ࡱ> 5@zbjbj22{XXn0 0 0 0 4 WWWhW4W XXpYYYYYY$jRl FcYYFcFc0 0 YYHFcP0 RY YFcd " YX \^Wz_BHu(J((, 0 0 0 0 ( Y\^`1YYY DLWr WBone Marrow Protocol applies to acute leukemias, myelodysplastic syndromes, myeloproliferative disorders, chronic lymphoproliferative disorders, malignant lymphomas, plasmacell dyscrasias, histiocytic and dendriticcell neoplasmsand mastocytosis. Protocol revision date: January 2004 No AJCC/UICC staging system Procedures Blood Film Aspirate, Cell Block Trephine Biopsy, Touch Imprint Authors LoAnn C. Peterson, MD Department of Pathology, Northwestern Memorial Hospital, Chicago, Illinois Steven J. Agosti, MD James A. Haley VA Hospital, University of South Florida, Tampa, Florida James Hoyer, MD Hematopathology, Mayo Clinic, Rochester, Minnesota For the Members of the Hematology and Clinical Microscopy Resource Committee and the Cancer Committee, College of American Pathologists Surgical Pathology Cancer Case Summary (Checklist) Protocol revision date: January 2004 Applies to hematopoietic and lymphoid disorders of the bone marrow only No AJCC/UICC staging system BONE MARROW: Blood Film, Aspirate, Cell Block, TrephineBiopsy, TouchImprint Patient name: Hematopathology/Surgical pathology number: Note: Check 1 response unless otherwise indicated. MACROSCOPIC Specimen Type ___ Aspirate ___ Biopsy ___ Both aspirate and biopsy ___ Blood film ___ Cell block (clot section) ___ Not specified *Biopsy Site *___ Not applicable *___ Right posterior iliac crest *___ Left posterior iliac crest *___ Other (specify): ___________________________ *___ Not specified *Aspirate Site *___ Not applicable *___ Right posterior iliac crest *___ Left posterior iliac crest *___ Sternum *___ Other (specify): ___________________________ *___ Not specified Adequacy of Specimen ___ Satisfactory ___ Limited ___ Unsatisfactory Phenotyping ___ Performed, see separate report ___ Performed (specify method and results): ______________________________ ___ Not performed Cytogenetics ___ Performed (see separate report) ___ Performed (specify results): ________________________________ ___ Not performed WHO Classification (check all that apply) Chronic Myeloproliferative Diseases ___ Chronic myelogenous leukemia ___ Chronic neutrophilic leukemia ___ Chronic eosinophilic leukemia/hypereosinophilic syndrome ___ Polycythemia vera ___ Chronic idiopathic myelofibrosis ___ Essential thrombocythemia ___ Myeloproliferative disease, unclassifiable Myelodysplastic/Myeloproliferative Diseases ___ Chronic myelomonocytic leukemia ___ Atypical chronic myeloid leukemia ___ Juvenile myelomonocytic leukemia ___ Myelodysplastic/myeloproliferative disease, unclassifiable Myelodysplastic Syndromes ___ Refractory anemia ___ Refractory anemia with ringed sideroblasts ___ Refractory cytopenia with multilineage dysplasia ___ Refractory cytopenia with multilineage dysplasia and ringed sideroblasts ___ Refractory anemia with excess blasts (RAEB) ___ RAEB-1 ___ RAEB-2 ___ Myelodysplastic syndrome, unclassifiable ___ Myelodysplastic syndrome associated with isolated del(5q) Acute Myeloid Leukemias (AMLs) ___ Acute myeloid leukemia with recurrent genetic abnormalities ___ AML with t(8;21)(q22;q22) ___ AML with abnormal bone marrow eosinophils inv(16) or t(16;16) or t(16;16)(p13;q22);CBF(/MYH11) ___ Acute promyelocytic leukemia t(15;17)(q22;q12) and variants ___ AML with 11q23 (MLL) abnormality ___ Acute myeloid leukemia with multilineage dysplasia ___ Following a myelodysplastic syndrome or myelodysplastic syndrome/myeloproliferative disorder ___ Without antecedent myelodysplastic syndrome ___ Acute myeloid leukemia and myelodysplastic syndromes, therapy-related ___ Alkylating agent-related ___ Topoisomerase type II inhibitor-related (some may be lymphoid) ___ Other types (specify): _____________________________ ___ Acute myeloid leukemia not otherwise categorized ___ AML minimally differentiated ___ AML without maturation ___ AML with maturation ___ Acute myelomonocytic leukemia ___ Acute monoblastic and monocytic leukemia ___ Acute erythroid leukemia ___ Acute megakaryoblastic