Hematopathology

Hematopathology

The Hematopathology group, led by Dr. Ferry since January, 2010 provides diagnostic services for patients at Massachusetts General Hospital and consultation services for U.S. and international pathologists. The group has focused on the careful morphologic, immunophenotypic and genetic characterization of lymphoid and myeloid neoplasms, in order to develop criteria for diagnosis and to better define clinically relevant hematologic diseases. The group works closely with hematologists and oncologists to provide optimal patient care. A major mission of the group is also to train future leaders in the field of hematopathology.

Faculty

• Judith A. Ferry, MD, Director of Hematopathology
• Robert P. Hasserjian, MD
• Abner Louissaint, Jr., MD, PHD
• Valentina Nardi, MD
• Frederic Preffer, PhD
• Aliyah R. Sohani, MD
• Lawrence R. Zukerberg, MD

Clinical Program

Approximately 3,500 in-house and consultation biopsies and resection specimens, 4000 flow cytometry specimens and 1400 clinical pathology specimens are reviewed primarily by the Hematopathology service each year. These include biopsies of bone marrow, lymph nodes, and a variety of extranodal sites including gastrointestinal tract, bone and soft tissue, head and neck and others. The Hematopathology service also reviews all splenectomy specimens and thymectomies, as well as providing input on cases from other subspecialties when there is a question of a hematologic neoplasm. Myeloid neoplasms and selected lymphoid neoplasms are also evaluated by cytogenetic analysis and next-generation sequencing, and these results are incorporated into the final diagnosis. In addition to in-house cases, the Hematopathology group reviews a large number of cases submitted in consultation from outside institutions. Hematopathology also interprets results of flow cytometric analysis; the busy flow cytometry laboratory performs analysis for lymphoid and myeloid neoplasms, including, in selected cases, measurable residual disease (MRD) analysis for acute lymphoblastic leukemia and acute myeloid leukemia. A total of approximately 1400 clinical pathology specimens (peripheral smears and body fluids including cerebrospinal, pleural, peritoneal, and ascitic fluid) are submitted to the Hematopathology service for pathologist review.

Academic and Research Accomplishments

The Hematopathology group has been interested in using a combination of morphology, immunophenotype, and genetic features to characterize lymphoid and myeloid disorders, to improve the diagnosis and classification of these diseases. Characterizing small B-cell neoplasms, diffuse large B-cell lymphomas, extranodal lymphomas, reactive proliferations that may mimic lymphomas, acute leukemias, and myelodysplastic syndromes have been particular interests. Dr. Harris is a founding member of the International Lymphoma Study Group, and led the development of the Revised European-American Classification of Lymphoid Neoplasms (REAL classification), published in 1994, and was an editor of the World Health Organization classification of tumors of the hematopoietic and lymphoid tissues, published in 2001 and 2008. Members of the Mass General Hematopathology group have written and edited books and monographs, and have contributed chapters to books on hematologic disorders. 

Educational Interactions with Other Departments

Hematopathology attendings and fellows participate in a number of weekly, biweekly or monthly multidisciplinary conferences with the Hematology/Oncology service during which pathology of active patient cases is shown and discussed, including Lymphoma Conference, Leukemia Conference, Lymphoma/Myeloma Clinicopathologic Conference, Leukemia/Bone Marrow Transplant Clinicopathologic Conference, and the Hematology Interdisciplinary Seminar.  In addition, the Hematopathology attendings, fellows and current rotating residents meet weekly to review and discuss interesting and challenging cases around the microscope (Interesting Case Conference) or to discuss a relevant article of interest (Journal Club). Residents and fellows present cases with interesting and instructive cytogenetic findings at the monthly Hematopathology/Cytogenetics Conference, which is attended by cytogeneticists from Brigham and Women's Hospital.  Hematology/Oncology fellows from the combined Dana Farber-Massachusetts General Hospital fellowship with interest in hematology participate in Hematopathology sign-out during a rotation in their second year of training.

Pathology Resident Education at Massachusetts General Hospital

Residents spend two months (AP) or two and one half months (CP or AP/CP) on Hematopathology, where they are primarily responsible for bone marrow, peripheral blood, lymph node, and other specimens involved by hematologic disorders. Daily sign-out occurs as two separate services (Bone Marrow and Lymph Node), each with a faculty member, at multiheaded microscopes. A fellow is usually present at each sign-out, and there are often visitors from other departments or institutions. Residents are responsible for reporting all diagnostic modalities on their cases, for example: bone marrow biopsy, aspirate smear, peripheral blood smear, flow cytometry, and immunohistochemistry are reviewed together by one resident-faculty-fellow team, reinforcing the importance of integrated reporting of hematologic neoplasms. The resident also receives reports of cytogenetics and molecular tests and works with the faculty member to incorporate this information into the final diagnosis. The Hematopathology faculty give didactic lectures to the residents during their Hematopathology rotation, including an intensive series of practically-oriented lectures and slide review sessions during the first week of each rotation.

Education of Hematopathology Fellows

The Mass General Pathology Hematopathology Fellowship is accredited by the ACGME for two positions. The two fellows supervise the residents in bone marrow and lymph node diagnosis. The fellows also handle the complex consultation cases referred to the Hematopathology faculty. The fellows participate in research projects during the fellowship and have produced a large number of research publications.

Previous and Current Fellows