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[[Image:Lymphoma macro.jpg | thumb | 200px | right | Lymphoma at [[cut-up]]. (WC/Emmanuelm)]]
'''Lymphoma''' is almost a specialty for itself.  It can be subclassified a number of ways.   
'''Lymphoma''' is almost a specialty for itself.  It can be subclassified a number of ways.   


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*[[Acute myeloid leukemia]] (AML).
*[[Acute myeloid leukemia]] (AML).
*[[Chronic myeloid leukemia]] (CML).
*[[Chronic myeloid leukemia]] (CML).
*Chronic lymphoid leukemia (CLL) - relatively good prognosis.
*[[Chronic lymphocytic leukemia]] (CLL) - relatively good prognosis.


===Histologic classification===
===Histologic classification===
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====Histologic terms====
====Histologic terms====
*Lymphomas = cells look discohesive, may be difficult to differentiate from poor differentiated carcinoma.
*Lymphomas = cells look discohesive, may be difficult to differentiate from poor differentiated carcinoma.
*Auer rods = Acute myeloid leukemia.
*[[Auer rods]] = [[acute myeloid leukemia]].
**Granular cytoplasmic rod (0.5-1 x4-6 micrometres).
**Granular cytoplasmic rod (0.5-1 x4-6 micrometres).
**Not pathognomonic.
*Reed-Sternberg cells = [[Hodgkin's lymphoma]].
*Reed-Sternberg cells = [[Hodgkin's lymphoma]].
**Large cell - very large nucleus.
**Large cell - very large nucleus.
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Others:
Others:
*AE1/AE3 -- to r/o carcinoma.
*[[AE1/AE3]] -ve -- to r/o carcinoma.


====T cell markers====
====T cell markers====
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==Intravascular lymphoma==
==Intravascular lymphoma==
*[[AKA]] ''angiotropic lymphoma'', ''intravascular malignant lymphomatosis'', ''malignant angioendotheliomatosis''
*Rare.
*Rare.
*Usually B-cell lineage (see below ''intravascular large B-cell lymphoma'').
*Usually B-cell lineage (see ''[[intravascular large B-cell lymphoma]]'').
**May be T-cell lineage.<ref name=pmid20337769>{{cite journal |author=Wang L, Li C, Gao T |title=Cutaneous intravascular anaplastic large cell lymphoma |journal=J Cutan Pathol |volume= |issue= |pages= |year=2010 |month=March |pmid=20337769 |doi=10.1111/j.1600-0560.2010.01538.x |url=}}</ref>
**May be T-cell lineage.<ref name=pmid20337769>{{cite journal |author=Wang L, Li C, Gao T |title=Cutaneous intravascular anaplastic large cell lymphoma |journal=J Cutan Pathol |volume= |issue= |pages= |year=2010 |month=March |pmid=20337769 |doi=10.1111/j.1600-0560.2010.01538.x |url=}}</ref>
===Intravascular large B-cell lymphoma===
====General====
*[[AKA]] ''angiotropic lymphoma'', ''intravascular malignant lymphomatosis'', ''malignant angioendotheliomatosis''.
=====Clinical=====
*Often a non-specific presentation.<ref name=pmid11579120>{{cite journal |author=Lapkuviene O, Forchetti D, Roepke JE |title=Unusual sites of involvement by hematologic malignancies. Case 1. Intravascular large B-cell lymphoma presenting with CNS symptoms |journal=J. Clin. Oncol. |volume=19 |issue=19 |pages=3988–91 |year=2001 |month=October |pmid=11579120 |doi= |url=http://jco.ascopubs.org/content/19/19/3988.full}}</ref>
**+/-Fever.
**+/-Multiple infarcts.
**+/-Non-specific skin lesions.
====Microscopic====
Features:
*Abundant atypical intravascular lymphoid cells that are:
**Large (~2-3X size of a mature lymphocyte or RBC).
**Nucleolus prominent.
Notes:
*It may be hard to find RBCs in the vessels.
*Looks sorta like a [[DLBCL]] -- but is intravascular.
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Intravascular_lymphoma_-_high_mag.jpg Intravascular lymphoma - high mag. (WC)].
*www:
**[http://jco.ascopubs.org/content/19/19/3988/F1.expansion.html ILBCL (ascopubs.org)].<ref name=pmid11579120/>
**[http://theoncologist.alphamedpress.org/cgi/content/full/11/8/923/F1 ILBCL in bone marrow (alphamedpress.org)].
**[http://annonc.oxfordjournals.org/content/13/9/1503/F1.expansion.html ILBCL - various images (oxfordjournals.org)].
**[http://path.upmc.edu/cases/case473/images/fig01a.jpg ILBCL (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case473.html http://path.upmc.edu/cases/case473.html]. Accessed on: 21 January 2012.</ref>
**[http://path.upmc.edu/cases/case697.html ILBCL - several images (upmc.edu)].
====IHC====
Features:<ref name=pmid11579120/>
*CD20 +ve - '''key feature'''.
*CD3 -ve.
*CD34 -ve.