leukemia ___ Acute basophilic leukemia ___ Acute panmyelosis with myelofibrosis ___ Myeloid sarcoma ___ Acute leukemia of ambiguous lineage ___ Undifferentiated acute leukemia ___ Bilineal acute leukemia ___ Biphenotypic acute leukemia Precursor B-cell and T-cell Neoplasms ___ Precursor B lymphoblastic leukemia/lymphoblastic lymphoma ___ Precursor T lymphoblastic leukemia/lymphoblastic lymphoma Mature B-cell Neoplasms ___ Chronic lymphocytic leukemia/small lymphocytic lymphoma ___ B-cell prolymphocytic leukemia ___ Lymphoplasmacytic lymphoma ___ Splenic marginal zone lymphoma ___ Hairy cell leukemia ___ Plasma cell myeloma ___ Monoclonal gammopathy of undetermined significance (MGUS) ___ Solitary plasmacytoma of bone ___ Extraosseus plasmacytoma ___ Primary amyloidosis ___ Heavy chain disease ___ Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT-lymphoma) ___ Nodal marginal zone B-cell lymphoma ___ Follicular lymphoma ___ Grade 1 ___ Grade 2 ___ Grade 3 ___ Mantle cell lymphoma ___ Diffuse large B-cell lymphoma ___ Mediastinal (thymic) large B-cell lymphoma ___ Primary effusion lymphoma ___ Burkitt lymphoma / leukemia B-cell Proliferations of Uncertain Malignant Potential ___ Lymphomatoid granulomatosis ___ Post-transplant lymphoproliferative disorder, polymorphic Mature T-cell and NK-cell Neoplasms Leukemic / Disseminated ___ T-cell prolymphocytic leukemia ___ T-cell large granular lymphocytic leukemia ___ Aggressive NK-cell leukemia ___ Adult T-cell leukemia/lymphoma Cutaneous ___ Mycosis fungoides ___ Szary syndrome ___ Primary cutaneous anaplastic large cell lymphoma ___ Lymphomatoid papulosis Other Extranodal ___ Extranodal NK/T-cell lymphoma, nasal-type ___ Enteropathy-type T-cell lymphoma ___ Hepatosplenic T-cell lymphoma ___ Subcutaneous panniculitis-like T-cell lymphoma Nodal ___ Angioimmunoblastic T-cell lymphoma ___ Peripheral T-cell lymphoma, unspecified ___ Anaplastic large cell lymphoma Neoplasm of Uncertain Lineage and Stage of Differentiation ___ Blastic NK-cell lymphoma Hodgkin Lymphoma ___ Nodular lymphocyte predominant Hodgkin lymphoma ___ Classical Hodgkin lymphoma ___ Nodular sclerosis classical Hodgkin lymphoma ___ Lymphocyte-rich classical Hodgkin lymphoma ___ Mixed cellularity classical Hodgkin lymphoma ___ Lymphocyte-depleted classical Hodgkin lymphoma Histiocytic and Dendritic-cell Neoplasms ___ Histiocytic sarcoma ___ Langerhans cell histiocytosis ___ Langerhans cell sarcoma ___ Interdigitating dendritic cell sarcoma / tumor ___ Follicular dendritic cell sarcoma / tumor ___ Dendritic cell sarcoma, not otherwise specified Mastocytosis ___ Indolent systemic mastocytosis ___ Systemic mastocytosis with associated clonal, hematologic non-mast-cell lineage disease ___ Aggressive systemic mastocytosis ___ Mast cell leukemia ___ Mast cell sarcoma Other ___ Malignant neoplasm, type cannot be determined *Additional Pathologic Findings *Specify: ____________________________________ *Comment(s) Background Documentation Protocol revision date: January 2004 I. Blood Film, Aspirate, Cell Block, Trephine Biopsy, TouchImprint A. Clinical Information 1. Patient identification a. Name b. Identification number c. Age (birth date) d. Sex 2. Responsible physician(s) 3. Date of procedure 4. Other clinical information a. Relevant history and physical findings (eg, prior diagnosis; prior therapy, including transplantation; physical findings; symptoms; indication for biopsy) b. Relevant laboratory and radiological data (eg, peripheral blood studies, serum protein analyses, radiographic data, imaging studies) c. Procedure (eg, aspirate, trephine biopsy) d. Anatomic site(s) of specimen(s) (eg, left and/or right posterior iliac crest) B. Macroscopic Examination 1. Specimen(s) (Note A) a. Blood (1) fluid specimen (anticoagulated) (2) slides i. number ii. unstained/stained (specify stain) b. Aspirate (1) fluid specimen volume (2) slides i. number ii. unstained/stained (specify stain) c. Touch preparations (1) number (2) unstained/stained (specify stain) d. Trephine biopsy (1) unfixed/fixed (specify fixative) (2) size (eg, number