who classification of tumours of haematopoietic and ... · pdf filetumours of haematopoietic...

QML PathoLogy NewsLetter // Issue 4, 2012 //

INSIDE THIS ISSUE:> WHOclassificationof

TumoursofHaematopoieticandLymphoidTissues byDrDebraNorris

> ManagementofWomen withAbnormalCytology byDrJasonStone

Issue 4, 2012

The guiding principle introduced in the REAL classification (1994)2 and 2001 WHO Classification (3rd edition)3 remains; that is, entities are defined by a combination of clinical, morphology, immunophenotype and genotype.

Thelongawaitedupdateofthe2001WHOlymphomaclassificationwasreleasedin2008¹. Thisclassificationbuildsonthe2001WHOclassificationandremainsacollaborativeeffortbetweentheAmericanandEuropeanhaematopathologysocieties,clinicaladvisorycommitteesandmorethan130authorsfrommorethan22countries.

WANT TO rEcEIvE THIS NEWSlETTEr vIA EmAIl INSTEAD? plEASE SEND yOUr DETAIlS TO [email protected] Or pHONE (07) 3121 4506.

WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues(4th Edition) - Lymphoma Classification in the Third Millennium

Dr Debra Norris FRCPA


TheguidingprincipleintroducedintheREALclassification(1994)²and2001WHOClassification(3rdedition)³remains;thatis,entitiesaredefinedbyacombinationofclinical,morphology,immunophenotypeandgenotype.Therelevantimportanceofthesefeaturesdiffersbetweendifferentdiseaseentitiesandnoone‘goldstandard’isrecognised.

Advancesandclarificationofdiseaseentitiesisincluded.Minorterminologychangesareseen,reflectingadvancementinknowledge,e.g.,hepatosplenicT-celllymphoma,whilstpredominantlyofgammadeltaphenotypemayoccasionallybealphabeta.SystemicALCLisseparatedintoALK+andALK-becauseofprognosticdifferences.TwostudieshaveshownatendencyforALCL,ALK-todiffergenetically(intermsofchromosomelossesorgains)fromALK+andPTCLNOS,althoughoverlappingfeaturesmaybefound¹.

Changesthatreaderswillnoteinclude:

• Theintroductionofprovisionalborderlinecategories; incorporationofrareprimarycutaneousT-cell lymphomaprovisionalentitiestakenfromthe WHO-EORTCconsensusclassificationforcutaneous lymphoma(released2005)4

• Therecognitionofsmallclonallymphoidpopulations, suchasMonoclonalB-celllymphocytosis,paediatric follicularhyperplasiawithmonoclonalB-cells

• Identificationofdiseasescharacterisedbyinvolvement ofspecificanatomicsites(e.g.,PrimaryDLBCLofthe CNS),orbyotherclinicalfeaturessuchasage(e.g., EBV+DLBCLoftheelderly;paediatricnodalmarginal zonelymphoma1,5)orclinicalscenario(e.g.,DLBCL associatedwithchronicinflammation).

Thereremainunresolvedissues,andtheclassificationwillalwaysbeaworkinprogress,e.g.,predictorsofprognosisinFL,DLBCLandperipheralT-celllymphomas5.SeparationofDLBCLintoGCBversusABCtypesbygeneexpressionprofilesclearlyhasprognosticimportance6.This,asyet,doesnotdirecttherapy.Norcanthisseparationbereliablyreproducedbycurrentroutinemorphology,immunophenotypeandcytogeneticanalysis;assuch,thissub typinghasnotbeenincorporatedinthecurrentclassificationforeverydayuse5.

Low Grade B-Cell Lymphomas: TheupdatedclassificationincludesentitiestoemphasisethatamongthelowgradeB-celllymphomastherearebothagerelatedandsiterelateddifferences.Inaddition,aninsitulesionofFLhasbeenrecognised¹.

Bothpaediatricfollicularandpaediatricmarginalzonelymphomashavebeenincludedasprovisionalentities,whichtendtobelocalisedandhaveanexcellentprognosis.PaediatricFLtypicallylacksBCL2expressionandthet(14;18)(q32;q21)isabsent.Similarly,prognosisofpaediatricnodalMZLisexcellentwithlowrelapserateandlongsurvivalafterconservativetreatment¹.

PrimaryintestinalFLtypicallyoccursintheduodenum;mostpatientshavelocaliseddisease(stageIEorIIE)andsurvival appearsexcellent,evenwithouttreatment.ItwouldappearthatintestinalhomingreceptorsretaintheclonalB-cellswithintheintestinalmucosa¹.

Primarycutaneousfolliclecentrelymphomaisadistinctlymphomaofneoplasticfolliclecentrecells,occurringontheheadortrunk.ThisrepresentsthemostcommontypeofcutaneousB-celllymphomaandisdistinctfromnodalfollicularlymphoma.Irrespectiveofgrowthpattern,thediseasehasanexcellentprognosiswithfiveyearsurvivalover95%.Cutaneousrelapses,seeninapproximately30%ofpatientsdonotindicateprogressivedisease1, 4.

Gradingoffollicularlymphomahasalsobeenaddressed.ItisacknowledgedintheupdatedclassificationthatGrade1andGrade2FLhavesimilaroutcome,arenotaffectedbyaggressivetherapy,andarenotdiagnosticallyreproducible;assuch,the2008classificationplacesthesecaseswithfewcentroblastsas‘FLGrade1-2(lowgrade)’.StratifyingGrade3FLisnowmandatory,withFLGrade3BmorecloselyrelatedtoDLBCLonthemolecularlevel.AlsoemphasisedisthatANYareaofDLBCLinanyFL,receivesaseparatediagnosisofDLBCL,i.e.,thereisnosuchthingasFLGrade3Awithdiffuseareas¹.

