H EMATOPOIETIC AND
LYMPHOID N EOPLASM
P ROJECT
Kentucky Cancer Registry
Spring training, 2010
W HY N EW R ULES ?

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
N EW R EFERENCE – THE
H EMATOPOIETIC D ATABASE
Manual (Rules)
Database

Reportability

Disease definition

Multiple primary rules

Synonyms

Site and histology codes

Definitive diagnostic
method

Grade


Glossary
Genetic tests and
Immunophenotyping

Tables

Treatments

Transformations

Abstractor notes
MP Calculator
H EMATOPOIETIC
D ATABASE
B RIEF DEMO OF DATABASE
FEATURES

Casefinding lists

Hematopoietic Manual

Search feature


By diagnosis or by code

Displayed information

Abstractor notes
Multiple Primary Calculator
WHO C LASSIFICATION
C ELL L INEAGES
“acute”
“chronic”
“immature”
“mature”
“undifferentiated”
“differentiated”
Reference: Hoffbrand, Pettit, Vyas: Color Atlas of Clinical hematology (4th ed.), 2010
M YELOID L INE –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.
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.
G R A C A M . D O R E S , M D , M P H , C L A S S I F I C AT I O N ,
C H A R A C T E R I S T I C S , A N D B E H AV I O R O F M Y E L O I D N E O P L A S M S , G I V E N AT T H E
S E E R A D VA N C E D T O P I C S W O R K S H O P O N A P R I L 1 9 , 2 0 1 0 .
F R O M P R E S E N TAT I O N B Y
M YELOID 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 L INE –6 TABLES

Precursor Lymphoid Neoplasms

Mature B-Cell Neoplasms
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Mature T-Cell and NK-Cell Neoplasms

Hodgkin Lymphoma

Histiocytic and Dendritic Cell Neoplasms

Post-Transplant Lymphoproliferative
Disorders
AT: W W W . LYM P H O M AT I O N . O R G / A B O U T - D E TA I L S . H T M
WHO C LASSIFICATION
2008: P RINCIPLES

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
C LASSIFICATION 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
C LASSIFICATION 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
S PECIAL T YPES OF
D IAGNOSES


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
D IAGNOSTIC
C ONFIRMATION
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
immunophenotyping
AND/OR
• Positive genetic
studies
Histology is positive for
cancer, and there are also
positive
immunophenotyping
and/or genetic test results.
…
R EVIEW M ANUAL
S ECTIONS

What’s New

Reportability rules

Multiple Primary rules

Primary site and histology rules

Grade rules

Glossary and Appendices
H EMATOPOIETIC
D ATABASE
R EVIEW DATABASE
F EATURES

Display codes

Search terms and codes


Definitions, synonyms

Display special studies, treatment,
transformations

Abstractor’s notes
MP Calculator