of pieces, aggregate length) e. Other (eg, cell block of particle concentrate) 2. Special studies (eg, flow cytometry immunophenotyping, cytogenetic analysis, molecular genetic analysis) C. Microscopic Examination 1. Blood a. Quantitative cellular data (1) differential counts (Note B) b. Morphologic cellular data (details of description will depend on morphologic findings and indication for biopsy) (1) normal cells i. red blood cells ii. leukocytes iii. platelets (2) abnormal findings, if present i. morphologic abnormalities (eg, oval macrocytes, schistocytes, pseudo-Pelger Het neutrophils, giant platelets) ii. abnormal cell types (eg, blasts, micromegakaryocytes) iii. other (eg, microorganisms) 2. Bone marrow aspirate smear(s) and/or touch preparation(s) a. Adequacy of specimen (if unsatisfactory for evaluation, specify reason, eg, absence of bone marrow elements) b. Quantitative cellular data (1) differential counts (Note B) (see reference for ranges1) (2) megakaryocytes (Note C) c. Morphologic cellular data (details of description will depend on morphologic findings and indication for biopsy) (1) normal cells i. erythroid precursors ii. myeloid cells iii. megakaryocytes iv. lymphocytes v. others (2) abnormal findings, if present i. morphologic abnormalities (eg, megaloblastic hematopoiesis, dysplasia) ii. abnormal or malignant cells (eg, blasts, lymphoma cells, myeloma cells, tumor cells) iii. other (eg, fungal organisms) 3. Trephine biopsy and/or cell block a. Adequacy of specimen (if unsatisfactory for evaluation, specify reason) b. Quantitative cellular data (1) cellularity and cell composition (2) megakaryocyte numbers c. Morphologic cellular data (details of description will depend on morphologic findings and indication for biopsy) (1) normal cells i. erythroid precursors ii. myeloid cells iii. lymphocytes iv. megakaryocytes v. others (2) abnormal findings, if present (it is often important to quantify the abnormalities, eg, percent involvement by lymphoma) i. morphologic abnormalities (eg, dysplastic megakaryocytes) ii. abnormal or malignant cells (eg, foci of blasts, lymphoma, myeloma, metastatic tumor) iii. other (eg, fibrosis, necrosis, granulomata, bony abnormalities) 4. Assessment of iron stores and sideroblastic iron, if performed 5. Results of cytochemical stains, if performed (Note D) 6. Results of histochemical stains, if performed (eg, reticulin stain, stains for organisms) 7. Results of immunohistochemical reactions, if performed (Note E) 8. Results/status of special studies, if performed a. Immunophenotyping by flow cytometry (Note E) b. Cytogenetic analysis (Note F) c. Molecular analysis (Note G) 9. Diagnostic assessment a. Diagnosis and classification of disease process with integration of results from blood, aspirate, and trephine biopsy specimens, as well as special studies (Note H) 10. Comments a. Correlation with previous bone marrow biopsies (Note I) b. Correlation with other specimens, as appropriate c. Correlation with clinical information, as appropriate d. Ancillary studies referred to reference laboratory (Note J) Explanatory Notes A. Macroscopic Examination of Specimen Not all specimen components will be present in an individual case. B. Quantitative Cellular Data Differential counts, including the number of cells counted, that are utilized in the evaluation of the specimen should be documented in the report. If estimates are used, these should be documented in the report. C. Bone Marrow Aspirate Since the trephine biopsy usually provides a more accurate assessment of megakaryocyte numbers than the aspirate alone, both should be used, if possible, to quantify megakaryocytes. D. Cytochemical Stains The most frequently utilized cytochemical stains for the evaluation of acute leukemias include myeloperoxidase, Sudan black B, non-specific esterase, and periodic acid-Schiff (PAS). Cytochemical stains for acid phosphatase with and without tartrate (TRAP) are often performed to aid in the diagnosis of hairy cell leukemia. E. Immunophenotyping (Including Immunohistochemistry and/or FlowCytometry) Immunophenotypic