it is my power point presentation of lymphoma for final year MBBS students,govt.medical college,kottayam
dr irshad ali k m
assistant professor,dept.of medicine,govt,medical college,kottayam
2. Lymphoma
• Clonal malignant disorders that are derived from
lymphoid cells: either precursor or mature T-cell
or B-cell
• Majority are of B- cell origin
• Divided into 2 main types :
1. Hodgkin’s lymphoma
2. Non - Hodgkin’s lymphoma
3. Blood Cell and Lymphocyte
Development
STEM CELLS
Multipotential
myeloid cells
Multipotential
lymphocytic cells
Differentiate & mature into 6
Types of blood cells
red cells basophils
neutrophils monocytes
eosinophils platelets
Differentiate & mature into 3
Types of lymphocytes
T lymphocytes
B lymphocytes
Natural Killer Cells
4. T-Cells and B-Cells
Immature lymphocytes that travel to the
thymus differentiate into T-Cells
– “T” is for thymus
Immature lymphocytes that travel to the
spleen or lymph nodes differentiate into B
cells
– "B" stands for the bursa of Fabricius, which is
an organ unique to birds, where B cells
mature.
7. A 25 year old lady
1 month of evening rise of temperature, night
sweats and noticed a lump in her neck
On examination pallor, generalized
lymphadenopathy, hepatosplenomegaly
12. Clinical features
• Bimodal age distribution :
– young adults ( 20-30 yrs) & elderly (> 50yrs) May
occur at any age
• M > F
• Lymphadenopathy:
– most often cervical region
– asymmetrical, discrete
– painless, non-tender
– elastic character on palpation ( rubbery)
– not adherent to skin
– fluctuate in size
13. • Contiguous spread via the lymphatic chain
eg.involvement of abdominal & thoracic LNs
• Extra nodal disease - rare
• Hepatospleenomegaly
14. • Constitutional symptoms ( B symptoms )
–Night sweats,
–sustained fever > 38 degree celsius,
–loss of weight >10% of body weight in 6 mo
• Fever sometimes cyclical (‘Pel-Ebstein fever’)
• Pain at the site of disease after drinking alcohol
• Pallor
• Pruritis
• Symptoms of Bulky (>10 cm) disease
16. • LN FNAC / biopsy :
– Malignant REED-STERNBERG ( RS) Cell: Bi-nucleate cell
with a prominent nucleolus. Derived from B cell, at an
early stage of differentiation
– Reactive background of eosinophils, lymphocytes,
plasma cells
– Fibrous tissue
25. Staging
• Stage I : Involvement of single LN region (I) or extra
lymphatic site (IAE )
• Stage II : Two or more LN regions involved (II) or an extra
lymphatic site and lymph node regions on the same side of
diaphragm
• Stage III : Involvement of lymph node regions on both sides
of diaphragm, with (IIIE) or without (III) localized extra
lymphatic involvement or involvement of the spleen (IIS) or
both (IISE)
• Stage IV : Involvement outside LN areas (Liver, bone
marrow)
A : Absence of ‘B’ symptoms
B : B symptoms present
26.
