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Philip R. Zollars, M.D.

Philip R. Zollars, M.D. President Clin-Path Associates, PLC. Fireman: Mr. Smith, at one point we decided to fight fire with fire…. Fireman: Mr. Smith, at one point we decided to fight fire with fire…. And, well…your house burned even faster!. Pathology:. Pathology:.

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Philip R. Zollars, M.D.

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  1. Philip R. Zollars, M.D. President Clin-Path Associates, PLC

  2. Fireman: Mr. Smith, at one point we decided to fight fire with fire….

  3. Fireman: Mr. Smith, at one point we decided to fight fire with fire…. • And, well…your house burned even faster!

  4. Pathology:

  5. Pathology: The science of the causes and effects of diseases.

  6. Pathology: • The basic principle in pathology is pattern recognition. • Variations in each and every disease process make the basic principle part challenging. • There is an exception to each and every rule. • Good judgment is extremely helpful.

  7. Pathology: • Good judgment comes from experience, which mostly comes from bad judgment. • Will Rodgers

  8. Pathology: • “It ain’t what you don’t know that gets you in trouble; it’s what you know for sure that just ain’t so”. • Mark Twain

  9. PathologyFree-time

  10. PathologyFree-time

  11. PathologyFree-time

  12. Bone Marrow Biopsies

  13. Bone Marrow BiopsyIndications • Unexplained anemia, abnormal red cell indices, cytopenias or cytoses. • Abnormal peripheral blood smear morphology suggestive of bone marrow pathology. • Diagnosis, staging and follow-up of acute and chronic leukemias, myelodysplastic syndromes, chronic myeloproliferative disorders, lymphomas, plasma cell myeloma, amyloidosis, and mastocytosis.

  14. Bone Marrow BiopsyIndications • Suspected bone marrow metastases. • Focal bony lesions on radiological imaging. • Unexplained organomegaly or presence of mass lesions inaccessible for biopsy. • Fever of unknown origin. • Evaluation of iron stores. • Lipid/glycogen storage disorders.

  15. Bone Marrow Procedure

  16. Bone Marrow Procedure

  17. Bone Marrow Procedure

  18. Bone Marrow ProcedureSpecimen Adequacy • Core should be at least 1 cm in length. • Approximately 7 ml of aspirate is required to perform morphology, flow cytometry, fluorescence in situ hybridization (FISH), and cytogenetics. • EDTA tube is required for smears (do not use sodium heparin because of staining artifact). • Flow cytometry, FISH, and cytogenetics use sodium heparin tubes.

  19. Bone Marrow ProcedureSpecimen Adequacy • Best to perform aspirate with Illinois needle. • Draw approximately 15 cm of vacuum. • Portion of aspirate can be squirted directly into formalin.

  20. Bone Marrow ProcedureSpecimen Adequacy

  21. Bone Marrow ProcedureClot Section Comparison

  22. Bone Marrow Procedure“Dry Tap” • Generally occurs in “packed” marrows, fibrotic marrows, or marrows with metastatic disease. • “Packed” marrows are generally acute or chronic leukemias with 100% cellularity. • Fibrotic marrows are generally myeloproliferative disorders, damaged marrows with fibrosis, or “Hairy cell” leukemia.

  23. Bone Marrow Procedure • Redirect Jamshidi before collecting bone core.

  24. Bone Marrow Report • When possible try to attain a consolidated report format (contains morphology, flow and FISH, and cytogenetics results). • Each testing type is less specific as a stand alone test, but combined become very powerful diagnostically.

  25. “Memories of what never was, become the good old days” • Steve Martin from the album “The Crow”

  26. The End!

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