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Lymphoma
Dr. Venkatesh M. Shashidhar
Senior Lecturer in Pathology Fiji School of Medicine
Lymphoma:
Haematological Neoplasia - Overview
Leukemias:
Acute & Chronic, Myeloid & Lymphoid
Lymphomas:
Hodgkins & Non-Hodgkins
Premalignant:
Myeloproliverative - MPS Myelodysplastic - MDS
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Lymphoma:
Introduction:
Neoplastic lymphoid proliferation Fever, lymphadenopathy. Firm rubbery lymphnodes – painless* Immune disorders - Deficiency/ autoimm Rare metastasis out of RES. Two types – Hodgkins & Non-Hodgkins. Viral, genetic, unknown etiology. Lack of programmed cell death - Apoptosis
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Lymphoma:
Lymphoma
Row of enlarged lymph nodes
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Lymphoma - Gross
Lymphoma Intestine
Lymphoma Intestine
Mediastinal Lymphnodes-NHL
Hodgkins Lymphoma (HL)
Lymphoma:
Hodgkins Lymphoma:
Painless, firm lymphadenopathy, Fever* Eosinophilia Only Reed-Sternberg cells malignant (B cell) Classification(WHO): Classic Hodgkins:
Lymphocyte predominant. Nodular Sclerosis. Mixed cellularity. Lymphocyte depleted.
Nodular lymph. predominant (non-classic)
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Hodgkins lymphoma
Hodgkins lymphoma cells
Hodgkins Lymphoma
Non-Hodgkins Lymphoma (NHL)
Lymphoma:
NHL – Classification:
According to cell type T cell, B cell, Histiocytic & Misc. NHL According to Clinical grade Low grade, Intermediate & High grade NHL. Histopathological Diffuse/Follicular NHL, Small, Intermediate & Large cell NHL
Ex: Lennert’s lymphoma is a low grade Tcell NHL. Burkitt’s lymphoma, a high grade B cell NHL
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Lymphocyte development:
Lymphoma:
Kiel Classification of NHL
B Cell NHL:
Low Grade: lymphocytic, plasmacytic, centrocytic, mixed centrocytic centroblastic. High Grade: Centroblastic, Immunoblastic, Burkitts, lymphoblastic.
T Cell NHL:
Low Grade: lymphocytic, mycosis, Lennerts High Grade: immunoblastic, lymphoblastic etc.
Rare types:
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Lymphoma:
NCI – Working Formulation
Low-grade NHL:
Small lymphocytic Follicular small cleaved
Intermediate-grade NHL:
Follicular large cell Diffuse small cleaved
High-grade NHL:
Immunoblastic Lymphoblastic
Miscellaneous: Histiocytic, Mycosis etc.
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NHL- Histologic types
Diffuse - & - Follicular
NHL- Histologic types
Small – Intermed. – Large
Staging of Lymphoma
Lymphoma spread to Spleen
Lymphoma spread to Spleen
Laboratory Diagnosis:
Lymphoma:
Laboratory Diagnosis:
Haematological:
Normocytic normochromic anemia, High ESR* Leucocytosis, Eosinophilia, lymphopenia Leukoerythroblastic picture - BM infiltration*
Bone marrow:
Normal, or late involvement. Trephine biopsy- diffuse or follicular infiltration
Biochemical:
High serum LDH – poor prognosis Hypercalcemia, Alkaline phosphatase, Uric acid. Serum transaminases & Bilirubin – Liver
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Lymphoma:
Laboratory Diagnosis:
Immunological:
Monoclonal gammopathy –B cell NHL, Myeloma Low normal gammaglobulins Autoimmune hemolytic anemia – auto ab.
Karyotypic/Genetic:
t(14;18) – B cell follicular (14* heavy chain) t(11;14) – diffuse NHL
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Burkitt’s Lymphoma
Lymphoma:
Burkitt’s Lymphoma
Unusual, B-Lymphoblastic high grade Young african children, jaw bones Isolated histiocytes, starry sky pattern EBV infection related. t(8;14) Chemotherapy – good response But relapse usual, 30% cure.
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Burkitt’s Lymphoma
Burkitt’s Lymphoma L.N.
Lymphoma:
Myeloma:
Multiple myeloma, plasmacytoma, myeloma, myelomatosis. Plasma cell neoplasm, monoclonal Ig. paraprotein. – Bence-jones protein – light chain. – very high ESR >100, Rouleaux. Bone pain, Lytic bone lesions, hypercalcemia, bleeding, Hyperviscosity syndrome – purpura, visual failure, neuropathy, heart failure etc.
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Myeloma – Bone Marrow
Myeloma: Skull X-Ray
Myeloma: Spine X-Ray
CWM-Hospital CPC Cases
Lymphoma:
Clinical details
A 28 year old lady presented with a swelling under her left jaw. (Figure 1) Her tooth on that side appeared infected. She was also found to have a large spleen, and axillary lymphadenopathy.
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Lymphoma:
Figure 1
Tender swelling
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Lymphoma:
Splenomegaly
Spleen
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Lymphoma:
Nodular Sclerosis - Hodgkins
Diffuse lymphoid mass
Fibrous septa
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Lymphoma:
Nodular Sclerosis - Hodgkins
Classic Reed Sternberg cells
Atypical multinucleated RS cells (Popcorn cells) 41
Lymphoma:
Clinical Details:
34 year male Neck swelling, 2-3 months, Fever, weight loss, no other lymphadenopathy Lymphnode biopsy done
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Lymphoma:
Right neck mass
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Lymphoma:
Lymphnode Biopsy
•Large cells •Mitotic figures
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Lymphoma:
Histiocytic/Tcell NHL
Diffuse pattern – no follicles. Large cells with moderate cytoplasm Plenty of mitotic figures – Rapid growth Nuclei are vesicular – pale, with prominent nucleoli Features suggest histiocytic or T-cell NHL Needs further marker studies for typing.
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Lymphoma:
Lymphoma Summary:
Solid malignancy of lymphoid tissue. Lymphadenopathy, fever, anemia. Hodgkins & Non-Hodgkins (NHL) types. RS-Cells, eosinophilia – Hodgkins. Low-grade, Intermediate & High grade. Blood, Biochemical, BM, LN - biopsy Immunological & Genetic tests. Chemotherapy, Radiotherapy, combination
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