==Burkitt's lymphoma==
==Burkitt's lymphoma==
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*Abbreviated ''EATL''.
*Abbreviated ''EATL''.
*[[AKA]] ''enteropathy-type T-cell lymphoma'' (ETTL).
*[[AKA]] ''enteropathy-type T-cell lymphoma'' (ETTL).
===General===
{{Main|Enteropathy-associated T-cell lymphoma}}
*T cell lymphoma due to [[celiac sprue]].
*Subdivided into type I and type II.<ref name=pmid21566094>{{cite journal |author=Delabie J, et al |title=Enteropathy-associated T-cell lymphoma: clinical and histological findings from the International Peripheral T-Cell Lymphoma Project|journal=Blood |volume=118|issue=148|pages= 148|year=2011|month=July}}</ref>
 
===Microscopic===
Features:<ref name=pmid21323966>{{Cite journal  | last1 = Takeshita | first1 = M. | last2 = Nakamura | first2 = S. | last3 = Kikuma | first3 = K. | last4 = Nakayama | first4 = Y. | last5 = Nimura | first5 = S. | last6 = Yao | first6 = T. | last7 = Urabe | first7 = S. | last8 = Ogawara | first8 = S. | last9 = Yonemasu | first9 = H. | title = Pathological and immunohistological findings and genetic aberrations of intestinal enteropathy-associated T cell lymphoma in Japan. | journal = Histopathology | volume = 58 | issue = 3 | pages = 395-407 | month = Feb | year = 2011 | doi = 10.1111/j.1365-2559.2011.03768.x | PMID = 21323966 }}</ref>
*Large ''or'' medium-sized lymphoid cells in the mucosa and submucosa.
**Large-sized cells ~ 2x RBC diameter = type 1.
**Medium sized cells ~ 1.5x RBC diameter = type 2.
*Intestinal epithelium usually preserved.
 
Image:
*[http://commons.wikimedia.org/wiki/File:Enteropathy-associated_T_cell_lymphoma_-_low_mag.jpg EATL (WC)].
 
===IHC===
Features - type 1:<ref name=pmid21323966/>
*CD56 +ve.
 
Features - type 2:<ref name=pmid21323966/><ref name=pmid21921780>{{Cite journal  | last1 = Chan | first1 = JK. | last2 = Chan | first2 = AC. | last3 = Cheuk | first3 = W. | last4 = Wan | first4 = SK. | last5 = Lee | first5 = WK. | last6 = Lui | first6 = YH. | last7 = Chan | first7 = WK. | title = Type II enteropathy-associated T-cell lymphoma: a distinct aggressive lymphoma with frequent γδ T-cell receptor expression. | journal = Am J Surg Pathol | volume = 35 | issue = 10 | pages = 1557-69 | month = Oct | year = 2011 | doi = 10.1097/PAS.0b013e318222dfcd | PMID = 21921780 }}</ref>
*CD3 +ve.
*CD5 -ve.
*CD8 -ve/+ve.
*CD56 -ve/+ve.
*CD30 +ve.


