Lymphoma

Dr. Raid Jastania

Dec 2006

• By the end of this session you should be able to:– Discuss the basis of the classification of

lymphomas– Know the different stages of B lymphocyte– List common genetic abnormalities in

lymphomas– Classify Hodgkin lymphoma and the difference

between the subtypes

Lymphoma• Classification WHO

– Lymphoid, Myeloid, Histiocytic

• Definitions:– Precursor, mature, stage of differentiation, naïve, peripheral,

small cell, large cell– CD’s

• Common types: Follicular lymphoma, Diffuse large B cell lymphoma

• Age: – Non Hodgkin: 6th- 7th decade– Hodgkin: 3rd decade

• Risk factors:– Abnormalities in the immune system.– EBV– HHV8– Hepatitis C virus– H. pylori

The Journey of the B cells

Bone marrow Peripheral blood

Lymph node

The Journey of the B cells

• Bone marrow- Blast- VDJ gene rearrangement- mature naïve Ig positive cells- IgM, IgD, CD5+

• Antigen- transformation- proliferation- mature B cell IgM

• Germinal center maturation, Somatic mutation.• IgG, IgA plasma cells and memory cells.• Plasma cells- bone marrow

The Journey of the B cells• Bone marrow- Blast- VDJ gene rearrangement- mature

naïve Ig positive cells- IgM, IgD– CD20, CD19,CD10, TdT, CD5+/-

• Antigen- transformation- proliferation- mature B cell IgM– CD20, CD10, Bcl-2

• Germinal center maturation, Somatic mutation.– CD20

• IgG, IgA plasma cells and memory cells.– Loose all the B cell markers CD138+

• Plasma cells- bone marrow

The Journey of the B cells

Bone marrow Peripheral blood

Lymph node

Genetics

• Follicular lymphoma t(14;18)– Bcl-2 over expression

• Mantle cell lymphoma: t(11;14)– CyclinD1 over expression

• Burkitt lymphoma: t(8;14)– C-myc over expression

Classification

• Based on:– Morphology– Immunophenotyping– Clinical presentation– Molecular/cytogenetic findings

Classification

• Predominantly disseminated: lymphoma/Leukemia

• Primary extranodal

• Primary nodal

Classification

• Predominantly disseminated: lymphoma/Leukemia– CLL, lymphoplasmacytic lymphoma, Myeloma

• Primary extranodal– Marginal zone lymphoma

• Primary nodal– Follicular lymphoma, mantle cell lymphoma

• Aggressive types– Diffuse large B cell lymphoma, Burkitt lymphoma