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Hematopoietic and Lymphoid Neoplasm Project

Hematopoietic and Lymphoid Neoplasm Project. Kentucky Cancer Registry Spring training, 2010. Why New Rules?. Medical advances Immunophenotyping, molecular and genetic testing New, more specific histology terms Revised WHO Classification of Hematopoietic and Lymphoid Neoplasms

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Hematopoietic and Lymphoid Neoplasm Project

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  1. Hematopoietic and Lymphoid Neoplasm Project Kentucky Cancer Registry Spring training, 2010

  2. 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

  3. New Reference – the Hematopoietic Database Manual (Rules) Database Disease definition Synonyms Definitive diagnostic method Genetic tests and Immunophenotyping Treatments Transformations Abstractor notes • Reportability • Multiple primary rules • Site and histology codes • Grade • Glossary • Tables MP Calculator

  4. Hematopoietic Database

  5. Brief demo of database features • Casefinding lists • Hematopoietic Manual • Search feature • By diagnosis or by code • Displayed information • Abstractor notes • Multiple Primary Calculator

  6. WHO Classification

  7. Cell Lineages

  8. “acute” “chronic” “immature” “mature” “undifferentiated” “differentiated” Reference: Hoffbrand, Pettit, Vyas: Color Atlas of Clinical hematology (4th ed.), 2010

  9. Myeloid Line –6 Tables • Myeloproliferative Neoplasms • Myelodysplastic/Myeloproliferative Neoplasms • Myelodysplastic Syndromes • Myeloid and Lymphoid Neoplasms with Eosinophilia and Abnormalities of PDGFRA, PDGFRB or FGFR1

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. 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

  15. at: www.lymphomation.org/about-details.htm

  16. 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

  17. 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

  18. 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

  19. 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

  20. Diagnostic Confirmation

  21. Review Manual Sections • What’s New • Reportability rules • Multiple Primary rules • Primary site and histology rules • Grade rules • Glossary and Appendices

  22. Hematopoietic Database

  23. Review database Features • Display codes • Search terms and codes • Definitions, synonyms • Display special studies, treatment, transformations • Abstractor’s notes • MP Calculator

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