Provisional Borderline Categories:B-cell lymphoma unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma

Overthelast20yearstherehasbeenacknowledgementofthemorphologicandimmunophenotypicoverlapbetweenCHLandsomecasesofDLBCL(usuallyprimarymediastinallargeB-celllymphomaPMBL,andmediastinalnodularsclerosissubtypeofclassicalHodgkinlymphomaNSCHL). Inthemajorityofcases,aspecificdiagnosiswillbeabletobemade.However,therewillbecases,typicallyinvolvingyoungmaleswithmediastinaldisease,whereboththemorphologyandimmunophenotypeexhibittransitionalfeaturesbetweenCHLandPMCL,e.g.,CD45+,preservationofB-cellprogram, togetherwithHodgkinmarkersCD30andCD15.InothercasesthatmorphologicallyfavourPMBL,theabsenceofCD20,expressionofCD15orEBV,wouldalsofavourthisdiagnosis.AcloserelationshipbetweenCHLandPMBLhasbeenshownbygeneexpressionprofiling,butgenomicstudiesof‘greyzone’or‘borderline’lymphomasareawaited.TheselymphomasgenerallyhaveamoreaggressiveclinicalcourseandpooreroutcomethaneitherPMBLorCHL.Thereisnoconsensusonoptimaltherapy¹.

B-cell lymphoma unclassifiable with features intermediate between DLBCL and Burkitt lymphoma SomeoftheselymphomaswerepreviouslyclassifiedasBurkitt-likelymphomaoratypicalBurkitts.Thisterminologyhasbeenremoved.ThecasesinthiscategorymayhavemorphologicalfeaturesintermediatebetweenBLandDLBCL,andconsistentBLimmunophenotype;morphologicallybemoretypicalofBLbutatypicalimmunophenotype;orgeneticfeaturesthatprecludeadiagnosisofBL.CaseswhicharemorphologicallytypicalofDLBCLwithahighproliferativeindexdoNOTbelonginthiscategory;otherwisetypicalBLwithoutdemonstrableMYCrearrangementwithcharacteristicimmunophenotypearenotinthiscategory.

Manyofthelymphomasinthiscategorywillbe‘doublehit’lymphomas,i.e.,carrytranslocationsofbothMYCandBCL2.Geneprofilestudiesof‘doublehit’caseshaveshownthatsomeofthesecaseshaveaprofileintermediatebetweenDLBCLandBL,whereasothersaremoresimilartoBL.OtherwisetypicalDLBCLwithaMYCrearrangementarenotincludedinthiscategory.Conversely,lymphomaswithanIG-MYCrearrangementasthesoleabnormalitylikelyrepresentBLevenifmorphologicallyatypical.Theselymphomasareaggressive,withfrequentBM,PBandCNSinvolvement,andresistanttocurrenttherapies¹.

continuedpage4>

QML PathoLogy NewsLetter // Issue 4, 2012 // PAGE3

Table 1: WHO Classification of the Mature B-cell, T-cell, and NK-cell Neoplasms (2008)

MATURE B-CELL NEOPLASMS MATURE T-CELL AND NK-CELL NEOPLASMS

Chroniclymphocyticleukaemia/smalllymphocyticlymphoma T-cellprolymphocyticleukaemia

B-cellprolymphocyticleukaemia T-celllargegranularlymphocyticleukaemia

Splenicmarginalzonelymphoma ChroniclymphoproliferativedisorderofNKcells*

Hairycellleukaemia AggressiveNKcellleukaemia

Spleniclymphoma/leukaemia,unclassifiable* SystemicEBV+T-celllymphoproliferativediseaseofchildhood

SplenicdiffuseredpulpsmallB-celllymphoma* Hydroavacciniforme-likelymphoma

Hairycellleukaemia-variant* AdultT-cellleukaemia/lymphoma

Lymphoplasmacyticlymphoma ExtranodalNK/T-celllymphoma,nasaltype

Waldenströmmacroglobulinemia Enteropathy-associatedT-celllymphoma

Heavychaindiseases HepatosplenicT-celllymphoma

Alphaheavychaindisease Subcutaneouspanniculitis-likeT-celllymphoma

Gammaheavychaindisease Mycosisfungoides

Muheavychaindisease Sézarysyndrome

Plasmacellmyeloma PrimarycutaneousCD30+T-celllymphoproliferativedisorders

Solitaryplasmacytomaofbone Lymphomatoidpapulosis

Extraosseousplasmacytoma Primarycutaneousanaplasticlargecelllymphoma

Extranodalmarginalzonelymphomaofmucosa-associatedlymphoidtissue(MALTlymphoma) Primarycutaneousgamma-deltaT-celllymphoma

Nodalmarginalzonelymphoma PrimarycutaneousCD8+aggressiveepidermotropic cytotoxicT-celllymphoma*

Paediatricnodalmarginalzonelymphoma* PrimarycutaneousCD4+small/mediumT-celllymphoma*

