MALIGNANT LYMPHOMA

NI PUTU EKAWATI

Lnn Distribution

Normal Histology

General Disorders

Reactive Proliferations of White cells and Nodes

Neoplastic Proliferations of White Cells

Acute Nonspesific Lympadenitis Chronic Nonspesific Lympadenitis Spesific lympadenitis

Lymphoid neoplasm Myeloid Neoplasm

AML, MDS, MPD

Langerhans cell Neoplasm

Malignant Lymphoma

Malignant counterpart of normal lymphocytes

Lymphoma Vs Leukemia
Leukemia : lymphoid neoplasm present with widespread involv. of the BM, usually accompanied by the presences of large numbers of tumor cells in peripheral blood Lymphoma : proliferations arising as discrete tissue masses.

Etiological and Pathogenetic factors

Chr translocation and oncogenes Inherited genetic factor Viruses HTLV 1, EBV Enviromental agents H pylori Gluten sensitive enteropathy Iatrogenic Radiotherapy Chemotherapy

WHO Classification : Reflection of the complexity of lymphoid differentiation

Tumor biology Histomorphology Immunophenotype Molecular genetics
Purpose Ordering Prognostication Treatment categories

WHO Classification
Lineage differentiation (B,T,NK) Stage of maturation

Precursor B/T cell Mature B/T cell

Localization (nodal Vs MALT, skin, spleen) Molecular (Bcl1, Bcl2, Myc, ALK etc)

WHO Classification

B Cell neoplasm

Precursor B cell neoplasm Mature B cell neoplasm

CLL/SLL Prolymphocytic leukemia Lymphoplasmacytic lymphoma Spleenic marginal zone lymphoma Hairy cell leukemia Plasma cell myeloma Extraosseus plasmacytoma Marginal zone leukemia extranodal (MALT) Marginal zone leukemia Nodal Follicular lymphoma Mantle cell lymphoma Diffuse large B cell lymphoma(var mediastinal) Burkit lymphoma Intravascular and primary effusion lymphoma

WHO Classification

T Cell and NK Neoplasm

Precursor T/NK cell neoplasm Mature T/NK cell neoplasm

Leucemic

/ disseminated

T-cell prolymphocytic leukemia Mycosis funguides/Sezary syndrome Primary cutaneus anaplastic large cell lymphoma

Cutaneus

Other

extranodal

NK/T cell lymphoma, nasal type Hepatosleenic T-cell lymphoma Angioimunoblastic lymphoma Anaplastic large cell lymphoma

Nodal

Frequent feature of mature T/NK cell lymphoma

Broad cytologic spectrum Disease definition is heavily dependent upon clinical features, not morphology Infrequent lymph node involvement Frequent spread to other extranodal sites Cytotoxic T cell or NK cell phenotype Frequent apoptosis and/or necrosis

WHO Classification

Hodgkin lymphoma
Nodular lymphocyte predominant HD Classical HD

Nodular

sclerosis HD Lymphocyte rich classical HD Mixed cellularity classical HD Lymphocyte depleted classical HD

HODGKIN LYMPHOMA
Clinically, spread in contiguous fashion Histologically:

Reed-sternberg cells Inflammatory cells

RSC derived from B cell of germinal centre Response to specific types of therapy

Clinical differences HL x NHL

HL

NHL

Localized to a single axial group of nodes Spread by contiguity Mesenteric & Waldeyer ring rarely involved Extranodal uncommon

Multiple pheriperal nodes Non contiguous Commonly involved

Common

Ann Arbor staging classification

Stage I : involvement of single lymph node region or lymphoid structure Stage II : involvement of two or more lymph nodes regions on the same side of diaphragm Stage III : involvement of lymph node regions or structures on both sides of diaphragm Stage IV : involvement of extranodal site(s)

Grouping Lymphoma by Clinical Behavior

Lymphoma that are indolent (slow growing) but usually incurable

CLL/SLL Follicular lymphoma MALT lymphoma

Lymphoma that are fairly aggressive if untreated but may be cured with appropriate therapy
Hodgkin disease Follicular lymphoma, large cell type Diffuse large B cell lymphoma

Lymphoma that are extremely aggressive if untreated but potentially curable with therapy
Burkitt lymphoma Lymphoblastic lymphoma

CD 20 (IHK)

MF

MF