27. Treatment - Guidelines
• Indications for RT:
– Stage I disease
– Stage II disease with 3 or lesser areas involved
– For Bulky disease
– For pressure problems
• Indications for CT
– All with B symptoms
– Stage II disease with >3 areas involved
– Stage III and IV disease
28. Treatment
• Stage IA , Stage IIA with 3 or < 3 areas involved:
Radiotherapy
• Stage IB, Stage II A with > 3 areas , Stage IIB:
Chemotherapy every 3-4 weeks, 6-8 cycles; either
alone, or in combination with radiotherapy
• Stage III & IV : Chemotherapy +
Radiotherapy ( for bulky disease or palliation of
symptoms)
30. Chemotherapy
• MOPP :
Nitrogen Mustard,
Vincristine (Oncovin),
Procarbazine,
Prednisolone
• ABVD:
Adriamycin,
Bleomycin,
Vinblastine,
Dacarbazine
• Higher dose for relapse or younger pts with poor
prognostic features
31. Prognosis
• Overall 10 yr survival – 80%
• In long term survivors there is a risk of
– secondary malignancy: (leukemia , NHL), Solid tumors-
Lung, breast
– Infections
– Cardiac, pulmonary, endocrinal abnormalities
32. International Prognostic Index (IPI)
• Age
• Advanced stage disease
• Performance status
• Elevated LDH
• Presence of Extra nodal disease
33. Non Hodgkin’s lymphoma
• Incidence is increasing
• NHL>HD
• Median age of presentation is 65-70 yrs
• M>F
• More often clinically disseminated at
diagnosis
• B-cell-70% ; T-cell-30%
34. Relative frequencies of different
lymphomas
Hodgkin
lymphoma
NHL
Diffuse large B-cell
Follicular
Other NHL
Non-Hodgkin Lymphomas
~85% of NHL are B-lineage
35. Specific types
• Precursor B cell lymphoblastic
leukemia/lymphoma
Most common cancer in chilhood is B cell ALL
36. Cells are hetrogenous insize and
round/convoluted nuclei,high
nuclear/cytoplasmic ratio and absence of
cytoplasmic granules
39. • Young pt-bone marrow transplatation
• Chlorambucil alone or with cyc,rituximab
• Fludarabine
• CVP-CYC,VINCRISTINE
40. MALT-LYMPHOMA
Extra nodal marginal zone
Associated with H.pylori
CD-5 negative
Can occur in
stomach,orbit,intestine,lung,thyroid,salivary
gland,skin,soft tissue,bladder,kidney,CNS
44. irregular nuclear contours of the medium-sized lymphoma cells and the presence of a
pink histiocyte. By immunohistochemistry the lymphoma cells expressed CD20, CD5
and Cyclin D1
46. • Classic appearance of spleen involved by
follicular lymphoma, namely the presence of
discrete, miliary, small, white "pearly" nodules
throughout the whole parenchyma.
52. BURKITT’S LYMPHOMA
• RARE
• T(8;14)
• T(2;8),C-MYC and LAMDA LIGHT CHAIN GENE
• HIV Associated
• Most rapidly progressive human tumour
53.
54.
55.
56. • The "starry sky" appearance seen under low
power is due to scattered tingible body-laden
macrophages (macrophages containing dead
apoptotic tumor cells).
57. Hairy cell leukemia
• B –CELL
• Presents as Pancytopenia
• Hairy projections on light/electron microscopy
66. • A 22-year-old female presented with 2 weeks
of fever, anemia, generalized
lymphadenopathy, hepatosplenomegaly, and
skin rashes. Her total leukocyte count was 306
× 109/L. Peripheral blood smear showed many
atypical lymphocytes with petal-shaped nuclei
like flowers as seen in the photograph..
68. • Peripheral blood immunophenotype noted
negative markers for myeloid and B lymphoid
lineage (CD10, CD19, CD3, CD5, CD7, cyto-
CD3, TCR, CD16, CD56) and strongly positive
for CD4 and CD25, and also CD2, which was
atypical. Bone marrow aspirate and biopsy
revealed involvement by acute leukemia.
Serology for HTLV-1 was positive and serum
calcium was normal
69. Anaplastic large T/null cell lymphoma
• ALK-ANAPLASTIC LYMPHOMA KINASE protein
positive
• t(2;5)
• CD-30 POSITIVE
73. • A 38-year-old lady was referred for FNAC of
multiple left axillary nodes, one of them in the
axillary tail of left breast, which appeared as a
breast lump in the upper outer quadrant. The
nodes ranged from 1 to 3 cm in size, were well
defined, mobile, firm and non-tender. s
74. • There were no systemic symptoms and no
other organomegaly. Peripheral blood counts
and erythrocyte sedimentation rate (ESR)
were within normal limit
75. Section of lymph node containing
vascularized germinal centres and
eosinophilic material
76. Rosai dorfman disease
• Rosai–Dorfman disease, also known as sinus
histiocytosis with massive lymphadenopathy,
is a rare disorder of unknown cause that is
characterized by abundant histiocytes in the
lymph nodes throughout the body.
77.
78. ONE WORD ANSWER
• FLOWER CELLS SEEN IN-
• BASKET CELLS SEEN IN-
• T(14;18) seen in-
• STARRY SKY PATTERN SEEN IN-
• Mycosis fungoides is ……T/B cell lymphoma
• CD 15 AND CD 30 NOT SEEN IN……HODGKINS
TYPE LYMPHOMA