How the Classification of Lymphoma Today Can Be Interpreted As a Marriage of Pathology, Genomics

Pharmacy Times interviewed Elaine Jaffe, MD, National Institutes of Health (NIH) distinguished investigator at the National Cancer Institute at NIH, who is receiving the American Society for Investigative Pathology Gold-Headed Cane Award and is presenting an award lecture at the Experimental Biology 2022 conference on the classification of lymphoma in the modern era—a marriage of pathology and genomics.

During this interview, Jaffe explains further how the classification of lymphoma today can be interpreted as a marriage of pathology and genomics.

Elaine Jaffe: Well, pathology is really the science of disease discovery. New pathologic entities are continually recognized, and diagnostic concepts change over time, and the diagnostic concepts are continually influenced by results of basic research.

So, what we see under the microscope is an important part of disease discovery, and is really, I think, a critical step in the process of disease discovery and definition. So, most of the insights into the pathogenesis of malignant lymphoma have really followed on the heels of accurate pathologic description. But the process is iterative.

So, knowledge of the new molecular pathways leads to development of new diagnostic tools, and these tools help us delineate disease entities and their borderlands. So, this influences how we make a diagnosis in the clinical setting.

So, as an example, take a disease—anaplastic large cell lymphoma. So, this was a tumor that was first recognized by pathologists because the cells infiltrated the sinuses of the lymph node, and they had distinctive morphologic features. Then it was discovered that they expressed CD30, but it was not until the molecular pathogenesis of this disease was elucidated that we really had the diagnostic tools to make the diagnosis accurately in the clinical setting, and some things that were originally thought to be possibly anaplastic large cell lymphoma were excluded, and some entities that were not recognized as anaplastic large cell lymphoma, such as the small cell variant, were included based on their molecular pathogenesis.

So, it starts with the microscope, but then you really have to understand the molecular pathogenesis, develop the diagnostic tools, and that leads to refinement of the entity.