analysis is essential to precisely diagnose and classify many of the hematologic malignancies.2 For example, immunophenotyping is used in the diagnosis of acute leukemias to determine lineage, especially in acute lymphoblastic leukemias and in acute myeloid leukemias (AMLs) that are negative by cytochemical stains for myeloperoxidase (eg, AML minimally differentiated). Evaluation of additional markers in acute leukemia aids in further subclassification (B versus T lineage in acute lymphoblastic leukemias, megakaryocyte lineage of blasts in AML, etc). Immunophenotyping is also integral to the diagnosis of the chronic lymphoproliferative disorders, such as chronic lymphocytic leukemia, to determine B- or T-cell lineage, test for presence of monotypic immunoglobulin light-chain restriction, and to evaluate for other markers, such as CD5, CD23, and CD103, to aid in categorization of the various disorders. Similarly, work-up of the bone marrow for lymphoma and plasma cell malignancies is aided by immunophenotyping. Immunophenotypic studies are not only useful for initial diagnosis, but may also be utilized as an adjunct to morphology in determining the presence and extent of bone marrow involvement at the time of staging of lymphomas or following therapy for both leukemias and lymphomas, especially if the phenotype has been previously determined. Immunophenotyping may also be necessary to document antigen expression when immunotherapy, such as anti-CD20, anti-CD33, or anti-CD53, is being considered. F. Cytogenetic Analysis Cytogenetic analysis is an integral part of the work up and classification of many hematologic malignancies.3 For example, the World Health Organization (WHO) classification for hematologic malignancies (Table 1) incorporates several specific cytogenetic abnormalities into the classification scheme for AMLs.4 The t(15;17) is diagnostic of acute promyelocytic leukemia. Cytogenetic analysis not only aids in the diagnosis and classification of the acute leukemias, but also gives important prognostic information. For example, AMLs associated with some specific translocations, such as t(8;21) and inv(16), occur primarily in younger individuals and are usually accompanied by a good response to therapy and a favorable prognosis. In contrast, AML with multilineage dysplasia is often associated with chromosomal deletions; for example, -7/del(7q), -5/del(5q), occurs more frequently in older individuals and is associated with an unfavorable response to therapy. Among the myeloproliferative disorders, identification of the t(9;22) is essential to confirm a morphologic diagnosis of chronic myelogenous leukemia and separate it from other myeloproliferative disorders. Detectionof cytogenetic alterations in the myelodysplastic syndromes, usually loss of chromosomal material, may also aid the diagnosis and give prognostic information. In addition, cytogenetic studies are used increasingly in the chronic lymphoid leukemias and non-Hodgkin lymphomas primarily to aid in classification but also to obtain prognostic information. Cytogenetic analysis is not only useful at diagnosis but also has utility in evaluating bone marrow after therapy for residual disease. If these results are not available at the time of the bone marrow report, an addendum could be issued when they become available. G. Molecular Analysis Molecular analyses are being performed increasingly to evaluate for the presence of genetic abnormalities in all types of hematologic malignancies.5 As with cytogenetic analysis, the detection of several specific genetic alterations gives both diagnostic and prognostic information and can also be used to aid in the detection of minimal residual disease. The most common molecular techniques available at the present time include Southern blot hybridization, polymerase chain reaction (PCR) and fluorescent in situ hybridization (FISH). Currently, molecular analysis is most helpful in assessing for clonality and detecting chromosomal translocations, but its role will undoubtedly increase in the future. If these results