The physicians in the John C. Davis Myeloma and Amyloid Program work closely with the Department of Pathology and Laboratory Medicine at Tufts Medical Center to better diagnose and provide treatments for patients with plasma cell diseases.
Pathologists are physicians who diagnose cancer and other diseases by examining tissues, cells and body fluids. Our pathology team includes some of Boston’s top experts in diagnosing and tracking cancers. These pathologists have trained at top-tier institutions and have special expertise in cancer pathology.
How pathology influences your care
If your physician suspects that you may have cancer, he or she will most likely schedule you for a procedure during which a Tufts MC clinician will obtain a sample of your blood or tissue. After the pathologist receives your specimen in the laboratory, they will examine it, and let your treating physician know:
- If you have cancer
- The type of cancer you have
- Whether the cancer is contained or if it has metastasized
- The stage of the cancer
Our pathologists also help your physician determine the course of your cancer treatment. Throughout treatment, your physician will ask you to provide blood and urine specimens. These specimens contain certain proteins that are separated by high resolution gel electrophoresis enabling the pathologist to look for any abnormal proteins which are indicative of your disease (see below). By performing this procedure on a regular basis during your visits with your treating physician, your pathologist can determine if the abnormal proteins are diminishing. By doing this, your treatment team can better understand where you are in the progression of your disease and how well your therapies are working.
Protein Immunofixation Electrophoresis
This patient has abnormal proteins (immunoglobulins) of IgG and Kappa. This pattern may be seen with patients who have multiple myleoma.
In the below graphs, the first image shows a hatched peak which represents an abnormal protein. The second image shows the same patient's serum after treatment at Tufts Medical Center.
Here is an example of several patients' specimens showing the separation of normal (and sometimes abnormal) proteins by gel electrophoresis. In this image, the abnormal protein is identified by the red box.
Bone Marrow Biopsy/Aspiration
We may also have the pathologists examine your bone marrow through a procedure called bone marrow biopsy /aspiration. This test is typically ordered during your initial evaluation, if you are not responding to treatment, or if you are pre- or post-transplant.
This microscopic section image is from a bone marrow aspiration and bone marrow biopsy and shows sheets of abnormal plasma cells.
Part of your bone marrow aspiration specimen may be sent for cytogenetic evaluation at your initial evaluation. The lab may examine dividing cells or may perform a fluorescence in situ hybridization (FISH) analysis to look for changes from the expected normal pattern of two copies of each chromosome or probe. Panel A shows an abnormal set of chromosomes (karyotype) and panel B shows the changes that may be seen in FISH analysis (gain and loss of regions of chromosomes). Any changes identified will guide the optimal choice of therapy.
Once you are in remission, we will continue to monitor you on a gradually less-frequent basis to ensure we catch the cancer early if it does return.
The Pathology Team for Diagnosing Plasma Cell Diseases
Steven A. Bogen, MD, PhD, FCAP, Medical Director of Clinical Chemistry
Janet Cowan, PhD, Medical Director of Cytogenetics
Gary L. Horowitz, MD, Director of Informatics
Barbarajean Magnani, MD, PhD, Chair and Pathologist-in-Chief
Monika Pilichowska, MD, PhD, FCAP, Director of Hematopathology
Arthur R. Rabson, MD, Medical Director of Immunology and Microbiology, and Tissue Typing
For more information on the Department of Pathology and Laboratory Medicine >