Follicularlymphoma PeripheralT-celllymphoma,NOS

Paediatricfollicularlymphoma* AngioimmunoblasticT-celllymphoma

Primarycutaneousfolliclecentrelymphoma Anaplasticlargecelllymphoma,ALK+

Mantlecelllymphoma Anaplasticlargecelllymphoma,ALK-*

DiffuselargeB-celllymphoma(DLBCL),NOS HODGKIN LYMPHOMA T-cell/histiocyterichlargeB-celllymphoma Nodularlymphocyte-predominantHodgkinlymphoma

PrimaryDLBCLoftheCNS ClassicalHodgkinlymphoma

PrimarycutaneousDLBCL,legtype NodularsclerosisclassicalHodgkinlymphoma

EBV+DLBCLoftheelderly* Lymphocyte-richclassicalHodgkinlymphoma

DLBCLassociatedwithchronicinflammation MixedcellularityclassicalHodgkinlymphoma

Lymphomatoidgranulomatosis Lymphocyte-depletedclassicalHodgkinlymphoma

Primarymediastinal(thymic)largeB-celllymphoma pOST TrANSplANTATION lympHOprOlIfErATIvE DISOrDErS (pTlD) IntravascularlargeB-celllymphoma

ALK+largeB-celllymphoma Earlylesions

Plasmablasticlymphoma Plasmacytichyperplasia

LargeB-celllymphomaarisinginHHV8-associatedmulticentric Castlemandisease Infectiousmononucleosis-likePTLD

Primaryeffusionlymphoma PolymorphicPTLD

Burkittlymphoma MonomorphicPTLD(B-andT/NK-celltypes)†

B-celllymphoma,unclassifiable,withfeaturesintermediatebetweendiffuselargeB-celllymphomaandBurkittlymphoma ClassicalHodgkinlymphomatypePTLD†

B-celllymphoma,unclassifiable,withfeaturesintermediatebetweendiffuselargeB-celllymphomaandclassicalHodgkinlymphoma

* Provisional entities for which the WHO Working Group felt there was insufficient evidence to recognise as distinct diseases at this time.† These lesions are classified according to the leukaemia or lymphoma to which they correspond.

Source: Jaffe ES, Harris HL, Stein H, Isaacson PG. Classification of lymphoid neoplasms: the microscope as a tool for disease discovery. Blood. 2008; 112:4384-4399.


References:1. SwerdlowSH,CampoE,HarrisNL,etal.WHOClassificationofTumoursof

HaematopoieticandLymphoidTissues(4thEd).Lyon,France:InternationalAgencyforResearchonCancer,2008.

2. HarrisNL,JaffeES,SteinH,etal.ArevisedEuropean-Americanclassificationoflymphoidneoplasms:aproposalfromtheInternationalLymphomaStudyGroup.Blood.1994;84:1361-1392.

3. JaffeES,HarrisNL,SteinH,VardimanJ.PathologyandGeneticsofTumoursofHaematopoieticandLymphoidTissues.Lyon,France:IARCPress;2001.

4. WillemzeR,JaffeES,BurgG,etal.WHO-EORTCclassificationforcutaneouslymphomas.Blood.2005;105:3768-3785.

5. JaffeES,HarrisHL,SteinH,IsaacsonPG.Classificationoflymphoidneoplasms:themicroscopeasatoolfordiseasediscovery.Blood.2008;112:4384-4399.

6. AlizadehAA,EisenMB,DavisRE,etal.DistincttypesofdiffuselargeB-celllymphomasidentifiedbygeneexpressionprofiling.Nature.2000;403:503-511.

EBV-positive DLBCL of the Elderly: EBV+clonalB-cellproliferationoccurringinpatients >50yearswithoutknownimmunodeficiencyorpriorlymphoma.Definedentities,suchasplasmablasticlymphoma,lymphomatoidgranulomatosisorDLBCLassociatedwithchronicinflammation;primaryeffusionlymphoma,areexcluded.InAsiancountriesthisconstitutes8-10%ofDLBCL.DataforWesterncountriesislargelyunknown.Approximately70%ofpatientswillpresentwithextranodaldisease.TheclinicalcourseisaggressiveandmediansurvivalapproximatelytwoyearsandnotpredictedbyIPIscore¹.

EBV-positive T-cell Lymphoproliferative Disorders of Childhood: Twonewentitiesareincludedintheupdatedclassification,reflectingtwomajortypesofEBVassociatedT-celllymphoproliferativedisordersreportedinthepaediatricagegroup.Bothshowgeographicdifferences,occurringwithincreasedfrequencyinAsians,NativeAmericansfromCentralandSouthAmericaandMexico.Hydroavacciniforme-likelymphomaisacutaneouslymphomawithanindolentclinicalcourse,butwithprogressionovermanyyears.SystemicEBV+T-celllymphoproliferativediseaseofchildhoodhasafulminantclinicalcourse,sharingoverlappingclinicalfeatureswithaggressiveNK-cellleukemia.ItmaybeassociatedwithchronicactiveEBVinfectionoroccurshortlyafterprimaryacuteEBVinfection.TheassociationwithprimaryEBVinfectionandtheracialpredispositionstronglysuggestageneticdefectinhostimmuneresponsetoEBV¹.

Conclusion: Theupdated2008lymphomaclassificationbuildsonthe2001classification,benefitingcliniciansinvolvedinpatientcare,pathologistsresponsiblefordiagnosisandresearchersalike5. Weareindeedindebtedtothedrivingforceoftheprincipleauthors ofthistextandclassification.

