ARCHIVES of Pathology & Laboratory Medicine

Vol. 150

Editor in Chief: Alain C. Borczuk, MD Deputy Executive Editor: Donna E. Hansel, MD, PhD Deputy Editors in Chief: Sanja Dacic, MD, PhD; Jerad M. Gardner, MD; Fan Lin, MD, PhD; David A. Schwartz, MD; Lynette M. Sholl, MD Executive Managing Editor: Patrick H. Kearns Managing Editor: Katie Giesen Associate Managing Editor: Hilary Price

Editorial Office: College of American Pathologists, 325 Waukegan Rd, Northfield, IL 60093-2750 847-832-7400; Fax: 847-832-8400; E-mail: archivesofpathology@cap.org

ASSOCIATE EDITORSClinical PathologyBone and Soft TissueN. Paul Ohori, MD
Anatomic PathologyDavid W. Bernard, MD, PhDPathologyMichelle D. Reid, MD, MSc
Adekunle M. Adesina, MD, PhDChung-Che (Jeff) Chang, MD, PhDMarilyn M. Bui, MD, PhDAnjali Saqi, MD, MBA
Timothy Craig Allen, MD, JDL. Jeffrey Medeiros, MDJohn D. Reith, MDMarina Vivero, MD
Richard L. Attanoos, MDJan A. Nowak, MD, PhDNicole D. Riddle, MDRoseann I. Wu, MD, MPH
Mary Beth Beasley, MDRandall J. Olsen, MD, PhDAndrew E. Rosenberg, MDNancy A. Young, MD
Patricia Chevez-Barrios, MDJorge Sepulveda, MDGene P. Siegal, MD, PhD
Lucian R. Chirieac, MDDeborah Sesok-Pizzini, MD, MBADermatopathology
Gregory J. Davis, MDNikoletta Sidiropoulos, MDBreast PathologyPaul W. Harms, MD, PhD
Michael T. Deavers, MDIla R. Singh, MD, PhDEdi Brogi, MD, PhDArtur Zembowicz, MD
Adel K. El-Naggar, MD, PhDYouli Zu, MD, PhDSabina Hajiyeva, MD
Gregory N. Fuller, MD, PhDOmar Hameed, MD, MBChBEndocrine Pathology
Kirk D. Jones, MDAdministrative andTimothy W. Jacobs, MDSylvia L. Asa, MD, PhD
Keith M. Kerr, BSc, MB, ChB,Regulatory AffairsShabnam Jaffer, MD
FRCPath, FRCPER. Marshall Austin, MD, PhDXiaoxian (Bill) Li, MD, PhDENT Pathology
Ashraf Khan, MDW. Stephen Black-Schaffer, MDDennis Sgroi, MDWilliam C. Faquin, MD, PhD
Haiyan Liu, MDRichard W. Brown, MDKalliopi P. Siziopikou, MD, PhDRaja R. Seethala, MD
Dina R. Mody, MDAlexis B. Carter, MDAaron M. Udager, MD, PhD
Anil V. Parwani, MD, PhDMaren Y. Fuller, MDCardiovascular PathologyMichelle D. Williams, MD
Victor G. Prieto, MD, PhDRichard J. Hausner, MDE. Rene Rodriguez, MDQihui "Jim" Zhai, MD
David L. Rimm, MD, PhDMichael L. Talbert, MDCarmela D. Tan, MD
Sinchita Roy-Chowdhuri, MD, PhDForensic Pathology
Mary R. Schwartz, MDSECTION EDITORSCytopathologyJohn R. Parker, MD
M. Kay Washington, MD, PhDANATOMIC PATHOLOGYDiane D. Davey, MDGlenn Rudner, MD
Maureen Zakowski, MDAutopsy PathologyYun Gong, MD
Lanjing "L.J." Zhang, MD, MSKim A. Collins, MDAndre L. Moreira, MD, PhD
Larry Nichols, MDRitu Nayar, MD

The ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE (ISSN: 0003-9985) is published monthly by the College of American Pathologists, 325 Waukegan Rd, Northfield, IL 60093, and is an official publication of the College of American Pathologists. Periodicals postage paid at Winnetka, IL, and at ad- ditional mailing office. SUBSCRIPTION RATES: The annual subscription rates for the ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE are as fol- lows: 1,100 other countries. No agency discount. Prepayment required in U.S. dollars drawn upon a U.S. bank. Individual copy prices: 95 other countries. Direct all orders, payments, claims, and inquires to: Archives of Pathology & Laboratory Medicine, College of American Pathologists, 325 Waukegan Rd, Northfield, IL 60093. Phone: 800-323-4040. Fax: 847-832-8153. CHANGE OF ADDRESS: POSTMASTER, send all address changes to ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE, 325 Waukegan Rd, Northfield, IL 60093. Notification of address change must be made at least 6 weeks in advance. Include both old and new addresses, and a recent mailing label. All articles published, including editorials, letters, and book reviews, represent the opinions of the authors and do not reflect official policy of the College of American Pathologists, the Editorial Board, or the institution with which the author is affiliated, unless this is clearly specified. Advertising: The appearance of display or classified advertising in this publication is not a CAP guarantee or endorsement of the product or the claims made for the product by the manufacturer. Copyright 2026 College of American Patholo- gists. All rights reserved. None of the contents of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without the prior written permission of the publisher. Printed in the USA.

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Gastrointestinal Pathology Olca Basturk, MD Ian Brown, MBBS, FRCPA Lawrence J. Burgart, MD Zongming Eric Chen, MD, PhD Vikram Deshpande, MD Jeffrey D. Goldsmith, MD Melanie Johncilla, MD David S. Klimstra, MD Laura W. Lamps, MD Robert M. Najarian, MD Nicole C. Panarelli, MD Deepa T. Patil, MBBS, MD Giacomo Puppa, MD Marie E. Robert, MD Antonia R. Sepulveda, MD, PhD Amitabh Srivastava, MD Catherine J. Streutker, MD Huamin Wang, MD, PhD T.T. Wu, MD, PhD Mamoun Younes, MD Lei Zhao, MD, PhD

Gynecologic Pathology Natalia Buza, MD Suzanne Crumley, MD Ian S. Hagemann, MD, PhD Ekene Okoye, MD Sudarshana Roychoudhury, MD

Hepatopathology Daniela S. Allende, MD, MBA Sadhna Dhingra, MD Wendy L. Frankel, MD Asif Rashid, MD, PhD Dongfeng Tan, MD

Immunohistochemistry Andrew M. Bellizzi, MD Kumarasen Cooper, MBChB Andrew L. Folpe, MD

Mediastinal Pathology Cesar A. Moran, MD Anja C. Roden, MD

Nephropathology Guillermo A. Herrera, MD Surya V. Seshan, MD Luan D. Truong, MD

Neuropathology Kar-Ming Fung, MD, PhD Roger E. Mclendon, MD Richard A. Prayson, MD Andreana L. Rivera, MD G. Jackson Snipes, MD, PhD Hidehiro Takei, MD Tarik Tihan, MD, PhD David Zagzag, MD, PhD

Ophthalmic Pathology Mukul K. Divatia, MD

Oral and Maxillofacial Pathology Catherine M. Flaitz, DDS, MS

Pediatric Pathology Michael A. Arnold, MD, PhD Aliya N. Husain, MD Jason A. Jarzembowski, MD, PhD

Placental Pathology Chrystalle Katte Carreon, MD Daniel Levitan, MD Alex K. Williamson, MD

Pulmonary Pathology Israh Akhtar, MD Douglas B. Flieder, MD Teri J. Franks, MD Andras Khoor, MD Brandon T. Larsen, MD, PhD Leslie A. Litzky, MD Alberto M. Marchevsky, MD Sanjay Mukhopadhyay, MD Kirtee Raparia, MD Frank Schneider, MD David I. Suster, MD Haijun (Steve) Zhou, MD, PhD

Urologic Pathology Bogdan A. Czerniak, MD, PhD Michael Ittmann, MD, PhD Zhong Jiang, MD Lakshmi Priya Kunju, MD Adeboye O. Osunkoya, MD Gladell P. Paner, MD Steven S. Shen, MD, PhD Satish Tickoo, MD

