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HEMATOPOIETIC AND LYMPHOID NEOPLASM PROJECT
WHY NEW RULES?
Medical advances
Immunophenotyping, molecular and genetic testing
New, more specific histology terms
Revised WHO Classification of Hematopoietic and Lymphoid Neoplasms
New reportability conditions
9751/3, 9975/3, 9831/3, and transformations
NEW REFERENCE – THE HEMATOPOIETIC
DATABASEManual (Rules)
Reportability
Multiple primary rules
Site and histology codes
Grade
Glossary
Tables
MP Calculator
Database
Disease definition
Synonyms
Definitive diagnostic method
Genetic tests and Immunophenotyping
Treatments
Transformations
Abstractor notes
HEMATOPOIETIC DATABASE
BRIEF DEMO OF DATABASE FEATURES
Casefinding lists
Hematopoietic Manual
Search feature
By diagnosis or by code
Displayed information
Abstractor notes
Multiple Primary Calculator
WHO CLASSIFICATION
CELL LINEAGES
“acute” “chronic”
“immature” “mature”
“undifferentiated” “differentiated”
Reference: Hoffbrand, Pettit, Vyas: Color Atlas of Clinical hematology (4 th ed.), 2010
MYELOID LINE –6 TABLES
Myeloproliferative Neoplasms
Myelodysplastic/Myeloproliferative Neoplasms
Myelodysplastic Syndromes
Myeloid and Lymphoid Neoplasms with Eosinophilia and Abnormalities of PDGFRA, PDGFRB or FGFR1
FROM PRESENTATION BY GRACA M. DORES, MD, MPH, CLASSIFICATION, CHARACTERISTICS, AND BEHAVIOR OF MYELOID NEOPLASMS, GIVEN AT THE SEER ADVANCED TOPICS WORKSHOP ON APRIL 19, 2010.
MYELOID TABLES 5 AND 6
Acute Myeloid Leukemia and Related Precursor Neoplasms
Acute Leukemias of Ambiguous Lineage
Show no clear differentiation along a single lineage
Includes those with mixed phenotypes
LYMPHOID LINE –6 TABLES
Precursor Lymphoid Neoplasms
Mature B-Cell Neoplasms
Mature T-Cell and NK-Cell Neoplasms
Hodgkin Lymphoma
Histiocytic and Dendritic Cell Neoplasms
Post-Transplant Lymphoproliferative Disorders
AT: WWW.LYMPHOMATION.ORG/ABOUT-DETAILS.HTM
WHO CLASSIFICATION 2008: PRINCIPLES
Term ‘NHL’ becoming obsolete
Neoplasms of precursor cells classified separately from those of more mature cells
Leukemia/Lymphoma are different manifestations of the same disease
Mature lymphoid neoplasms are subclassified on the basis of differentiation, morphology, immunophenotype, genetic tests, and clinical presentation
CLASSIFICATION BASED ON:
Morphology and biologic features
Lymphoma, Myeloid sarcoma, and plasma cell tumors are diagnosed by tissue biopsy
Leukemias by blood counts and BM biopsy
Genetic tests – DNA analysis
FISH for follicular lymphoma
Karyotyping of CML for Philadelphia chromosome
CLASSIFICATION BASED ON:
Immunophenotype
Identifies molecules associated with some lymphomas and leukemias which are expressed on the outer surface of the cell
Includes IHC and flow cytometry
Examples are Burkitt lymphoma and Adult T cell leukemia/lymphoma
Clinical features
Myeloproliferative neoplasm, unclassifiable
SPECIAL TYPES OF DIAGNOSES
Provisional diagnoses
NOS histology – could be awaiting further test results or could be only information available. Update if more info comes in
NOS with possible/probable specific histology – DO NOT USE these ambiguous terms – code the NOS term until more definitively diagnosed
Ex. MPN (9960/3), probably PV (9950/3). Code 9960 until you have a definitive diagnosis
Diagnosis of exclusion – based on equivocal tests and clinical presentation
Examples: MDS, refractory thrombocytopenia
DIAGNOSTIC CONFIRMATION
Code Label Definition
1 Positive histology Tissue microscopically examined and positive
2 Positive cytology Fluid cells microscopically examined and positive
3 Positive histology PLUS• Positive immunophenotypingAND/OR• Positive genetic studies
Histology is positive for cancer, and there are also positiveimmunophenotyping and/or genetic test results.
…
REVIEW MANUAL SECTIONS
What’s New
Reportability rules
Multiple Primary rules
Primary site and histology rules
Grade rules
Glossary and Appendices
HEMATOPOIETIC DATABASE
REVIEW DATABASE FEATURES
Display codes
Search terms and codes
Definitions, synonyms
Display special studies, treatment, transformations
Abstractor’s notes
MP Calculator