GraduatingfromtheUniversityofQueensland(MBBSHons)(1984),DrNorristrainedinhistopathologyattheMaterandPrincessAlexandraHospitals,beforeobtainingafellowshipinpathologyin1994.ShethentookupapositionasStaffHistopathologistattheMaterHospitalbeforejoiningQMLPathologyinOctober2002asaConsultantHistopathologistattheCentralLaboratory.In1997,DrNorrisundertookafellowshipinhaematopathologywithworldrenownedauthorityDrNancyHarrisatMassachusettsGeneralHospital.

DrNorrisareasofexpertiseareparticularlyinlymphoma(bothnodalandextranodalincludingcutaneous),gastrointestinalpathologyanddermatopathology.Intheseareas,shelectureswidelyandreceivesconsultations.

Phone: (07) 3121 4429 Email: [email protected]

Dr Debra Norris frcpA

Medical director and Pathologist in charge: histology

Pathologist Profile

Cutaneous CD30+ Lymphoproliferative Disorder showing the morphologic overlap between Lymphomatoid Papulosis and Cutaneous Anaplastic Large Cell Lymphoma.


Education wrap up for 2012

Throughouttheyear,QMLPathologyhasbeenveryactiveinthefieldofContinuingEducation.QMLPathologyhashostedahighstandardofeducationtothemedicalcommunityinmetro,ruralandremoteareasacrossQueenslandandNewSouthWales.

Sinceitsinceptionin1992,QMLPathology’sContinuingEducationprogramhasreliedontheexpertiseofourleadingmedicalspecialistsandexpertpathologiststopresentthemostcurrentandrelevantdevelopmentstothemedicalcommunity.

Over2000medicalpractitionersthroughoutQueenslandandNewSouthWaleshaveparticipatedinaccreditedeventshostedbyQMLPathologyin2012.Ourprogramshavereceivedrecognitionfromthemedicalcommunity,aswellasgoverningbodies,fordeliveringtopicalandvariededucationforGeneralPractitioners(GPs),PracticeNursesandSpecialists,aswellasfulfillingaccreditationcriteriaforrespectivecolleges.

QMLPathologywouldliketothankourvaluedpresentersandparticipantsfortheirinvolvementthroughouttheyear.WewouldalsoliketothankoureventpartnersBDDiagnostics,Lilly,BoehringerIngelheimandSanofiDiabetesfortheirpartnershipandassistancein2012.

Toimproveourdeliveryofeducation,weareconstantlyevaluatingouractivities.Ifyouhaveanyfeedbackto assistusinthis,pleasedonothesitatetocontactusat QMLPathologyMarketingore-maildirectly [email protected].

clINIcAl AUDIT UpDATESWelcometotheendofanotherbusyyearforourClinicalAudits.AsweareapproachingtheendoftheGPRACGPTriennium(December2013),GPsareremindedofourCat1activitiesavailabletoallmedicalpractitioners.ToregisterforanyofourongoingAudits,pleasecontactyourlocalMedicalLiaisonOfficerorQMLPathologyMarketing.

SURGICAL SKIN AUDITDiagnosticAccuracy(wheretheprovisionaldiagnosismadebythereferringdoctorequalledthehistologicaldiagnosisforcomparison)hasremainedataveryhighstandardandsomeverypleasingresultsoverallisevident.

CYTOLOGY PAP SMEAR AUDITOnceagainwehaveverypleasingresultsforthePapSmearAudit.Manycliniciansarecontinuingtotakeparteachmonthoncecompletingtheiraudit.GraphicalstatisticsandpositiveHPVnumbershavebeengreatlybeneficial,accordingtofeedbackreceived.

Thankyoutoallparticipants,welookforwardtoanotherbusyyearin2013fortheendoftheGPTriennium.


Management of Women with Abnormal Cytology Dr Jason Stone, Cytopathologist

ThecurrentmanagementofwomenwithabnormalcervicalcytologyisbasedontheNHMRCapprovedguidelines2005.Alothasdevelopedsincethe2005guidelinesincludingourincreasedunderstandingofHPVbiology,theintroductionoftheHPVvaccine,roleofHPVtestingandtheincreaseduptakeofliquid-basedcytology.

Thisguidanceiscurrentlyunderreview(the‘NationalCervicalScreeningProgramRenewal’).ThereviewwillensurethatallAustralianwomenhaveaccesstoascreeningprogrambased onthelatestevidenceandbestpractice.ThefirstmeetingsoftheRenewalwereinNovember2011andtheprocessisexpectedto becompletedbymid2014.

Thisisasummaryofthecurrentmanagementguidelines.

Low-grade squamous abnormalitiesThiscategoryincorporatesthesubgroupsofCIN1,HPVinfectionandatypicalsquamouschangesthatfallshortofCIN1.Theriskfordiseaseprogressionisthesameforallofthesesubgroupshenceallaremanagedthesame.

MostofthesefindingsareduetoatransientHPVinfectionwhichislikelytospontaneouslyregresswithin8to16months.TheaimoftheguidelinesaretodetectthesmallproportionwhichdonotregressandgoontobecomepersistentHPVinfection,whilstsimultaneouslynotovertreatingthevastmajoritynotneedinganymedicalintervention.

Women with a smear report of low-grade squamous abnormality should have a repeat smear at 12 months.

If the repeat smear at 12 months again shows low-grade squamous abnormality, the woman should be referred for colposcopy.

If the 12 month repeat smear is normal, the woman should have a further smear in 12 months, i.e., 24 months after the index smear. If this second repeat is normal, she can return to the routine screening interval.