are not available at the time of the bone marrow report, an addendum could be issued when they become available. H. Disease Classification The Protocol recommends the World Health Organization (WHO) classification of tumors of hematopoietic and lymphoid tissues (Table 1).4 Variants and subtypes of lesions most applicable to bone marrow biopsies are shown in Tables 2 through 6. I. Previous Biopsy When bone marrow biopsies are performed following an initial diagnostic biopsy, comparison of the current biopsy with the prior biopsy findings, if possible and relevant, should be reported. J. Referred Ancillary Studies If ancillary studies are referred to another laboratory, it is suggested that the date of the referral and the name of the reference laboratory be included in the report. If the results are not included in the initial bone marrow report, the status and location of referral laboratory results should be given. Table 1. World Health Organization (WHO) Classification of Tumors of Hematopoietic and Lymphoid Tissues Chronic myeloproliferative diseases Chronic myelogenous leukemia, (Philadelphia chromosome t(9;22)(q34;q11), BCR/ABL positive) Chronic neutrophilic leukemia Chronic eosinophilic leukemia (and the hypereosinophilic syndrome) Polycythemia vera Chronic idiopathic myelofibrosis (with extramedullary hematopoiesis) Essential thrombocythemia Myeloproliferative disease, unclassifiable Myelodysplastic/myeloproliferative diseases Chronic myelomonocytic leukemia Atypical chronic myeloid leukemia Juvenile myelomonocytic leukemia Myelodysplastic/myeloproliferative disease, unclassifiable Myelodysplastic syndromes Refractory anemia Refractory anemia with ringed sideroblasts Refractory cytopenia with multilineage dysplasia Refractory cytopenia with multilineage dysplasia and ringed sideroblasts Refractory anemia with excess blasts (RAEB) RAEB-1 RAEB-2 Myelodysplastic syndrome, unclassifiable Myelodysplastic syndrome associated with isolated del(5q) chromosome abnormality Acute myeloid leukemias (AML) Acute myeloid leukemia with recurrent genetic abnormalities AML with t(8;21)(q22;q22); (AML1/ETO) AML with abnormal bone marrow eosinophils (inv(16)(p13q22) or t(16;16)(p13;q22);CBF(/MYH11) Acute promyelocytic leukemia (AML) with t(15;17)(q22;q11-12) PML/RAR() and variants AML with 11q23 (MLL) abnormalities Acute myeloid leukemia with multilineage dysplasia Following a myelodysplastic syndrome or myelodysplastic syndrome/myeloproliferative disorder Without antecedent myelodysplastic syndrome Acute myeloid leukemia and myelodysplastic syndromes, therapy related Alkylating agent-related Topoisomerase type II inhibitor-related (some may be lymphoid) Other types Acute myeloid leukemia not otherwise categorized AML, minimally differentiated AML without maturation AML with maturation Acute myelomonocytic leukemia Acute monoblastic and monocytic leukemia Acute erythroid leukemia Acute megakaryoblastic leukemia Acute basophilic leukemia Acute panmyelosis with myelofibrosis Myeloid sarcoma Acute leukemia of ambiguous lineage Undifferentiated acute leukemia Bilineal acute leukemia Biphenotypic acute leukemia Precursor B-cell and T-cell neoplasms Precursor B lymphoblastic leukemia/lymphoblastic lymphoma (precursor B-cell acute lymphoblastic leukemia) Precursor T lymphoblastic leukemia/lymphoblastic lymphoma (precursor T-cell acute lymphoblastic leukemia) Mature B-cell neoplasms Chronic lymphocytic leukemia/small lymphocytic lymphoma B-cell prolymphocytic leukemia Lymphoplasmacytic lymphoma Splenic marginal zone lymphoma Hairy cell leukemia Plasma cell myeloma Monoclonal gammopathy of undetermined significance (MGUS) Solitary plasmacytoma of bone Extraosseus plasmacytoma Primary amyloidosis Heavy chain diseases Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) Nodal marginal zone B-cell lymphoma Follicular lymphoma Grade 1 Grade 2 Grade 3 Mantle cell lymphoma Diffuse large B-cell lymphoma Mediastinal (thymic) large B-cell lymphoma Primary effusion lymphoma Burkitt lymphoma / leukemia B-cell proliferations of uncertain malignant potential