Anatomic Pathology Consult Page

Neoplastic Hematopathology & Flow Cytometry

The Division of Hematologic Pathology has expertise in all aspects of the diagnostic evaluation of patients with hematologic malignancy. We offer world-class consultative interpretation of the morphology of blood, bone marrow, lymph node and other hematologic specimens, and have specialty expertise in the application of ancillary techniques, especially flow cytometry. These ancillary studies are important not only for diagnosis but also monitoring patients after therapy for detection of residual disease.

Our testing and consultation services aid treating physicians, oncologists, and hematologists as well as pathologists confronted with difficult diagnostic problems in leukemia and lymphoma.

Lab Hours
8:00 a.m. to 5:30 p.m., Monday through Friday.

Johns Hopkins Medicine
Cytometry Laboratory

401 N. Broadway
Room 2300
Baltimore, MD 21231
Phone 410-614-2968
Fax 410-614-2912


Experience

Many years of experience working closely with pathologists as well as with treating oncologists and hematologists have enabled us to understand both the diagnostic complexities and the practical implications in this extremely complex area. We can help you determine not only the most appropriate test for diagnosis, but also the circumstances in which additional costly testing may not be needed. We are always available to discuss the special features of any case.


Expertise

Expert Consultation
The Hematologic Pathology Division is directed by Dr. Michael J. Borowitz, an internationally renowned hematopathologist with particular expertise in the flow cytometric diagnosis of hematologic malignancies. He has been a leader in numerous organizations concerned with the clinical application of this technology. Drs. Chris Gocke, Milena Vuica-Ross, and Kathleen Burns are board certified hematopathologists with expertise in all aspects of diagnosis of hematologic disorders.

Although we have expertise in the appropriate application of state-of-the-art technology to the diagnosis of leukemia and lymphoma, we also are experts in the morphologic diagnosis of these tumors. We believe that excellent morphologic analysis is essential to the interpretation of ancillary techniques, and that it continues to provide the cornerstone to diagnosis.

Special capabilities and services
The Flow Cytometry lab has been an international leader in developing and applying new technologies. We were among the first to use a "pattern recognition" approach to diagnosis. Using four-color multiparameter analysis, we have developed a highly sensitive method for detecting malignant hematopoietic cells and describing these cells in a manner most appropriate for classification.

The laboratory performs more than 2,000 tests per year on the flow cytometric analysis of hematologic malignancies. Other flow cytometric tests performed by the laboratory include routine lymphocyte subset analysis, CD34 enumeration, and detection of GPI-anchored proteins for the diagnosis of paroxysmal nocturnal hemoglobinuria.

The division also works closely with the Cytogenetics, Immunopathology, and Molecular Diagnostics Laboratories. When customers would benefit from the testing services of these other labs, our lab can jointly coordinate all services and we can incorporate all appropriate information into our final interpretation.


Timely Results

Test results generally can be supplied in one or two days from receipt of sample, depending on the nature of the workup performed. If requested, preliminary assessment can be given the same day. Flow cytometric results are available within hours if needed. Phone reports are routine, and hard copy is usually available by fax the following day.


Faculty

Dr. Michael Borowitz

Michael J. Borowitz, M.D., Ph.D.

Phone:410-614-2889
Fax:410-502-1493
E-mail:

Education and Training

Notable Accomplishments
Dr. Borowitz is one of the leaders in applying immunologic techniques to diagnose and classify leukemia and lymphoma. He has published numerous articles documenting the importance of these ancillary studies in the accurate diagnosis of these cancers, and has been particularly active in applying sophisticated approaches using the technique of flow cytometry. He has also been a leader in standardizing the practice of flow cytometry as it applies to leukemia and lymphoma, and has worked on developing improved proficiency testing programs and guidelines as well as good laboratory practice.

Major Professional Leadership


Tests

To order, call Customer Service at 1-800-997-5475 between 8:00 a.m. and 11:00 p.m.