Fluctuatinglow-gradesquamousabnormalities mayindicatepersistentHPVinfection,hencethe nextmanagementguideline:

Referral for colposcopy should be considered for a woman with fluctuating low-grade squamous reports, i.e., two in a three year timeframe, regardless of intervening normal cytology reports.

Mostwomenover30haveclearedtheirHPVinfection. Thisagegroupalsohasahigherincidenceofsquamouscervicalcarcinoma.Thereforeanindexsmearreportoflow-gradesquamousabnormality,especiallywithoutthereassuringhistoryofanegativesmearintheprecedingtwotothreeyears,mayportendeitherapersistentHPVinfectionorahighergradelesion.

Women over 30 years who have not had a negative Pap smear within the preceding 2-3 years, may be offered immediate colposcopy or a repeat smear in 6 months.

Interestingly,20-25%ofpatientswithaPapsmearreportoflow-gradesquamousabnormalityhaveaconcurrenthistologicaldiagnosisofahigh-gradesquamouslesion.Thisostensibly

concerningfigureisreproducedaroundtheworldregardlessofthequalityofthesmeartakerorreportinglaboratory.IntheAustraliancontext,theriskofinvasivecancerdevelopingintheoneyearintervalbeforerepeattestingisexceptionallylowandinsufficienttowarrantdifferentmanagement.ThecurrentreviewofthescreeningprogramwillbeassessingthepotentialroleofHPVtestingoflow-gradesmearsasameansoftriagingwhichhavehighriskHPVinfectionandmayrequiredifferentmanagement.

High-grade squamous abnormalities A woman with a Pap smear report of possible high-grade squamous lesion or high-grade squamous lesion should be referred for colposcopy.

If there is a report of a definite or a possible invasive component, the woman should be referred to a specialist gynaecologist, ideally within two weeks.

Glandular lesionsAllglandularabnormalitiesarerecommendedtohavecolposcopicassessment:

A woman with a Pap smear report of possible high-grade glandular lesion or endocervical adenocarcinoma in situ (AIS) should be referred to a specialist gynaecologist

A woman with a Pap smear report of adenocarcinoma (of any origin) should be referred to a specialist gynaecologist.

Follow up of women previously treated for high-grade diseaseFollowupoftreatedhighgradediseaserequirescolposcopyandrepeatsmearat4-6monthsaftertreatment.

At12months,afurtherrepeatsmearandHPVtestingiscarriedout.

Once a woman has tested negative to both HPV testing and cervical cytology on two consecutive occasions, i.e., 12 months apart, she can return to the normal screening interval rather than continuing annual Pap smears.

ThisistheonlyuseofHPVtestingthatiscurrently Medicarerebatable.

ConclusionItisimportanttorememberthatthecervicalsmearisonlyascreeningtest,andpatientsshouldbeawarethatithasasmall,unpreventable,incidenceoffalsepositivesandfalsenegatives.ThebestwayforawomantoreduceheroddsofgettingcervicalcancerisregularPapsmearsandtoattendanyprescribedfollowupsmears.

Dr Jason Stone MBChB FRCPath FRCPA

Consultant Histopathologist & CytopathologistPhone: (07) 3121 4426 Email: [email protected]

Dr Bryan Knight BSc (anatomy) MB ChB MMed (anatomical pathology) FIAC ACAP PhD

We would like to take this opportunity to thank Dr Knight for his contribution as the Head of Department of Cytopathology, Dr Knight will be continuing on with QML Pathology as a cytopathologist.

Congratulations Dr Jason Stone, our new Head of Department of Cytopathology.

Real-Time Results...Anytime, Anywhere.Path-Way and Path-Way Mobile, the new web-based application by QML Pathology, provide you with access to pathology results in real-time, at anytime, from anywhere.

To register, visit www.path-way.com.au

After graduating with a Bachelor of Medicine and Bachelor of Surgery in 1997 from the University of Cape Town, South Africa, where he received multiple academic prizes, Dr Jason Stone continued his internship and clinical rotations at Greys Hospital Pietermaritzburg, South Africa.

In 2000, Dr Stone went to the UK and worked in the Department of Physiology and Histology at Bristol University. He commenced his histopathology training in Sheffield where he handled a wide range of general surgical specimens, including non-gynaecological cytopathology.

Dr Stone joined Doncaster and Bassetlaw Hospital as a Consulting Pathologist in 2006, and in 2010 moved to Australia and joined the QML Pathology Brisbane histology and cytology team.

In addition to his work at the Brisbane Laboratory, Dr Stone also oversees histology and cytology for the Mackay region.

Special Interests: Breast and gynaecological pathology, and cytopathology.


Cytopathology training programmeManydoctorsarenotawarethattheQMLPathologyCytopathologyDepartmenthasaverysuccessfulin-housetrainingprogrammethathasbeenrunningsince1995. Theprogrammeincludesscreeningofgynaecologicspecimens(papsmears)andnon-gynaecologicspecimens.Since1995wehavetrained54graduatestoscreengynaecologicandnon-gynaecologicspecimens.

Ittakesapproximately6to8monthstofullytrainacandidatetoscreencervicalpapsmears,andmostscreenerstakeovertwoyearstobecomecompetentinscreeningallofthevariousnon-gynaecologicspecimens,suchasurines,sputa,FineNeedleAspiratesetc.Thetrainingprogrammeinvolvesaformalisedseriesoflectures,multi-headermicroscopesessions,theoryquestions,slidescreeningsetsandsupervisedscreening.TraineesaresupervisedbyagroupofseniorscientistsknownasMentors, whoareintegraltothesuccessofourtrainingprogram.