Lymphomatoid granulomatosis Post-transplant lymphoproliferative disorder, polymorphic Mature T-cell and natural killer (NK)-cell neoplasms Leukemic / disseminated T-cell prolymphocytic leukemia T-cell large granular lymphocytic leukemia Aggressive NK-cell leukemia Adult T-cell leukemia/lymphoma Cutaneous Mycosis fungoides Szary syndrome Primary cutaneous anaplastic large cell lymphoma Lymphomatoid papulosis Other extranodal Extranodal NK/T-cell lymphoma, nasal-type Enteropathy-type T-cell lymphoma Hepatosplenic T-cell lymphoma Subcutaneous panniculitis-like T-cell lymphoma Nodal Angioimmunoblastic T-cell lymphoma Peripheral T-cell lymphoma, unspecified Anaplastic large cell lymphoma Neoplasm of uncertain lineage and stage of differentiation Blastic NK-cell lymphoma Hodgkin lymphoma Nodular lymphocyte predominant Hodgkin lymphoma Classical Hodgkin lymphoma Nodular sclerosis classical Hodgkin lymphoma Lymphocyte-rich classical Hodgkin lymphoma, Mixed cellularity classical Hodgkin lymphoma Lymphocyte-depleted classical Hodgkin lymphoma Histiocytic and dendritic-cell neoplasms Histiocytic sarcoma Langerhans cell histiocytosis Langerhans cell sarcoma Interdigitating dendritic cell sarcoma / tumor Follicular dendritic cell sarcoma / tumor Dendritic cell sarcoma, not otherwise specified Mastocytosis Cutaneous mastocytosis Indolent systemic mastocytosis Systemic mastocytosis with associated clonal, hematologic nonmast-cell lineage disease Aggressive systemic mastocytosis Mast cell leukemia Mast cell sarcoma Extracutaneous mastocytoma Table 2. Genetic Subgroups of Precursor B-Lymphoblastic Leukemia/Lymphoblastic Lymphoma Genetic Abnormalities Prognosis t(9;22)(q34;q11.2); BCR/ABL Unfavorable t(4;11)(q21;23); AF4/MLL Unfavorable t(1;19)(q23;p13.3) PBX/E2A Unfavorable but varies with therapeuticregimen t(12;21)(p12;q22) TEL/AML1 Favorable Hyperdiploid > 50 Favorable Hypodiploidy Unfavorable Table 3. Diffuse Large B-Cell Lymphoma, Morphologic Variants and Subtypes Morphologic variants Centroblastic Immunoblastic T-cell/histiocyte-rich Anaplastic Other variants / subtypes Plasmablastic Diffuse large B-cell lymphoma with expression of full-length ALK Table 4. Burkitt Lymphoma, Morphologic Variants and Subtypes Burkitt lymphoma, morphologic variants Classical Variants Burkitt lymphoma with plasmacytoid differentiation Atypical Burkitt/Burkitt-like Burkitt lymphoma, subtypes (clinical and genetic) Endemic Sporadic Immunodeficiency-associated Table 5. Plasma Cell Neoplasms: Subtypes and Variants Plasma cell myeloma variants Non-secretory myeloma Indolent myeloma Smoldering myeloma Plasma cell leukemia Plasmacytoma Solitary plasmacytoma of bone Extramedullary plasmacytoma Immunoglobulin deposition diseases Primary amyloidosis Systemic light and heavy chain deposition diseases Osteosclerotic myeloma (POEMS) syndrome Heavy chain diseases (HCD) Gamma HCD Mu HCD Alpha HCD Table 6. Categories of Post-Transplant Lymphoproliferative Diseases (PTLD) Early lesions Reactive plasmacytic hyperplasia Infectious mononucleosis-like Polymorphic PTLD Monomorphic (classify according to lymphoma classification) B-cell neoplasms Diffuse large B-cell lymphoma (immunoblastic, centroblastic, anaplastic) Burkitt/Burkitt-like lymphoma Plasma cell myeloma Plasmacytoma-like lesions T-cell lymphomas Peripheral T-cell lymphoma, not otherwise specified Other types Hodgkin lymphoma and Hodgkin lymphoma-like PTLD Hodgkin lymphoma References 1. Bain BJ. The bone marrow aspirate of healthy subjects. Br J Haematol. 1996;94:206-209. 2. Jennings CD, Foon KA. Review: recent advances in flow cytometry application to the diagnosis of hematologic malignancy. Blood. 1997;90:2863-2892. 3. LeBeau MM. Role of Cytogenetics in the Diagnosis and Classification of Hematopoietic Neoplasms. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:391-418. 4. Jaffe ES, Harris NL, Stein H, Vardiman JW, eds. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press; 2001. 5. Bagg A, Kallakury BVS. Molecular pathology of leukemia and lymphoma. AmJ Clin Pathol. 