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Lymphoma
- 2. LEUKEMIAS/LYMPHOMAS • MALIGNANT PROLIFERATIONS of WHITE BLOOD CELLS • Liquid (lukemia) vs Solid (lymphoma) • All leukemias of lymphocytes have lymphoma counterparts • Primary lymphomas can have “leukemic” phases, including multiple myelomas • Any myeloid leukemia can infiltrate a lymph node, or any other site, but if/when it does it is NOT called a lymphoma, but simply a myeloid infiltrate INTO a lymph node
- 4. CLASSIFICATION • NON-HODGKIN –PRECURSOR B –PERIPHERAL B –PRECURSOR T –PERIPHERAL T • HODGKIN’S DISEASE (i.e., HODGKINS LYMPHOMA)
- 10. LYMPHOCYTE MARKERS (CD-) i.e., LYMPHOCYTE ANTIGENS • T-Cell: 1,3,4,5,8 • B-Cell: 10 (CALLA), 19,20,21,23,79a • Mono/Mac: 11c, 13, 14, 15, 33, 34 • STEM: 34 • RS: 15, 30 • All: 45 (Leukocyte Common Antigen) • NK: (16, 56)
- 11. Hodgkin’s Disease • Background – first described in 1832 by Dr. Thomas Hodgkin – characterized by the presence of Reed-Sternberg cells • multinucleated giant cells • described by Sternberg in 1898 and Reed in 1902 – classified as an infectious disease until 1950’s
- 17. PERIPHERAL B • CHRONIC LYMPHOCYTIC LEUKEMIA/LYMPHOMA • Lymphoplasmacytic • Splenic and Nodal Marginal Zone • EXTRA-nodal Marginal Zone • Mantle Cell • Follicular • Marginal Zone • Hairy Cell Leukemia • Plasmacytoma/Multiple Myeloma • Diffuse Large B Cell • BURKITT LYMPHOMA (Starry Sky)
- 18. PRECURSOR T • Precursor T LYMPHOBLASTIC LEUKEMIA/LYMPHOMA (T-ALL)
- 19. PRECURSOR B • Precursor B LYMPHOBLASTIC LEUKEMIA/LYMPHOMA (B-ALL)
- 20. PERIPHERAL T and NK • Large Granular • Mycosis fungoides/Sezary Cell syndrome (skin) • Peripheral T-Cell • Anaplastic large cell • Angioimmunoblastic T-Cell • Enteropathy-associated T-Cell • Panniculitis-like • Hepatosplenic gamma-delta • Adult T-Cell • NK/T Cell nasal • NK-Cell leukemia
- 21. NHL - Pathogenesis • Immune suppression/dysregulation – HIV, organ transplant, RA, SCID • H. pylori – MALT • EBV – Burkitt,s, ? Hodgkin’s • HHV 8 – Castleman’s • HTLV 1 – T cell leukemia, lymphoma • t(14;18) – follicular • t(11;14) – Mantle cell • t(8;14) – Burkitt’s
- 22. When To Suspect Lymphoma • Painful swelling of lymph nodes located in the neck, underarm and groin. • Unexplained Fever • Night Sweats • Constant Fatigue • Unexplained Weight loss • Itchy Skin
- 23. Pathology • Indolent Aggressive Follicular Marginal zone Diffuse large cell MALT Mantle cell Burkitt’s
- 24. NHL: Approach to the Patient • Staging evaluation – History and PE – Routine blood work • CBC, diff, plts, electrolytes, BUN, Cr, LFT’s, uric acid, LDH, B2M – CT scans chest/abd/pelvis – Bone marrow evaluation – Other studies as indicated (lumbar puncture, gallium, etc…)
- 31. HALLMARK CELLS
Editor's Notes
- CHRONIC leukemias, are essentially DIFFERENT from ACUTE leukemias, sorta.
- CLP, Common lymphoid precursor; BLB, pre-B lymphoblast; DN, CD4/CD8 double-negative pro-T cell; DP, CD4/CD8 double-positive pre-T cell; GC, germinal-center B cell; MC, mantle B cell; MZ, marginal zone B cell; NBC, naive B cell; PTC, peripheral T cell.
- Most pathologists HATE lymphoma classifications with a passion!
- STERNBERG REED cells are called “lacunar” cells in one of the most common forms of HD called NODULAR SCLEROSING
- I HATE this slide.
- I HATE this slide even worse.
- Why does the pathologist often use the word “buttocks” cell, to describe a “cleaved” cell lymphoma?
- “HAIRY” cell leukemia/lymphoma consists of lymphocytes which look hairy, but remember, on SEM and TEM they all look hairy!