After2years,thetraineesareeligibletositfortheAustralianSocietyofCytologycertificate-anationalexaminationwhichtestscompetencyinallaspectsofCytologyscreeninginAustralia.Onseveraloccasions,aQMLPathologycandidatehasgainedthehighestmarkinthisexam,andmanyofourcandidateshavepassedwithdistinction.

SpecialistRegistrarsinHistopathologyalsomakeuseoftheexcellentteachingresourcesavailableintheCytopathologyDepartment.

QMLPathologyCytopathologyisveryproudofthequalityofitsgraduatesandthecultureofongoingeducationinthedepartment.Thiscommitmenttotrainingformsoneaspect oftheongoinggoaltomaintainthehighqualitycytologyservice thatQMLPathologyDepartmentofCytopathologyoffers.

WearepleasedtointroduceourtwonewestgraduatesAmyHassum(picturedleft)andKerrynBuchanski(right)whograduatedinSeptember2012.

Since1995,fourtrainingco-ordinatorshaveoverseenthetrainingprogramme.Ourcurrentco-ordinator,TereseBoost(picturedcentre),hasheldthepositionforfiveyears.TereseisherselfagraduateoftheoriginalQMLPathologytrainingprogrammein1995,gainingherASCcertificatein1998and aMaster’sdegreeinCytologyin2006.


Collection Centre Updates

NEW cOllEcTION cENTrES

BALDHILLS.....................................................................(07)32611486 11BaldHillsRoad OpeningHours: Mon-Fri: 7.00am–12.00pm

BUDERIM........................................................................(07)54410200 16-18KingStreet OpeningHours: Mon-Fri: 8.00am–12.00pm

CANUNGRA.....................................................................(07)55434800 49ChristieStreet OpeningHours: Mon-Fri: 8.00am–11.00am

COLLINGWOODPARK..................................................... (07)38143377 RedbankPlazaMedicalCentre,Level1RedbankPlaza 1CollingwoodParkDrive OpeningHours: Mon-Fri: 8.00am–1.00pm

MACKAY–CANELANDDENTAL.....................................(07)49512999 CanelandDental,CanelandCentralShoppingCentre CnrMangroveRoad&VictoriaStreet OpeningHours: Mon-Fri:9.00am–1.00pm

REDLANDBAY.................................................................(07)38292903 Shop4,100DonaldRoad OpeningHours: Mon-Fri: 7.00am–12.00pm

suMNer......................................................................... (07)33765051 1/50SumnersRoad OpeningHours: Mon-Fri:7.30am–11.30am,12.00pm–1.30pm

rElOcATED cOllEcTION cENTrES

PIALBA............................................................................. (07)41248645 14LiuzziStreet OpeningHours: Mon-Fri: 7.00am–12.00pm

THE FOLLOWING COLLECTION CENTRES ARE NOW BY APPOINTMENT ONLY

CAIRNSCITY.................................................................. (07)40312668 BarrierReefMedicalCentre,377SheridanStreet

COOROYEAST................................................................ (07)54410200 CnrPearlandElmStreets

IBUKI.............................................................................. (07)54410200 IbukiHealthandWellness,6QuambyPlace,NoosaHeads

IMBIL.............................................................................. (07)54410200 6ImbilIslandRoad

PeregIaN sPrINgs...................................................... (07)54410200 PeregianSpringsShoppingCentre,HavanaRoadWest

rossLea.........................................................................(07)47289193 112BowenRoad

SPRINGWOOD................................................................ (07)32901501 DennisRoadMedicalCentre,18DennisRoad

TOWNSVILLECITY..........................................................(07)47242794 UrbanQuarters-Townsville Room4,MyFamilyDoctors,StanleyStreet


Doctor’s Noticeboard

TheDoctor’sNoticeboardisafreeserviceforpractitionerstoadvisechangestotheirpractice. Ifyouwouldliketoplaceanotice,[email protected].

DR NAEEM KHAN,MBBS,FRCS,FRACS

GeneralSurgeonand GastrointestinalEndoscopist

DrNaeemKhanisaGeneralSurgeonandGastrointestinalEndoscopistwithaspecialinterestinLaparoscopicBreast,ColorectalandHerniasurgery.DrNaeemKhansuccessfullycompleted5yearsof

advancedsurgicaltrainingatPrincessAlexandraHospitalinBrisbanewhichisacentreofexcellenceforsurgicaltraininginAustralia,andcompletedhispostgraduatetraininginQueenslandin2011.

PriortothisDrKhanobtainedhisEnglishfellowshipfromtheRoyalCollegeofSurgeonsandPhysiciansin2000,hasworkedasasurgeoninSouthAfricaandhasacquiredaverybroadsurgicalexperience.

Inaddition,DrKhanisaseniorlecturer(UniversityofQueensland)andisaregulartutorofjuniordoctorsandinternationalmedicalgraduates.Hetakesprideinprovidingthebestprofessionaladviceandpersonableservicetowhichhispatientscanrelate.

BasedatCaboolturePublicHospital,healsooperatesandconsultsatCaboolturePrivateHospital.

AppointmentsforDrKhancanbemadeon:(07)54959440.

DR DAVID PHILLIPS,ConsultantPhysician,Diabetes,ThyroidandEndocrinehasrelocatedto:

118AshmoreRoad BenowaQLD4215

Phone:(07)55975976

Fax:(07)55970459

GraduatedUniversityofQueenslandMBBS,MRCP(UK),FRACP.PostgraduatetrainingUnitedKingdomandRoyalBrisbaneHospital(clinicallecturerinendocrinology).

