Non-Hodgkin Lymphoma
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Transcript of Non-Hodgkin Lymphoma
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Non-Hodgkin Lymphoma
Dr. Raid Jastania
Dec 2006
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• By the end of this session you should be able to:– Classify Non-Hodgkin lymphoma– Know the clinical and pathological features of
common Non-Hodgkin B-cell lymphomas (ALL, CLL, Mantle cell lymphoma, Follicular lymphoma, Marginal zone lymphoma, DLBCL, and Burkitt lymphoma)
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Classification of Non-Hodgkin Lymphoma
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Classification of Non-Hodgkin Lymphoma (selected common entities)
• Precursor B cell– Acute lymphoblastic
lymphoma
• Peripheral B cell– Small lymphocytic
lymphoma SLL, Chronic lymphocytic leukemia CLL
– Mantle cell lymphoma– Follicular lymphoma– Marginal zone lymphoma– Diffuse large B cell
lymphom– Burkitt lymphoma
• Precursor T cell– Acute lymphoblastic
lymphoma
• Peripheral T cell– Anaplastic large T cell
lymphoma
– Peripheral T cell lymphoma
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B cell
• Precursor Naïve Mantle Germinal center Marginal zone
Morphology
• Blast Small mature Large transformed plasma cell
Markers
• CD34/TdT CD5 CD20/CD10 CD20 only
Homing
• BM Peripheral LN LN/extralymphatic
Symptoms
• BM suppression Leukemia LN involve mass
Patterns
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Acute lymphoblastic lymphoma/leukemia (ALL)
• Clinical: children, young adults, leukemic, mediastianl mass (T cell ALL), Bone marrow involvement, high grade
• Pathology: medium size Blasts, uniform
• Immuno: TdT, CD 34, CD10, (CD20 or CD3)
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Small lymphocytic lymphoma SLL, Chronic lymphocytic leukemia CLL
• Clinical: low grade, asymptomatic, nodal and leukemic, elderly 7th, 8th decade
• Pathology: small cells, vague nodularity, proliferation centers
• Immuno: CD20, CD23, CD5
• Can transform to large cell lymphoma (Richter transformation)
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Mantle cell lymphoma
• Clinical: Variable (low grade to aggressive) >50 year, nodal, GI tract
• Pathology: small uniform cells
• Immuno: CD20, CD5, CyclinD1
• T(11;14) cyclinD1
• Transformation to large cell lymphoma is very rare
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Follicular lymphoma
• Clinical: Low grade, Nodal, > 40 years
• Pathology: large malignant follicles, mixture of small (centrocytes) and large cells (centroblasts)
• Immuno: CD20, CD10, Bcl-2
• T(14;18) Bcl-2 over expression
• 30% transform to large cell lymphoma
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Marginal zone lymphoma
• Clinical: nodal or extranodal (MALT), low grade
• Pathology: mixture of small, large lymphocytes and plasma cells
• Immuno: CD20 only
• Can transform to large cell lymphoma
• Treatment
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Diffuse large B-cell lymphoma
• Heterogenous group: Denovo, or transformed low grade lymphoma (FL)
• Nodal or extranodal, Intermediate grade
• Pathology: Sheets of large cells, mitosis, apoptosis
• Immuno: CD20, most CD10+
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Burkitt lymphoma
• Clinical: 3 types– 1. Endemic: African EBV– 2. Sporadic: North America– 3. Immunosuppressed (HIV)
• Aggressive tumor• Pathology: medium size, high mitosis, apoptosis,
Starry sky pattern• Immuno: CD20, CD10• T(8;14) C-myc over expression
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Test
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