Sa A. Wang, MD, University of Texas MD Anderson Cancer Center, Houston, TX
Robert P. Hasserjian, MD, Massachusetts General Hospital, Boston, MA
Bone marrow biopsy and aspirate performed to evaluate cytopenia(s) is very common, comprising nearly half of all bone marrow samples in both primary and tertiary/referral settings. The changes in bone marrow neoplasms that cause cytopenia are often subtle and easily missed; conversely, non-neoplastic processes that cause cytopenias, such as infections and drugs, can mimic malignancy morphologically. Marrow infiltrative processes, such as lymphomas, that can cause cytopenias may be missed due to the subtlety of the bone marrow changes. The increasing use of reference laboratories requires that pathologists who practice in that setting interpret ancillary results appropriately in the overall context of these cases.
This course focuses on bone marrow pathology interpretation and recommends practical approaches in the workup of cytopenia(s). The target audience includes general pathologists who sign out bone marrow cases as well as hematopathologists, residents, and hematopathology fellows. We will review the morphology of various bone marrow conditions that can cause cytopenia and demonstrate how to integrate results of ancillary laboratory tests (such as flow cytometry and cytogenetics) and pertinent clinical findings into the final diagnosis. During the course of the case discussions, we will update the audience on recent advances in the field, including the 2008 WHO Classification of Myeloid and Lymphoid Neoplasms.
Upon completion of this educational activity, the participants should be able to: 1) Learn appropriate and cost-effective approach to the workup of bone marrow specimens procured to evaluate unexplained cytopenia, including use of information from morphology ancillary testing (flow cytometry immunophenotyping, cytogenetics, and molecular genetics), and the clinical findings; 2) Learn to avoid pitfalls in the diagnosis of cytopenic patients, including missing subtle neoplasms and misclassifying reactive conditions that may simulate neoplasms; and 3) Adopt an algorithmic approach the diagnosis of myelodysplastic syndromes (the most common clinical concern in cytopenic patients undergoing a bone marrow examination).
We will use a PowerPoint presentation formation. Each presentation will consists of an overview of a particular key scenario, followed by case illustrations, practice points, and recommended diagnostic algorithms. Time will be allocated for questions and interactive discussions. We will provide written handouts of the presentations to the participants and post the presentations (including illustrative case images) on the USCAP website after the meeting.