Officeconsultationsrestrictedtodiabetes,thyroid andendocrinology.

Comfortableroomsandampleoffstreetparking.

PROF. PAMELA MCCOMBEwouldliketoadvisethat shehasasessionalroomavailableat:

Suite286,GroundFloor StAndrew’sPlace,33NorthStreet SpringHillQ4000(Opp.StAndrew’sHospital)

Sessionsareavailableatthefollowingtimes: WednesdaysAM/PM ThursdaysPM FridaysAM

Pleasecall(07)32369960or [email protected].

DR SHAFIq YASIN,MBBS,DPM,MRCPsych,FRANZCP

Director&ConsultantPsychiatrist

ASSESSMENT&MANAGEMENT

•Depression •Anxiety •SelfHarmBehaviourandSuicideRisk •Schizophrenia •BipolarIllness •PersonalityDisorders •EatingDisorders •SleepDisorders •ADHD

E:[email protected] www.yasinpsychiatricservice.com.au

Forappointmentspleasephone:0477017070 orfaxGPreferrallettersto:(07)32457898.

Suite2 TheHubSpecialistCentre CnrLoraine&RickeyStreets,Capalaba

ErrOrS & OmISSIONSInthelastissueoftheQMLPathologyDoctorsnewsletter,wementionedthediscontinuationofthefaecalreducingsubstancetest.TheentrywastitledFatReducingSubstances,whenitshouldhavebeentitledFaecal ReducingSubstances.

Dr ANDrEW DAvIDSON

FertilitySpecialistandGynaecologist

Asof5thNovember2012,DrDavidson’snewBrisbanePracticeaddresswillbe:

Level10,WatkinsMedicalCentre 225WickhamTceBRISBANE4000

PleaseuseourexistingRobinacontacts: Phone:(07)56677711 Fax:(07)56677733 Email:[email protected]


EvE HEAlTH pIONEErS TElEHEAlTH

EveHealthisproudtoannounceTelehealth,anewinitiativeinpatientaccessibilityandcare.Telehealthoffersthepotentialforsignificantpatientbenefits,particularlyinremote,regionalandoutermetropolitanareas.Telehealthconsultationaimstoprovideimmediateaccesstospecialistswithoutthetimeandexpenseoftraveltoourmetropolitancentre.

Theparticipationofthepatient’susualhealthcareproviderduringtheconsultationwillprovideappropriate,immediateaccesstoallmanagementoptionsandenhancedcontinuityandqualityofcare.

EveHealth Shop5/199 GreyStreet SouthBankQld4101

Phone:(07)33321999

Email:[email protected]

Pleasevisitourwebsitewww.evehealth.com.au formoreinformationonourdoctors.

DR NAVID ADIB,MBBS(Qld),FRACP(PaedRheum),PhD(Manchester)

PaediatricRheumatologist

Childhoodmusculoskeletalandjointpains InflammatoryarthritisandAuto-immunediseases

WesleyRooms:Suite13,Level10 EvanThomsonBuilding 24ChaselyStreet Auchenflower4066

Bookings Ph:(07)38701029 Fax:(07)38710700

pOSITION vAcANTLawntonCountryMarketMedicalCentre

VRandNonVR,MaleandFemaleDoctorsrequired.DWSandAoNavailable.WearelocatedinaverybusyshoppingcentrenextdoortotheChemist.Lookingfordoctorstoworkflexiblehourswithahigherincome,withoutalongerwaitingperiod.Highpercentageguaranteed.ThepracticehasRNsupport,Physiotherapy,ExercisePhysiotherapy,Dietician,Psychologist,Podiatryandplansforonsitepathology.

AllenquiriespleasephoneNeilon0406804559.

GP POSITION AVAILABLE - BRIBIE ISLAND

BellaraFamilyMedicalPractice

OpportunityforF/TVRGPtojoinourlongestablishedGPownedseasidePractice.ThePracticeisfullycomputerised,accreditedandoffersmixedbilling.WehaveanexcellentsupportiveteamofDoctors,RegisteredNurseandAdminstaff.Familyfriendlyhourswithnoon-call.ThePracticeiscoveredbyanafterhoursservice.

PleasecontactTrishJackson(PracticeManager)on Ph:(07)34089077(officehours),or DrRajonPh:0418714183oremail:[email protected].

DR LEN YARED,MBBS,FRANZCOG,FRCOG

Obstetrician&GynaecologistWishestoadvisethatheisstillpracticinginObstetricsandGynaecologyandthathispracticeaddressis:643LoganRoad,Greenslopes,Qld4120Phone:(07)33941071Fax:(07)38471538Email:[email protected]:(07)33943636

Warfarin Dosing Over ChristmasQMLPathologywishestoadvisethatovertheupcomingChristmasperiod,theQMLPathologyWarfarinCareClinicwillbeclosed. PleasenotethatNONEWREGISTRATIONSwillbetakenfrom2.00pmonFriday,14December2012,withtheregistrationlinere-openingat7.00amonWednesday,2January2013.

Duringthisperiod,itisessentialthatanynewpatientsonWarfarinaresuppliedwithinstructionsand/orreferredtotheirlocaldoctor forsupervision.PatientswhoarecurrentlymonitoredbyQMLPathologyandarebeingdischargedfromhospitalwillbeacceptedover thisperiod.