We provide a multidisciplinary approach to the diagnosis of leukemia and lymphoma, aided by our close collaboration with the Cytogenetics, Immunopathology, and Molecular Diagnostics laboratories. Our lab has pioneered methods for enhanced sensitivity, enabling us to provide more precise and detailed information from a single specimen. Equally crucial, our faculty are experts in analyzing and interpreting the results provided by this state-of-the-art technology.

Leukemia
Flow Cytometry (Phenotypic Characterization, Residual Disease Detection)
Morphology Consultations -- Blood and Marrow
Cytogenetics (in collaboration with the Cytogenetics Laboratory)
Molecular Diagnostics (in collaboration with the Molecular Diagnostics Laboratory)

Lymphoma
Flow Cytometry (Phenotypic Characterization, Staging, Residual Disease Detection, Fine Needle Aspirates)
Morphology Consultations -- Lymph Node and other Tissue Biopsies
Immunohistochemistry
Molecular diagnostics (in collaboration with the Molecular Diagnostic Laboratory)

Specialty Tests
CD34 Counting
PNH (Paroxysmal Nocturnal Hemoglobinuria) Diagnosis


Special Ordering Instructions

Leukemia

Test Specimen Store Comments
Flow Cytometry Peripheral blood - 5cc lavender or green top tube

Bone Marrow - 3cc green top tube preferred
Room temp Cell surface antigen typing to characterize leukemia; to distinguish myeloid and lymphoid leukemia; or to detect residual disease. PLEASE INCLUDE CLINICAL INFORMATION. At the minimum it is necessary to know if the suspicion is acute leukemia or CLL
[Note: suspected L3(Burkitt's) should be sent on wet ice.]
Morphologic Consultation Wright-stained or unstained slides; bone marrow sections, tissue blocks Room temp  
Cytogenetics See the Cytogenetics site for more information.    
Molecular Diagnostics See the Molecular Diagnostics site for instructions.    

Lymphoma

Test Specimen Store Comments
Flow Cytometry Lymph node bx - min 5x5x5 mm portion of fresh lymph node in RPMI or other tissue culture medium 2-8°C(wet ice) Cell surface antigen typing to aid in the diagnosis and classification of lymphoma; this material may also be used for molecular or cytogenetic studies
  Fine needle asp - suspended in RPMI or other tissue culture medium 2-8°C(wet ice) Cell surface antigen typing to aid in the diagnosis and classification of lymphoma or detection of residual disease
  Bone marrow - 3cc green top tube preferred Room temp Cell surface phenotyping for staging or detection of minimal disease
Immuno-histochemistry Lymph node or other tissue bx - min 5x5x5 mm portion of fresh lymph node in Michel's transport medium Room temp Cell surface antigen typing to aid in the diagnosis and classification of lymphoma. Tissue in Michel's medium is used for frozen section immunohistochemistry which is superior for determination of clonality and permits assessment of a larger number of antigens. Michel's tissue is not suitable for molecular studies. Fresh tissue in RPMI or frozen tissue on dry ice can also be used
  Paraffin tissue blocks Room temp Cell antigen typing to aid in the diagnosis and classification of lymphoma. Paraffin tissue immunohistochemistry is superior for permitting a correlation between immunology and cytology; this is especially important in cases of suspected Hodgkin's disease. Paraffin material is suitable for some, though not all molecular studies
Morphologic Consultation Lymph node or other tissue biopsy sections, tissue blocks Room Temp  
Molecular Diagnostics See the Molecular Diagnostics site for instructions.    

Flow Cytometry - Special Tests

Test Specimen Store Comments
CD34 Counting Peripheral blood - 3 to 5cc lavender top tube or bone marrow - 3cc green top tube Room temp Cell surface antigen typing to determine the % or absolute number of CD34+ cells
PNH phenotyping Peripheral blood - 3 to 5cc lavender top tube or bone marrow - 3cc green top tube Room temp Cell surface antigen typing to detect CD59 and other GPI-linked proteins; these antigens are absent in PNH (Paroxysmal Nocturnal Hemoglobinuria)