Frozen sections in hematopathology

The diagnostic complexity of lymphoproliferative disorders has increased tremendously within the last decade as evidenced by the recently published World Health Organization (WHO) classification of hematological malignancies. Diagnosis of these malignancies now often requires confirmation by ancillary studies, such as immunohistochemistry, flow cytometry, cytogenetics, and/or molecular studies. In fact, in some cases, these ancillary studies are diagnostic rather than simply confirmatory; furthermore, results from these studies may play a direct role in selecting patient therapy. Importantly, this comprehensive approach to the diagnosis of hematological disorders starts at the time of receipt of fresh tissue in the anatomic pathology laboratory. Appropriate handling and triaging of this fresh tissue, which includes recognizing grossly abnormal areas, interpreting the frozen section, and deciding to send portions of the specimen to ancillary laboratories, is pivotal to the optimal diagnosis, prognostication, and ultimate management of the patient.