Case study: THP in Pathology
Author: Giulia de Falco (QMUL)
A Teaching with Historical Perspectives (THP) case in pathology begins from a simple but powerful pedagogical insight: pathological categories do not emerge as neutral descriptions of disease. They are historically constructed through changing forms of observation, classification, evidence, and scientific interpretation. Teaching pathology historically allows students to understand that what appears today as a stable diagnostic category often results from decades of debate, technological change, and conceptual redefinition.
A particularly strong example is the history of Burkitt lymphoma. In the late 1950s, Denis Burkitt observed a recurring pattern of rapidly growing jaw tumours among children in equatorial Africa. At that time, the knowledge we have today about cancer, risk factors and underlying genetic abnormalities was not known. Denis Burkitt in fact described an unknown entity as a tumour, which was later identified as a lymphoma. His observation that that previously unknown entity was extremely common in a specific geographical region and age group, while remaining largely absent elsewhere, led to the study of the epidemiological additional risk factors in that geographical region, which then eventually led to studying the possible links between infectious diseases (e.g. malaria and viral infections) and cancer. This immediately offers students a historical entry point into pathology: before classification becomes stable, disease first appears as an unresolved problem. Geography, age distribution, tumour morphology, and epidemiological concentration all became part of the initial diagnostic reasoning. What counted as relevant evidence was already broader than morphology alone.
As research developed, the understanding of Burkitt lymphoma changed significantly. The Epstein-Barr virus, a bona fide tumour virus, was isolated from a Burkitt lymphoma cell culture, leading to the start of viral oncogenesis. Burkitt lymphoma is also the tumour in which the first chromosomal translocation specifically involving an oncogene was described associated to cancer (the MYC oncogene), again starting the era of investigation of molecular abnormalities underlying cancer. This moved pathology from predominantly morphological interpretation toward molecular and immunological classification. The same disease came to be understood through a different methodological lens.
The modern classification of Burkitt lymphoma as a non-Hodgkin’s lymphoma evolved through decades of studies and embedding of scientific findings, also thanks to the fast development of technology which led to a better understanding of genetic lesions.
This historical development provides an ideal THP teaching activity because students can directly compare different moments in classification, and how classification of cancer evolved and is constantly updated. They examine early published descriptions, original clinical images, and later diagnostic frameworks, including current classifications produced by the World Health Organization (WHO). The key pedagogical question is no longer simply “what is Burkitt lymphoma?” but rather: how did this tumour enhance current understanding on what leads to cancer, how does classification change, what becomes visible, diagnostically relevant, and clinically actionable?
Through this comparison, students recognise that pathology is not only a descriptive science but also an interpretive practice shaped by available methods and conceptual frameworks. If morphology dominates, certain features become central; if molecular evidence dominates, the disease is redefined again. Classification therefore organises not only diagnosis but also prognosis, treatment, and research priorities towards personalised medicine.
The learning impact is substantial. Students begin to see that pathological knowledge develops through historical shifts in what counts as evidence. Disease categories are understood not as fixed objects but as evolving scientific constructions. This strengthens conceptual understanding while also developing epistemic awareness: learners understand that accepting one classificatory method rather than another changes the pathological problem itself.
In this sense, THP in pathology makes visible a broader principle that applies across disciplines: a pathological category is never merely descriptive; it defines what counts as evidence, what questions are asked, and which forms of intervention become possible.