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Each exam will almost certainly have a slide in the short or long case with a trephine that you are expected to interpret, and in many instances there will be more than one (the Autumn 2013 diet contained no aspirates). So this is something that you should plan early (at least 2-3 months prior to the exam) to speak to the consultant histopathologist to run through some basic slides and we would suggest you cover the following:
- chronic lymphocytic leukaemia
- hairy cell leukaemia
- diffuse large cell lymphoma
- lymphoplasmacytic lymphoma
- follicular lymphoma
- Hodgkin's disease
- myelodysplasia (including looking for the phenomenon ALIPs (abnormal localisation of immature precursors)
- essential thrombocythaemia
- myelofibrosis
- amyloidosis
- plasma cell myeloma
And some more of the rarer conditions (these may be more difficult to find but a few of these have come up in the past):
- Systemic mastocytosis (can look like hairy cell leukaemia)
- Visceral leishmaniasis
- Castleman's disease
- Granulomatous disease
- Langerhans Cell Histiocytosis
- Gaucher's disease
- Haemophagocytic lymphohistiocytosis
Trephine reporting is very rarely done now by haematologists however you will be expected to have a basic grasp of how to interpret and H&E or MGG stain, and request the appropriate immunohistochemistry. In view of the relative lack of experience of most people we would recommend going on a local course if trephine reporting is not something you do on a regular basis.
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