Subtle differences = new classifications
In a row beside the microscope of Christopher Fletcher, MD, are thick notebooks with handwritten descriptions of the thousands of sarcomas he has viewed in his 20 years as a surgical pathologist. These low-tech folios, along with Fletcher's prodigious memory, are among the most powerful tools for improved treatments for sarcoma.
"Making these kinds of connections has enabled us to identify nearly 20 new subtypes of soft tissue tumors."
—Christopher Fletcher, MD
Fletcher's wealth of experience viewing slices of sarcomas under the microscope has enabled him, as no computer possibly could, to identify new types and subtypes of sarcomas and clarify the characteristics of known ones. In the case of malignant fibrous histiocytoma—the most commonly diagnosed form of sarcoma from the mid- 1970s to mid-1990s—Fletcher demonstrated that it wasn't a distinct condition at all, but a "grab bag" category for various sarcomas that needed to be subdivided into distinct types, clarifying the choices for treatment.
"How sarcomas are classified has an enormous impact on how they're treated," says Fletcher, director of surgical pathology at Brigham and Women's and chief of onco-pathology at Dana-Farber. "We have one of the largest soft-tissue pathology practices in the world, which means we see more sarcomas, and types of them, than almost anyone else. An unusual form may click in my mind with something I saw four or five years earlier. Making these kinds of connections has enabled us to identify nearly 20 new subtypes of soft tissue tumors, both benign and malignant."
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