The foundation of every cancer diagnosis starts behind the scenes, where a pathologist and a team of specialists painstakingly evaluate a patient’s molecular, cytogenetic, and flow cytometry testing to determine whether the individual has cancer, and if so, precisely what type of malignancy, its stage, and how extensive the cancer may be.
Reza Nejati, MD
Associate Professor
Department of Pathology
Fox Chase Cancer Cente
Because the pathology report is at the heart of every differential diagnosis and the treatment that follows, Reza Nejati, MD, an Associate Professor, Department of Pathology at Fox Chase Cancer Center, is passionate about ensuring that oncologists and pathologists as well as trainees have a deep understanding of challenging hematologic neoplasms in order to apply updated diagnostic criteria and emerging recommendations to improve patient outcomes.
To accomplish this, in early 2025, Dr. Nejati started the Multi-Institutional Hematopathology Interesting Case Conference (MHICC). What began as a monthly virtual meeting to review challenging and unusual hematopathology cases has rapidly expanded into an international network. The participants initially included pathologists, oncologists, and trainees from renowned centers. Very quickly, word spread about the conference, which grew exponentially to attract the world’s most influential institutions.
Now, the forum is a brain trust of 100-plus pathologists, oncologists, radiation oncologists, and trainees from leading institutions. Nejati says, “Every month we discuss rare cases—outliers with unique characteristics and genetic mutations that defy existing classifications and treatment protocols—cases that create dilemmas arriving at a differential diagnosis and optimal therapies and pose highly nuanced questions you can’t necessarily ‘look up’ in the literature.”
The forum is interactive, case-based, and interdisciplinary with an emphasis on collaborative conversation that leads to enhanced diagnostic accuracy and more precise clinical decision-making.
Entities Often Overlap
For example, entities sometimes overlap with each other: In one MHICC case, a blastic plasmacytoid dendritic cell neoplasm (BPDCN) had a translocation seen in acute myeloid leukemias—the defining genomic change for acute mild leukemia. Through group discussion, participants determined that despite the genetic overlap, the case fit the BPDCN classification—an insight that directly influenced the patient’s treatment and prognosis.
“Presenting cases from the world’s most renowned cancer centers gives everyone a unique opportunity to learn from the best—to gain an enhanced perspective derived from each hospital’s core culture, scientific accomplishments, and the populations it serves. Some cases are so unusual that only one cancer center in the group has encountered the anomaly in clinical practice,” says Nejati.
MHICC Case in Point
In another rare case presentation, a diagnosis initially thought to be Castleman disease was reconsidered after additional molecular studies, which revealed angioimmunoblastic T cell lymphoma with Castleman-like features. Yet again, this illustrated the value of collaborative review in identifying and understanding atypical presentations.
As the conference continues to evolve, it is helping to shape the broader field of hematopathology. Insights from MHICC discussions contribute to more refined disease classifications and inform new treatment strategies, an effort aligned with the goals of the World Health Organization’s WHO Classification of Tumours 5th Edition, Haematolymphoid Tumours, to which Dr. Nejati contributed.
JOIN US AT MHICC
The MHICC welcomes all healthcare professionals with an interest in hematopathology and related fields. This includes, but is not limited to:
- Pathologists as well as medical and radiation oncologists
- Fellows, residents, and trainees in pathology, hematopathology, molecular pathology, hematologic oncology, and radiation oncology