SECTION EDITORS CLINICAL PATHOLOGY Clinical Chemistry

Melissa M. Budelier, PhD, DABCC Dean C. Carlow, MD, PhD Amitava Dasgupta, PhD Sridevi Devaraj, PhD, DABCC Erin J. Kaleta, PhD, DABCC Stephen R. Master, MD, PhD Xin Yi, PhD, DABCC

Clinical Immunology M. Qasim Ansari, MD Smaroula Dilioglou, PhD Todd N. Eagar, PhD Semyon Risin, MD, PhD

Coagulation

Paul M. Allison, MD Jessica Jacobson, MD Jun Teruya, MD, DSc X. Long Zheng, MD, PhD

HematopathologyRichard Levenson, MDAlexander J. Lazar, MD, PhDDebra G. B. Leonard, MD, PhD
Amy Chadburn, MDStephen TC Wong, PhDNeal I. Lindeman, MDRicardo V. Lloyd, MD, PhD David N. Louis, MD
John Kim Choi, MD, PhDAnirban Maitra, MBBS
Genevieve M. Crane, MD, PhDClinical EffectivenessDipen Maru, MDEugene J. Mark, MD
Eric D. Hsi, MDand EconomicsJuan Miguel Mosquera, MD, MScGeorge Michalopoulos, MD, PhD
S. David Hudnall, MDDiana M. Cardona, MDArundhati Rao, MD, PhDKrzysztof Moroz, MD
Jerry Hussong, MDMichael C. Dugan, MDJessica S. Thomas, MD, PhD, MPHWilliam A. Muller, MD, PhD
Jeffrey L. Jorgensen, MD, PhDBrian R. Jackson, MDJeffrey L. Myers, MD
Michael J. Kluk, MD, PhDJeffrey W. Prichard, DOResidents AffairsTristram G. Parslow, MD, PhD
Tara Miller, MDEmily E. Volk, MDSuzanne Z. Powell, MDDeborah E. Powell, MD
Sergio Pina-Oviedo, MDMichael B. Prystowsky, MD, PhD
Digital PathologySocial MediaRobert L. Reddick, MD
MicrobiologyDavid S. McClintock, MDChristina A. Arnold, MDStanley J. Robboy, MD
S. Wesley Long, MD, PhDLiron Pantanowitz, MDAdam L. Booth, MDA. Joe Saad, MD
Audrey N. Schuetz, MD, MPHMichael Thrall, MDYasmeen M. Butt, MDHenry D. Tazelaar, MD
Lisa M. Stempak, MDYukako Yagi, PhDMarcos Lepe, MDWilliam D. Travis, MD
Gail L. Woods, MDElizabeth L. Mckinnon, MDEdward O. Uthman, MD
Emerging TechnologiesPembe Oltulu, MDGail H. Vance, MD
Molecular Pathologyand TechniquesVishwas Parekh, MDDavid H. Walker, MD
Anjen Chenn, MD, PhDPaul A. Christensen, MDRaghavendra Pillappa, MDThomas M. Wheeler, MD
Ninette Cohen, PhDJunya Fukuoka, MD, PhDSaranya Singaravel, DCP,Myra L. Wilkerson, MD
Fei Dong, MDRaul S. Gonzalez, MDDipNB (Path)R. Bruce Williams, MD
Jennifer Laudadio, MDXiaoyin "Sara" Jiang, MDDaniel C. Skipper, DOIgnacio I. Wistuba, MD
Dolores H. Lopez-Terrada, MD, PhDSean R. Williamson, MDPeter Paul Yu, MD
Federico A. Monzon, MDTransplantation PathologyRichard J. Zarbo, MD, DMD
Dwight H. Oliver, MDEnvironmental PathologyRoberto J. Barrios, MD
Gary W. Procop, MDAndrew Churg, MD, PhDAnthony Chang, MDCONTRIBUTING
Gregory J. Tsongalis, PhDFrancoise Galateau-Salle, MDMichael C. Fishbein, MDEDITORS
