The Revised European American Lymphoma Classification

In 1991 a group of pathologists from both sides of the Atlantic and the Far East formed an International Lymphoma Study Group that met annually to discuss research. Not surprisingly, this group soon began to address issues of lymphoma classification as outlined above and the need for a new approach to classification soon became evident. Of three alternative approaches that emerged, to update either the Working Formulation or the Kiel classification or to produce an entirely new classification, a decision was made to adopt the latter course. The basis for what was to become the Revised European American Lymphoma (REAL) Classification3 was the construction of a list of neoplastic lymphopro-liferative disorders each defined as far as possible according to a set of five properties, namely morphology (histology), immunophenotype, genotype, normal cell counterpart, and clinical features. The degree to which these properties contribute to the classification of each entity varies. In some cases, such as mantle cell lymphoma, each property is highly distinctive, perhaps reflecting its basic distinctive genotype,4 while for others such as nasal-type natural killer (NK)-cell lymphoma5 clinical features together with immunophenotype are the most important.

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