1999;112(Suppl 1):S76-S92. Bibliography Bennett JM, Catovsky D, Daniel MT, et al. Criteria for the diagnosis of acute leukemia of megakaryocytic lineage (M7): a report of the French-American-British Cooperative Group. Ann Intern Med. 1985;103:460-462. Bennett JM, Catovsky D, Daniel MT, et al. Proposals for the classification of the myelodysplastic syndromes. Br J Haematol. 1982;51:189-199. Bennett JM, Catovsky D, Daniel MT, et al. Proposed revised criteria for the classification of acute myeloid leukemia: a report of the French-American-British Cooperative Group. An Intern Med. 1985;103:620-625. Bennett JM, Catovsky D, Daniel MT, et al. The chronic myeloid leukemias: guidelines for distinguishing chronic granulocytic, atypical chronic myeloid, and chronic myelomonocytic leukaemia. Br J Haematol. 1994;87:746-754. Brunning RD, McKenna RW. Tumors of the Bone Marrow. Third Series, Fascicle 9. Washington, DC: Armed Forces Institute of Pathology; 1994. Brynes RK, McKenna RW, Sundberg RD. Bone marrow aspiration and trephine biopsy. Am J Clin Pathol. 1978;70:753-759. Cheson BD, Cassileth PA, Head DR, et al. Report of the National Cancer Institute-sponsored workshop on definitions of diagnosis and response in acute myeloid leukemia. J Clin Oncol. 1990;8:813-819. Grimwade D, Walker H, Oliver F, et al. The importance of diagnostic cytogenetics on outcome in AML: analysis of 1,612 patients entered into the MRC AML10 trial. Blood. 1998;92:2322-2333. Harris NL, Jaffe ES, Stein H, et al. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. 1994;84:1361-1392. Harris NL, Jaffe ES, Diebold J, et al. The World Health Organization Classification of the Hematopoietic and Lymphoid Tissues: report of the Clinical Advisory Committee Meeting. Airlie House, Virginia, November, 1997. Mod Pathol. 2000;13(2):193-207. Fenaux P, Morel P, Lai JL. Cytogenetics of myelodysplastic syndromes. Semin Hematol. 1996;33:127-138. Foucar K. Chronic lymphoid leukemias and lymphoproliferative disorders. Mod Pathol. 1999;12:141-150. Frizzera G, Wu CD, Inghirami G. The usefulness of immunophenotypic and genotypic studies in the diagnosis and classification of hematopoietic and lymphoid neoplasms. Am J Clin Pathol. 1999;111(suppl 1):S13-S39. Horny HP, Parwaresch MR, Lennert K. Bone marrow findings in systemic mastocytosis. Hum Pathol. 1985;16:808-814. Kroft SH, McKenna RW. The bone marrow manifestations of Hodgkin's disease and non-Hodgkin's lymphomas and lymphoma-like disorders. In: Knowles DB, ed. Neoplastic Hematopathology. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:1447-1529. Kyle RA, Greipp PR. Plasma cell dyscrasias: current status. CRC Crit Rev Oncol/Hematol. 1998;8:93-152. Peterson L, Brunning RB. Bone specimen processing. In: Knowles DB, ed. Neoplastic Hematopathology. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:1391-1405. Pui CH, Campana D, Crist WM. Toward a clinically useful classification of the acute leukemias. Leukemia. 1995;9:2154-2157. Raimondi SC. Current status of cytogenetic research in childhood acute lymphoblastic leukemia. Blood. 1993;46:219-234. Valent P, Horny H-P, Escribano L, et al. Diagnostic criteria and classification of mastocytosis: a consensus proposal. Leuk Res. 2001;25:603-25. Zeleznik-Le NJ, Guiseppina N, Rowley JD. The molecular biology of myeloproliferative disorders as revealed by chromosomal abnormalities. SemHematol. 1995;32:201-219. Bone Marrow Hematologic System CAP Approved CAP Approved Hematologic System Bone Marrow PAGE 2 PAGE 3 PAGE 8 * Data elements with asterisks are not required for accreditation purposes for the Commission on Cancer. These elements may be clinically important, but are not yet validated or regularly used in patient management. Alternatively, the necessary data may not be available to the pathologist at the time of pathologic assessment of this specimen. PAGE 3 * Data elements with asterisks are not required for accreditation purposes for the Commission on Cancer. These elements may be clinically important, but are not yet validated or regularly used in patient management. 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