collect records or wait for review. Coordinate with your current hematology team so care and record transfer can proceed in parallel.

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Related questions

What Is BPDCN's Long-Term Outlook and Survival Rate? What Do BPDCN Skin Lesions Look Like? Signs to Know Why Is a BPDCN Transplant Recommended While in Remission? How Rare Is BPDCN? Incidence and Who Usually Gets It What Are Tagraxofusp's Common Non-CLS Side Effects in BPDCN?

What Is the Pathophysiology of CLS During BPDCN Treatment? How Do CD123, CD4, and CD56 Support BPDCN Diagnosis? How Is Capillary Leak Syndrome Managed During Tagraxofusp? What Intensive Chemotherapy Regimens Are Used for BPDCN? What Are the Early Signs of Acute and Chronic GVHD? Why Is BPDCN Frequently Misdiagnosed? Common Mimics What Do TET2, ASXL1, and ZRSR2 Mean in BPDCN NGS Results? What Is the Long-Term BPDCN Survivor Surveillance Schedule? How Does Tagraxofusp (Elzonris) Work Against BPDCN? What Do Plasmacytoid Dendritic Cells Do in Immunity? What Should I Ask My Oncologist About BPDCN Expertise? Why Might BPDCN Need Chemotherapy in the Spinal Fluid?

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Curated prompts to bring to your next appointment.

1.Which specific pathology slides, tissue blocks, and flow cytometry files do you need my local hospital to send before my appointment?
2.Do you have a specialized intake coordinator who can help facilitate the secure transfer of my physical biopsy materials and imaging?
3.Are there any specific molecular or genetic tests that weren't run locally that you plan to run on my tissue when it arrives?
4.Can your team begin reviewing my case based on the written reports while we wait for the physical slides and discs to arrive?
5.Is your review limited to confirming the diagnosis, or will it also include treatment recommendations and clinical trial eligibility?

References (9)

1
Blastic Plasmacytoid Dendritic Cell Neoplasm: Clinical Presentation and Diagnosis.
Deconinck E, Petrella T, Garnache Ottou F
Hematology/oncology clinics of North America 2020; (34(3)):491-500 doi:10.1016/j.hoc.2020.01.010.
PMID: 32336414
2
Immunophenotypic characterization of reactive and neoplastic plasmacytoid dendritic cells permits establishment of a 10-color flow cytometric panel for initial workup and residual disease evaluation of blastic plasmacytoid dendritic cell neoplasm.
Wang W, Khoury JD, Miranda RN, et al.
Haematologica 2021; (106(4)):1047-1055 doi:10.3324/haematol.2020.247569.
PMID: 32241840
3
Simultaneous deletion of 3'ETV6 and 5'EWSR1 genes in blastic plasmacytoid dendritic cell neoplasm: case report and literature review.
Tang Z, Tang G, Wang SA, et al.
Molecular cytogenetics 2016; (9()):23 doi:10.1186/s13039-016-0232-1.
PMID: 26925167
4
Features of non-activation dendritic state and immune deficiency in blastic plasmacytoid dendritic cell neoplasm (BPDCN).
Beird HC, Khan M, Wang F, et al.
Blood cancer journal 2019; (9(12)):99 doi:10.1038/s41408-019-0262-0.
PMID: 31811114
5
Imaging findings for 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in blastic plasmacytoid dendritic cell neoplasm: case series and literature review.
Zhou Y, Li K, Jin X, et al.
Frontiers in medicine 2025; (12()):1581760 doi:10.3389/fmed.2025.1581760.
PMID: 41048960
6
Secondary review of extramural hematopathology cases for patients referred to an academic center: The increasing importance of subspecialized hematopathology practice.
Hamnvag HM, Van Norman S, Chen Y, et al.
American journal of clinical pathology 2025; (164(5)):800-805 doi:10.1093/ajcp/aqaf105.
PMID: 40994294
7
Impact of Expert Pathologic Review of Lymphoma Diagnosis: Study of Patients From the French Lymphopath Network.
Laurent C, Baron M, Amara N, et al.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology 2017; (35(18)):2008-2017 doi:10.1200/JCO.2016.71.2083.
PMID: 28459613
8
Pediatric Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report.
Zheng JX, Betts EV, Dwyre DM, et al.
Clinical pathology (Thousand Oaks, Ventura County, Calif.) 2024; (17()):2632010X241304564 doi:10.1177/2632010X241304564.
PMID: 39687328
9
Dual Expression of TCF4 and CD123 Is Highly Sensitive and Specific For Blastic Plasmacytoid Dendritic Cell Neoplasm.
Sukswai N, Aung PP, Yin CC, et al.
The American journal of surgical pathology 2019; (43(10)):1429-1437 doi:10.1097/PAS.0000000000001316.
PMID: 31261288

This checklist is for informational purposes only and does not constitute medical advice. Work with your hematology team and the receiving center, and do not delay urgent BPDCN treatment, transfusions, or hospital care while gathering records.