(15)malignant lymphoma

8/13/2019 (15)Malignant Lymphoma

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MALIGNANT LYMPHOMA

NI PUTU EKAWATI


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Lnn Distribution


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Normal Histology


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General Disorders

Reactive

Proliferations of

White cells andNodes

Acute Nonspesific

Lympadenitis

Chronic NonspesificLympadenitis

Spesific

lympadenitis

NeoplasticProliferations ofWhite Cells Lymphoid neoplasm

Myeloid NeoplasmAML, MDS, MPD

Langerhans cell

Neoplasm


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Malignant Lymphoma

Malignant counterpart of normal

lymphocytes


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Lymphoma Vs Leukemia

Leukemia : lymphoid neoplasm presentwith widespread involv. of the BM, usuallyaccompanied by the presences of large

numbers of tumor cells in peripheral blood Lymphoma : proliferations arising as

discrete tissue masses.


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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


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WHO Classification : Reflection of the

complexity of lymphoid differentiation

Tumor biology

Histomorphology

Immunophenotype

Molecular genetics

Purpose

Ordering Prognostication

Treatment categories


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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)


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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


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WHO Classification

T Cell and NK Neoplasm

Precursor T/NK cell neoplasm

Mature T/NK cell neoplasm Leucemic / disseminated

T-cell prolymphocytic leukemia

Cutaneus Mycosis funguides/Sezary syndrome

Primary cutaneus anaplastic large cell lymphoma

Other extranodal NK/T cell lymphoma, nasal type Hepatosleenic T-cell lymphoma

NodalAngioimunoblastic lymphoma

Anaplastic large cell lymphoma


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Frequent feature of mature T/NK cell

lymphoma

Broad cytologic spectrum

Disease definition is heavily dependentupon 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


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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


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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


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Clinical differences HL x NHL

HL

Localized to a single

axial group of nodes

Spread by contiguity Mesenteric &

Waldeyer ring rarely

involved

Extranodal uncommon

NHL

Multiple pheriperal

nodes

Non contiguous Commonly involved

Common


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Ann Arbor staging classification

Stage I : involvement of single lymph noderegion 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)


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Grouping Lymphoma by

Clinical Behavior

Lymphoma that are indolent (slow

growing) but usually incurable

CLL/SLL

Follicular lymphoma

MALT lymphoma


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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


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CD 20 (IHK)


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MF


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MF


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(15)malignant lymphoma

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