Difference between revisions of "Small cell lymphomas"

Jump to navigation Jump to search

Small cell lymphomas (view source)

Revision as of 22:47, 29 December 2013

4,883 bytes removed ,  22:47, 29 December 2013
split out
(split out)
Line 107: Line 107:


==Follicular lymphoma==
==Follicular lymphoma==
===General===
*Abbreviated ''FL''.
*A very common type of lymphoma.
{{Main|Follicular lymphoma}}
*Expresses BCL2,<ref name=pmid18359244>{{cite journal |author=Vitolo U, Ferreri AJ, Montoto S |title=Follicular lymphomas |journal=Crit. Rev. Oncol. Hematol. |volume=66 |issue=3 |pages=248–61 |year=2008 |month=June |pmid=18359244 |doi=10.1016/j.critrevonc.2008.01.014 |url=}}</ref> like many other small cell lymphomas.
 
===Microscopic===
Features (lymph node):
*Abundant abnormally-shaped lymphoid follicles - '''key feature''' - including some of the following:
**Non-polarized mantle zone (normal mantle zone is usu. thicker at capsular aspect).
**Non-polarized germinal center (normal germinal center has dark & light area).
**Loss of tingible body macrophages.
**Sinuses effaced (lost).
 
Note:
*The intrafollicular component of the lymph node is compressed - follicles are often described as "kissing", as they nearly touch.
*In [[bone marrow]] specimens the neoplastic cells classically have a paratrabecular arrangement,<ref name=pmid17284114>{{Cite journal  | last1 = Iancu | first1 = D. | last2 = Hao | first2 = S. | last3 = Lin | first3 = P. | last4 = Anderson | first4 = SK. | last5 = Jorgensen | first5 = JL. | last6 = McLaughlin | first6 = P. | last7 = Medeiros | first7 = LJ. | title = Follicular lymphoma in staging bone marrow specimens: correlation of histologic findings with the results of flow cytometry immunophenotypic analysis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 282-7 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[282:FLISBM]2.0.CO;2 | PMID = 17284114 }}</ref> i.e. the lymphoma cells are found adjacent to the bone spicules.
 
DDx:
*Reactive follicular hyperplasia.
*[[Diffuse large B-cell lymphoma]] - esp. for the grade 3B.
 
====Images====
*[http://www.flickr.com/photos/euthman/3311641845/ Follicular lymphoma - bone marrow (flickr.com)].
*[http://library.med.utah.edu/WebPath/HEMEHTML/HEME034.html Follicular lymphoma (utah.edu)].
====Grading====
*Grade 1-2: <= 22 centroblasts / HPF; where 1 HPF ~= 0.2376 mm^2 (22 mm eye piece @ 40X objective).
*Grade 3A: >22 centroblasts / HPF; where 1 HPF ~= 0.2376 mm^2 (22 mm eye piece @ 40X objective).
*Grade 3B: only centroblasts (within a nodular architecture).
 
Notes:
*Significant interobserver variability.<ref>DG. 17 August 2010.</ref>
*Grade 1 & Grade 2 lumped together.
*One should evaluate 10 HPFs.
*''Only'' centroblasts ''without'' a nodular architecture is ''[[Diffuse large B cell lymphoma]]'' ([[DLBCL]]).
 
The usual cut points mentioned by people with [[HPFitis]] are:<ref name=Ref_Sternberg4_813>{{Ref Sternberg4|813}}</ref>
*Grade 1: 0-5 centroblasts / HPF.
*Grade 2: 5-15 centroblasts / HPF.
*Grade 3: >15 centroblasts / HPF.
 
===IHC===
Features:<ref name=pmid18359244/>
*CD10 +ve.
*BCL6 +ve.
 
Others:
*CD5 -ve.
**+ve in mantle cell lymphoma.
*CD23 -ve/+ve.
**+ve in CLL.
*CD43 -ve.
**+ve in mantle cell lymphoma, marginal zone lymphoma.
*CD11c -ve -- flow cytometry only.
*CD21 -ve in tumour cells; highlights follicular dendritic cells.
 
Image:
*[http://www.pathpedia.com/education/eatlas/histopathology/lymph_node/follicular_lymphoma/follicular-lymphoma-%5B16-ln021_cd21%5D.jpeg Follicular lymphoma - CD21 (pathpedia.com)].
 
A panel to work-up:
*BCL2, BCL6, CD3, CD5, CD10, CD20, CD23, cyclin D1.
 
===Molecular===
*t(14;18)(q32;q21)/IGH-BCL2 in 70-95% of cases.<ref name=pmid18359244/>
**Should not be confused with t(14;18)(q32;q21)/IGH-MALT1 seen in MALT lymphomas.<ref name=pmid16950858>{{cite journal |author=Bacon CM, Du MQ, Dogan A |title=Mucosa-associated lymphoid tissue (MALT) lymphoma: a practical guide for pathologists |journal=J. Clin. Pathol. |volume=60 |issue=4 |pages=361–72 |year=2007 |month=April |pmid=16950858 |pmc=2001121 |doi=10.1136/jcp.2005.031146 |url=}}</ref>
 
===Sign out===
<pre>
RETROPERITONEAL MASS, RIGHT, CORE BIOPSIES:
- NON-HODGKIN B-CELL LYMPHOMA, FAVOUR FOLLICULAR LYMPHOMA.
 
COMMENT:
Morphology:
-Small cells: size ~ mature lymphocytes, quantity - many, angular and round.
-Large cells (intermixed with small cells): size ~1.5-2x mature lymphocyte,
small nucleoli, moderate quantity of grey/basophilic cytoplasm, moderate
nuclear pleomorphism.
-Architecture: no gland formation, discohesive, no follicles apparent, no sheets
of large cells.
-Mitoses are uncommon.
 
Immunohistochemical stains (tumour cells):
Positive: CD45 (strong, membranous/cytoplasmic), CD20 (strong, membranous/cytoplasmic),
BCL-2 (strong, membranous/cytoplasmic), CD10 (strong, membranous), BCL-6 (moderate,
patchy, nuclear).
 
Negative: pankeratin, CD3, CD5, CD30, CD21 (follicular dendritic cells not apparent),
CD23 (scattered, rare).
 
Ki-67: highlights the large cells, primarily -- 5-35% of cells within the core.
 
The findings favour a follicular lymphoma, based on the cellular morphology and
immunostains; however, they are limited by the type of tissue sampling (core biopsy).
Clinical correlation is suggested.
</pre>


==Mantle cell lymphoma==
==Mantle cell lymphoma==
Michael
48,833

edits

Retrieved from "https://librepathology.org/wiki/Special:MobileDiff/27238"

Navigation menu