Section: Hemepath

Duration: 2 months

Goals & Objectives

The primary goals of this rotation are for the residents to learn the roles of modern immunophenotypic studies in the diagnosis and classification of leukemias and lymphomas and the skills of morphologic diagnosis in hematologic tissues. All residents should acquire a foundation which will allow them to handle difficult hematopathology problems in an appropriate fashion. Those with particular interest have opportunities to gain experience with new and evolving technologies as well.

Duties & Responsiblities

1. Interpret lymph node and related tissue biopsies. Write a microscopic description of H&E morphology. Quantitate each antibody stain performed on sections and/or cytopreps. Review graphs of dual-labeled flow cytometric antibody results, assess appropriateness of gates and describe results. Review and sign out the cases with the clinical pathologist on service. Read regularly in the recommended references and current literature about the cases you see and the questions that arise. Assign SNOMED codes.
2. For cases in consultation from Surgical Pathology, which have been previously written up, review and return with resident and attending hematopathologists' initials on the same day for cases received in the a.m. and before noon the next day for those received in the p.m. Contact surgical pathologists by phone if significant alterations are made in the report.
3. For cases submitted for flow cytometry, review a Wright stained slide of the sample and appropriately note on the flow cytometry accession sheet the type of disease in question and the appropriate antibody panel (i.e., acute leukemia, chronic lymphoid leukemia or lymphoma).
4. Evaluate cases, including those submitted for morphologic evaluation only, for the need for additional studies such as gene rearrangements, cytogenetics or additional markers and communicate these to the referring pathologist or clinician. Request appropriate studies and ensure that the correct materials are transported to the specialized laboratory (Molecular Pathology, Cytogenetics, etc.).
5. Interpret immunologic marker results of bone marrow and peripheral blood specimens. Perform a differential count of films and/or cytopreps of separated cells and describe cells. Review and refer to bone marrow morphologic results when appropriate. Review flow cytometry graphs and assess appropriateness of gates. Describe significant positive and negative results. Review and sign out with the clinical pathologist on service. Assign SNOMED codes.
6. For cases on which molecular diagnostic tests are performed, review the pathology slides and data and results of molecular testing (gels, blots, etc.). Write an interpretive report and present to Dr. Shrimpton and the Hematopathology attending. Write any appropriate addendums to previously issued Hematopathology or Bone Marrow reports, also for review by the attending pathologist.
7. Learn technical aspects of processing lymph node, bone marrow and blood specimens for immunologic markers and related studies (including cultures, molecular studies and cytogenetics). Learn how to prioritize small-sample processing for optimal case-specific studies. Residents are encouraged to process control materials through entire technical procedures.
8. Utilize and contribute to lymphoma glass slide study sets.
9. Attend Hematopathology conferences and present cases at Thursday Hematology/Oncology conferences.
10. Participate in leukemia or lymphoma protocol reviews as indicated by the attending pathologist

Evaluation

Global Rating of Live or Recorded Performance: A rater judges general categories of ability (patient care skills, medical knowledge, interpersonal and communication skills) and the ratings are completed retrospectively based on general impressions collected over a period of time (end of rotation) derived from multiple sources of information (direct observations or interactions); input from other faculty, lab technicians and residents and review of work products or written materials. Evaluations will be based on the above objectives.

Recommended Reading