Magic. There is no other word to describe it. We clearly remember the wide-eyed wonder with which we looked up to our hematopathology mentors as they converted bits and pieces of complex data into comprehensive hematopathology reports. Interpretation of subtle morphologic findings and unusual (often unheard-of) cytogenetics and molecular genetics – these were all “simple” tricks of their trade. We watched in awe as they spoke with their hematology-oncology colleagues, assuring them with mutual respect. Even now, as practicing hematopathologists ourselves, we marvel at our good fortune in having stumbled across this subspecialty and the incredible ancillary toolbox it brings with it.
It’s difficult to believe that it was only around 50 years ago that Janet Rowley discovered the chromosomal translocation underlying chronic myeloid leukemia and changed our understanding of cancer biology forever. The field of hematopathology grew exponentially thanks to significant changes to the way we approach and classify hematopoietic disorders. Within the pathology subspecialties, hematology led the way in using phenotypic, cytogenetic, and molecular genetic classification schemes – some of which even trump morphologic manifestations of disease. The literature is burgeoning with evolving data that further strengthen the classification of hematologic malignancies, continually improving our ability to care for our patients.
As hematopathologists, one of our most important responsibilities is to apply literature-based, objective criteria when establishing a diagnosis and communicating our findings with our hematologist-oncologist colleagues so that they can offer the best possible care to our patients. Precise subclassification is particularly essential for accurate risk stratification and appropriate treatment selection. The WHO classification scheme for hematopoietic neoplasms is an incredible resource that has rendered this task feasible for the vast majority of patients we encounter in daily practice – but, even so, it is essential to realize that no classification system is perfect.
We are excited to present this “hematology/hematopathology takeover” issue of The Pathologist. In it, some of the world’s most renowned experts in our field summarize the historical context of hematopathology classification and discuss contemporary issues in diagnosing and treating hematopoietic disorders. We have selected cases that present challenges in the categorization and therapeutic approach of bone marrow and lymph node malignancies – and it’s our hope that they will help guide you in understanding how to approach these diseases from diagnostic and therapeutic angles.
We are grateful to Michael Schubert, Editor of The Pathologist, for allowing us space and intellectual liberty to present to you hematopathology at the intersection of history, morphology, phenotype, molecular analysis, and therapeutics. For the entire readership – health sciences students, medical laboratory scientists, pathology trainees, pathology faculty, and our patient-facing hematology colleagues – we hope that you find these cases interesting, educational, and inspiring, and that you leave with a sense of renewed wonder and intrigue about disorders of the hematopoietic system.
Read on to discover the cases...
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