SpecialistD

iagnosticServicesPtyLtd(ABN

84007190043)t/aQM

LPathologyPUB/MR/001(Nov-12)

ThisnewsletterhasbeenpreparedandpublishedbyQMLPathologyfortheinformationofreferringdoctors.Althougheveryefforthasbeenmadetoensurethatthenewsletterisfreefromerrororomission,readersareadvisedthatthenewsletterisnotasubstitutefordetailedprofessionaladvice.©Copyright2012

FURTHER HISTORICAL CLINICAL DATA CAN BE OBTAINED BY CONTACTING YOUR LOCAL MEDICAL LIAISON OFFICER.

Infectious Diseases ReportGEOGRAPHICDISTRIBUTION-SEPTEMBER2012

REGIONS:1Cairns2GoldCoast/NorthernRivers3Ipswich

4Mackay5MountIsa6NewEngland7NorthBrisbaneSuburbs

8NorthernTerritory9Redcliffe10Rockhampton11SouthBrisbaneSuburbs

12SunshineCoast13Toowoomba14Townsville15WideBay/Burnett

orgaNIsM Regions(asperkeybelow) totaL1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 seP aug JUL JUN

Adenovirus(nottyped) 15 3 3 15 14 1 10 5 5 7 78 104 47 38

Adenovirus(typingpending) 6 1 2 3 1 1 1 15 23 19 15

BarmahForestvirus 1 1 2 1 2 2 1 1 2 13 17 9 16

Bordetellapertussis 2 19 18 10 2 14 26 23 52 23 27 5 221 236 206 210

Brucellaspecies 2 1 1 1 1 2 1 9 10 11 4

Campylobacterjejuni 3 3 1 0 0

Chlamydiapneumoniae 0 0 0 0

Chlamydiatrachomatis,nottyped 84 119 43 33 6 88 45 53 145 34 18 46 17 731 754 554 684

Coxiellaburnetii 3 1 4 6 3 14

Cryptococcusspecies 1 1 3 3 2

Cytomegalovirus(CMV) 2 11 7 1 12 13 2 8 5 4 65 82 36 58

Entamoebahistolytica 0 1 2 0

Enterovirus-nottyped 0 1 0 0

Epstein-Barrvirus(EBV) 5 7 8 3 23 7 1 26 10 2 11 5 108 137 112 95

Flavivirusunspecified 2 3 1 1 1 1 3 12 14 8 19

HepatitisAvirus 1 1 6 3 2

HepatitisBvirus 7 7 10 4 5 41 3 2 2 81 100 92 65

HepatitisCvirus 15 60 30 2 1 31 26 5 82 22 13 13 9 309 288 262 297

HepatitisDvirus 1 1 0 0 0

HepatitisEvirus 0 0 0 0

HerpessimplexType1 20 49 14 8 2 44 24 9 73 22 4 18 5 292 354 245 302

HerpessimplexType2 13 34 6 9 1 21 12 4 33 15 2 6 3 159 183 151 187

Herpessimplexvirus-nottyped 0 0 0 1

HIV-1 2 1 3 13 10 11

HTLV-1 0 0 0 0

HumanMetapneumovirus 4 20 13 24 21 8 37 19 2 6 154 185 46 31

InfluenzaAvirus 8 21 15 7 3 58 45 19 68 67 18 23 8 360 2219 1145 333

InfluenzaBvirus 15 42 26 4 2 65 72 19 111 37 33 7 5 438 685 180 122

Legionellapneumophila(allserogroups) 0 1 0 2

Legionellaspecies 1 1 1 3 3 2 5

Leptospiraspecies 1 1 1 3 4 2 3

Measlesvirus 1 1 0 0 0

Mumpsvirus 0 1 1 0

Mycoplasmapneumoniae 19 142 72 42 9 2 110 130 41 215 98 28 33 20 961 1337 848 221

Neisseriagonorrhoeae 9 5 1 9 1 1 5 1 2 1 35 38 41 43

Parainfluenzavirus 2 18 4 4 1 15 16 3 25 8 2 6 1 105 100 41 48

Parvovirus 1 2 4 4 1 4 2 6 4 2 2 32 25 31 28

Pneumocystiscarinii 1 1 0 1 2

RespiratorySyncytialvirus 2 20 13 2 1 1 12 16 13 16 13 8 5 4 126 190 159 130

Rhinovirus(alltypes) 7 23 9 3 1 23 1 17 5 46 13 9 12 2 171 270 241 317

Rickettsia-SpottedFeverGroup 4 4 3 6 3

RossRivervirus 2 5 2 1 3 3 3 6 2 5 32 20 21 23

Rubellavirus 0 1 1 2

SalmonellaparatyphiA 0 0 0

SalmonellaparatyphiB 0 0 0

Salmonellatyphi 0 1 2

StreptococcusGroupA 6 12 7 1 5 12 6 18 7 1 7 2 84 90 52 64

Toxoplasmagondii 0 1 1 2

Treponemapallidum 24 10 4 2 8 23 7 7 28 3 4 22 1 143 164 105 119

Trichomonasvaginalis 21 1 5 2 1 5 35 28 24 27

VaricellaZostervirus 8 37 15 3 39 22 4 64 15 2 6 3 218 235 175 222

TOTAl 273 671 323 141 39 9 640 2 527 235 1115 425 153 271 95 4919 7933 4897 3769

who classification of tumours of haematopoietic and ... · pdf filetumours of haematopoietic...

Documents