Yasushi Yatabe, MD, PhDAllen Gibbs, MD Sylvie Lantuejoul, MD, PhDLillian Gaber, MD Maxwell L. Smith, MDHussam Abu-Farsakh, MD Susan C. Baer, MD
Transfusion MedicineVictor L. Roggli, MDHeather Stevenson-Lerner, MD, PhDKevin M. Burns, MD
Jill Adamski, MD, PhDAnjana V. Yeldandi, MDLisa Yerian, MDJames L. Connolly, MD
Aleksandar Babic, MD, PhDChristopher P. Crum, MD
Vishesh Chhibber, MDEpidemiology andVirologyChristopher Doern, PhD, D(ABMM)
Elizabeth A. Hartwell, MDBiostatisticsEileen M. Burd, PhD, D(ABMM)Jonathan I. Epstein, MD
Kevin J. Land, MDJan Krumsiek, PhDJeannette Guarner, MDApril Ewton, MD
Matt Vassar, PhDMarie Louise Landry, MDSusan L. Haley, MD
ADMINISTRATIVE ANDMichelle M. Hebert, MD
REGULATORY AFFAIRSGlobal HealthEXECUTIVEDavid G. Hicks, MD
Artificial IntelligenceHallgrimur Benediktsson, MDADVISORY BOARDJ. Charles Jennette, MD
James H. Harrison, Jr., MD, PhDSamreung Rangdaeng, MDMahul B. Amin, MDNirag C. Jhala, MD
Fedaa Najdawi, MDDaniel A. Arber, MDKristine Konopka, MD
Andrew Quinn, MDImmune TherapyBarbara F. Atkinson, MDGerald J. Kost, MD, PhD
Ajit Singh, PhDDeborah A. R. Dillon, MDDavid L. Booker, MDGrace Y. Lin, MD, PhD
Oluwole Fadare, MDJenny Chang, MDCindy B. McCloskey, MD
InformaticsBrooke E. Howitt, MDBarbara S. Ducatman, MDAndrew G. Nicholson, MD
Ulysses G.J. Balis, MDAlvaro C. Laga, MDHarry L. Evans, MDMauro Papotti, MD
Michael J. Becich, MD, PhDMari Mino-Kenudson, MDRobert Folberg, MDMichael R. Pins, MD
Jordan Olson, MDErik Thunnissen, MD, PhDRichard C. Friedberg, MD, PhDAndrew Renshaw, MD
Zhenhong Qu, MD, PhDScott A. Tomlins, MD, PhDEric F. Glassy, MDGabriel L. Sica, MD, PhD
Ming S. Tsao, MD, FRCPCAllen M. Gown, MDShi Wei, MD, PhD
Pathology EducationStanley R. Hamilton, MDEva M. Wojcik, MD
Sarah M. Bean, MDMolecular CytopathologyM. Elizabeth H. Hammond, MDRebecca F. Yorke, MD
Ralph Green, MDGilda da Cunha Santos, MD, PhDJames S. Hernandez, MD
Tahyna Hernandez, MDDeepali Jain, MDWilliam F. Hickey, MD
Amy Y. Lin, MDSarah E. Kerr, MDJason L. Hornick, MD, PhD
Sara E. Monaco, MDJennifer L. Hunt, MD
Quality AssuranceNatasha Rekhtman, MD, PhDRobert L. Hunter Jr., MD, PhD
Arzu Buyuk, MDElaine S. Jaffe, MD
Stephen S. Raab, MDPrecision MedicinePeter E. Jensen, MD
Stephen Ruby, MDAngela N. Bartley, MDRebecca L. Johnson, MD
Kenneth J. Bloom, MDDonald S. Karcher, MD
SPECIAL SECTIONSJonathan L. Curry, MDKaren L. Kaul, MD, PhD
Advanced Imaging inFred R. Hirsch, MD, PhDMarsha C. Kinney, MD
PathologyA. John Iafrate, MD, PhDDaniel M. Knowles, MD
Michael Feldman, MD, PhDDiana N. Ionescu, MDPeter Kragel, MD
Lida P. Hariri, MD, PhDSarika P. Jain, MDMarc Ladanyi, MD