The Hematopathology Section of the Laboratory of Pathology, NCI, offers expert diagnostic services in the field of hematopathology. Dr. Stefania Pittaluga, Staff Clinician, and I handle diagnostic service responsibilities equally, each rotating as the staff on service 50% of the time. However, because of the challenging nature of the material we receive for review, and obligations related to specific clinical protocols and teaching conferences, our clinical obligations extend well beyond the designated """"""""on-service"""""""" time. In the past year we were responsible for more than 2200 cases. Dr. Pittaluga oversees triage of clinical samples received by the laboratory, a time consuming activity due to the complicated and sometimes competing demands of clinical protocols. In addition to serving as a Staff Hematopathologist, she assists in supervising the Immunohistochemistry service, and does the laboratory development for new hematopathology tests that are later introduced into the routine test library. She also directs the In Situ Hybridization service. She is supported in these activities by a laboratory technician, and a Post-Baccalaureate fellow. Dr. Pittaluga is also Program Director of the Hematology Fellowship program. Dr. Pittaluga and I provide assistance in the diagnosis and classification of reactive and neoplastic lymphoproliferative disorders, immunodeficiency states, and diverse hematological malignancies. We provide consultative and collaborative services to physicians in the NCI, as well as to physicians studying patients with hematolymphoid disorders in other institutes, in particular NIAID, NHLBI, NHGRI, and NIAMSD. We cosponsor a monthly multidisciplinary case review conference discussing diagnostic or management problems in lymphoma, and in addition regularly present at conferences sponsored by NCI clinical branches (Pediatric Oncology, Medical Oncology, Dermatology, Experimental Transplantation &Immunology), and by NIAID, NHLBI, and NHGRI. We serve as Associate Investigators on more than 40 clinical protocols being conducted in the NCI and other NIH institutes. These protocols frequently mandate specialized testing to characterize the biological markers relevant to the particular study. In collaboration with other service units (Specialized Diagnostics, Cytogenetics, Flow Cytometry), we utilize a variety of diagnostic tools. The Section also provides in situ hybridization services for detection of Epstein Barr viral (EBV) sequences, and other diagnostic and experimental targets. We receive more than 2000 cases in consultation each year. Recent studies have highlighted the importance of secondary review for the diagnosis and proper treatment of patients with lymphoma. 1 Because of the demands that the consultation service places on our time, we try to restrict consultations to difficult or challenging cases. Many cases are submitted by other academic institutions, based on diagnostic uncertainty, or because of differences of opinion among several institutions. We regularly refuse to accept consultations that we regard to be of a routine nature, and recommend that such cases be sent to routine reference laboratories. We frequently make novel observations based on this unique clinical practice, and a number of publications have emanated from case material originally reviewed in consultation. Thus, I believe our clinical work enhances, rather than detracts, from our academic productivity. In many instances consultation cases are submitted to us based on prior publications from our laboratory. These cases contribute to our research mission, as they help us to expand our knowledge of rare entities, and characterize these disorders. Specific examples and the relevant publications are discussed under other projects. However, among them they include prognostic factors in classical Hodkgin lymphoma,2 classification of peripheral T-cell lymphomas,3 4,5 the role of EBV in lymphoma,6,7 and pediatric lymphomas.8,9 1. Jaffe ES. Centralized review offers promise for the clinician, the pathologist, and the patient with newly diagnosed lymphoma. J Clin Oncol 2011;29:1398-9. 2. Venkataraman G, Song JY, Tzankov A, Dirnhofer S, Heinze G, Kohl M, Traverse-Glehen A, Eberle FC, Hanson JC, Raffeld MA, Pittaluga S, Jaffe ES. Aberrant T-cell antigen expression in classical Hodgkin lymphoma is associated with decreased event-free survival and overall survival. Blood 2013;121:1795-804. 3. Nicolae A, Pittaluga S, Venkataraman G, Vijnovich-Baron A, Xi L, Raffeld M, Jaffe ES. Peripheral T-cell Lymphomas of Follicular T-Helper Cell Derivation With Hodgkin/Reed-Sternberg Cells of B-cell Lineage: Both EBV-positive and EBV-negative Variants Exist. The American journal of surgical pathology 2013;37:816-26. 4. Huppmann AR, Roullet MR, Raffeld M, Jaffe ES. Angioimmunoblastic T-cell lymphoma partially obscured by an Epstein-Barr virus-negative clonal plasma cell proliferation. J Clin Oncol 2013;31:e28-30. 5. Bajor-Dattilo EB, Pittaluga S, Jaffe ES. Pathobiology of T-cell and NK-cell lymphomas. Best practice &research 2013;26:75-87. 6. Nicolae A, Huppmann AR, Slack GW, Ferry JA, Harris NL, Pittaluga S, Jaffe ES, Hasserjian RP. EBV Is Infrequently Expressed in the LP Cells of Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL) in Both Children and Adults. Laboratory Investigation 2013;93:352A-A. 7. Menon MP, Hutchinson L, Garver J, Jaffe ES, Woda BA. Transformation of follicular lymphoma to Epstein-Barr virus-related Hodgkin-like lymphoma. J Clin Oncol 2013;31:e53-6. 8. Liu Q, Salaverria I, Pittaluga S, Jegalian AG, Xi L, Siebert R, Raffeld M, Hewitt SM, Jaffe ES. Follicular lymphomas in children and young adults: a comparison of the pediatric variant with usual follicular lymphoma. The American journal of surgical pathology 2013;37:333-43. 9. Huppmann AR, Xi L, Raffeld M, Pittaluga S, Jaffe ES. Subcutaneous panniculitis-like T-cell lymphoma in the pediatric age group: A lymphoma of low malignant potential. Pediatr Blood Cancer 2013.
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