Hematopoietic and Lymphoid Neoplasm Project
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Transcript Hematopoietic and Lymphoid Neoplasm Project
H EMATOPOIETIC AND
LYMPHOID N EOPLASM
C ODING ( PER 2010 RULES )
Kentucky Cancer Registry
Abstractor’s Training, March, 2012
C IRCULATORY
SYSTEM
Includes
The cardiovascular system
Heart and blood vessels
Carries nutrients, oxygen, and waste products
to and from cells
The lymphatic system
Lymphatic vessels, lymph nodes, lymphoid
tissue in spleen, thymus, tonsils, and small
intestine
LYMPHATIC
SYSTEM
It is the interconnected system of spaces and
vessels between body tissues and organs
which carry lymph. It regulates fluid balance
in the body and helps fight infection.
Functions:
Drainage of tissue fluid and transport of
lymph to the venous system
Defense of body, through filtration and
phagocytosis
H EMATOPOIESIS
Hematopoiesis is the formation of blood cells
Blood is made up of plasma and formed
elements:
Red blood cells (erythrocytes)
White blood cells (leukocytes)
Platelets (thrombocytes)
H EMATOPOIESIS
Red blood cells and platelets are formed in
the bone marrow (myeloid tissue)
White blood cells are produced in bone
marrow and in lymphoid tissue. Some
leukocytes (granulocytes, lymphocytes, and
monocytes) originate in bone marrow but
multiply in lymphoid tissue.
H ISTORICAL
CLASSIFICATION
Originally thought to be separate systems
and separate diseases (leukemias and
lymphomas). Classified by size and shape of
tumor cells; pattern of spread
Medical advances led to re-classification
Immunophenotyping, molecular and genetic
testing
Revised WHO Classification of Hematopoietic
and Lymphoid Neoplasms; published in 2008;
coding changes in 2010
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 –
TABLES 1-4
Myeloproliferative Neoplasms
Myeloid and Lymphoid Neoplasms with
Eosinophilia and Abnormalities of PDGFRA,
PDGFRB or FGFR1
Myelodysplastic/Myeloproliferative
Neoplasms
Myelodysplastic Syndromes
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
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.
…
‘O THER ’ T REATMENT
Do NOT collect blood transfusions as treatment for any of these diseases.
Collect phlebotomy as treatment for polycythemia vera ONLY
Collect blood thinners (such as aspirin and heparin, etc.) for:
9740/3 Mast cell sarcoma
9741/3 Systemic mastocytosis
9742/3 Mast cell leukemia
9875/3 Chronic myelogenous leukemia BCR/ABL1 positive
9950/3 Polycythemia vera
9961/3 Primary myelofibrosis
9962/3 Essential thrombocythemia
9963/3 Chronic neutrophilic leukemia
9975/3 Myelodysplastic/myeloproliferative neoplasm, unclassifiable
H EMATOPOIETIC
D ATABASE
2010 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
R EVIEW M ANUAL
S ECTIONS
What’s New
Reportability rules
Multiple Primary rules
Primary site and histology rules
Grade rules
Glossary and Appendices