Hematopathology Tutorial Instructions

Departmentof Pathology, State University of New York at Stony Brook

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.  This is a tutorial about lymphomas: non-Hodgkin's lymphomas, Hodgkin's lymphomas, and plasma cell dyscrasias. These three entities make up the three large supersections on the Table of Contents, and each supersection is subdivided into several main pages or sections. The emphasis is on how these lymphomas are diagnosed and what the important morphological and biological distinctions are among them. Text and copious color illustrations are supplied, as well as hyperlinks between associated sections.
        The tutorial is designed to be useful both to pathologists and to other physicians who treat patients with lymphomas. Residents and health professions students also will profit from viewing the tutorial; and even lay individuals may find answers to some of their questions. World-class hematopathologists should probably look elsewhere for enlightenment; or, if they proceed, they should be gentle and constructive with their feedback.
         The objectives of this course are to gain a useful understanding of various aspects of non-Hodgkin's lymphomas, Hodgkin's lymphomas, and plasma cell dyscrasias. Upon completion of this tutorial, readers should be able to:

Discuss the epidemiology of lymphomas.
Explain the behavior and prognosis of different kinds of lymphomas, including some of the biological mechanisms underlying their evolution.
Classify lymphomas according to the traditional Working Formulation and the more recent REAL classification.
Enumerate the techniques used to diagnose lymphomas in the laboratory, including immunoperoxidase staining, flow cytometry, and cytogenetics.
Identify the morpohological distinctions between lymphomas, including what each individual type looks like and what features characterize larger classes of lymphomas such as follicular lymphomas or T-cell lymphomas.
Differentiate between supergroups of lymphomas, such as non-Hodgkin's versus Hodgkin's, low-grade versus high-grade, T-cell versus B-cell.
Distinguish among benign and malignant lymphoid proliferations, such as lymphomas versus reactive adenopathies, or mulitple myeloma versus monoclonal gammopathies of uncertain significance.

The section on non-Hodgkin's lymphomas (the largest) tackles first B-cell and then T-cell lymphomas. The B-cell lymphomas are approached from low-grade to high-grade as follows:

Low-grade lymphomas with diffuse growth: small lymphocytic lymphoma and its variants and mantle cell lymphoma.
Low-grade and intermediate grade follicular lymphoma: all follicular lymphomas with a follicular growth pattern.
Intermediate grade lymphomas: diffuse lymphomas that may or may not be of follicular center cell origin. Immunoblastic lymphoma is included here despite its membership in the Working Formulation high grade category.
High grade lymphomas: lymphoblastic lymphoma and small non-cleaved cell lymphoma (Burkitt's).

How to Live, What to Do: You can study the tutorial as a whole or peruse one of subtopics. Probably the best way to do either is to view each main page as a unit, jumping back and forth between the main page and its associated illustrative pages (indicated as links within the main page). Most of the links within each main page take you to subpages stuffed with photomicrographs. When you're done with a main page, you can jump to the succeeding one by clicking on the Next link.
Occasionally links will take you elsewhere, such as to other main pages in the tutorial, to other hematopathology web sites with relevant material, or (mea culpa--but rarely) to completely frivolous amusements. Remember, any time you leave a main page or section, returning is as simple as clicking on your browser's Back button. Also, each main page contains links to the previous and next ones; if you get lost, the Table of Contents can redirect you to your target.
The less linear-minded may choose to careen around the site more randomly, like bees buzzing from bloom to bloom to skim off the exquisite nectar. Finally, the Table of Contents page is linked to a search engine, where you can enter a word or phrase and see links to all pages that contain it.

Navigation: Each of the main sections or pages is listed in the Table of Contents. Navigational aids are located on each of these main section pages toward the top of the blue band at the left of the page and also at the bottom of the page. Using these aids, the reader can click to jump either to the Table of Contents, the next section, or the previous one. Thus a tireless reader could traverse the entire tutorial in order without ever having to return to the Table of Contents.
Each section or page also contains links to pages with additional illustrations. If you visit one of these illustrative pages, you should use the Back button of your web browser to return to the main section page you just left. On each illustrative page, you will also find links to the Table of Contents.

Fare Thee Well: If you encounter any problems accessing this web site, you probably will not be reading these words. Nonetheless, you can contact either the site's webmaster, John Wolf, or the site's author, me, Dr. Weissmann, about your difficulties.
Whatever your degree of medical sophistication, I hope you find something useful here. And enjoy the photomicrographs--they are the soul of the tutorial.

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