==Angioimmunoblastic T-cell lymphoma==
==Angioimmunoblastic T-cell lymphoma==
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Features:
Features:
*Intermediate size cells with:
*Intermediate size cells with:
**+/-Vesicular nuclei.
**+/-[[Vesicular nuclei]].
**Clear, moderate cytoplasm.
**Clear, moderate cytoplasm.
*"Empty" sinus; subcapsular sinuses "open".
*"Empty" sinus; subcapsular sinuses "open".
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*Abbreviated ''PMBL''.
*Abbreviated ''PMBL''.
*[[AKA]] ''primary mediastinal large B-cell lymphoma''.
*[[AKA]] ''primary mediastinal large B-cell lymphoma''.
 
{{Main|Primary mediastinal B-cell lymphoma}}
===General===
Features:<ref name=pmid19074109 >{{Cite journal  | last1 = Johnson | first1 = PW. | last2 = Davies | first2 = AJ. | title = Primary mediastinal B-cell lymphoma. | journal = Hematology Am Soc Hematol Educ Program | volume =  | issue =  | pages = 349-58 | month =  | year = 2008 | doi = 10.1182/asheducation-2008.1.349 | PMID = 19074109 }}</ref><ref name=pmid20207294>{{Cite journal  | last1 = Coso | first1 = D. | last2 = Rey | first2 = J. | last3 = Bouabdallah | first3 = R. | title = [Primary mediastinal B-cell lymphoma] | journal = Rev Pneumol Clin | volume = 66 | issue = 1 | pages = 32-5 | month = Feb | year = 2010 | doi = 10.1016/j.pneumo.2009.12.007 | PMID = 20207294 }}</ref>
*Rare.
*Young adults.
*[[Mediastinum]].
 
===Microscopic===
Features:
*Atypical large lymphoid cells - see ''[[DLBCL]]''.
*Classically associated with:
**Fibrosis
**Clear cells.
 
Note:
*Neither fibrosis or clear cells are required for the [[diagnosis]] nor are they pathognomonic.<ref name=pmid11251018 >{{Cite journal  | last1 = van Besien | first1 = K. | last2 = Kelta | first2 = M. | last3 = Bahaguna | first3 = P. | title = Primary mediastinal B-cell lymphoma: a review of pathology and management. | journal = J Clin Oncol | volume = 19 | issue = 6 | pages = 1855-64 | month = Mar | year = 2001 | doi =  | PMID = 11251018 }}</ref>
 
DDx:
*Other types of [[DLBCL]].
*Poorly differentiated carcinoma.
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Primary_mediastinal_large_B-cell_lymphoma_-_very_high_mag.jpg PMBL - very high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Primary_mediastinal_large_B-cell_lymphoma_-_intermed_mag.jpg PMBL - intermed. mag. (WC)].
*www:
**[http://path.upmc.edu/cases/case371.html PMBL - several images (upmc.edu)].
 
===Sign out===
<pre>
MASS, ANTERIOR MEDIASTINAL, CORE BIOPSY:
- LARGE B-CELL LYMPHOMA IN A FIBROTIC BACKGROUND WITH NECROSIS, SEE COMMENT
 
COMMENT:
Morphology:
Tumour cells: size ~2x a mature lymphocyte, a moderate quantity of grey/basophilic
  cytoplasm, no clear cells are identified.
Cells intermixed with tumour: mature lymphocytes, rare eosinophils.
Architecture: no gland formation, discohesive, no follicles apparent, extensive fibrosis.
 
Tumour cells:
POSITIVE: CD45, CD20, CD10, BCL-6, BCL-2.
NEGATIVE: pankeratin, PLAP, CD3, CD30.
Ki-67: 50% of large (lymphoid) cells.
</pre>


==Anaplastic large cell lymphoma==
==Anaplastic large cell lymphoma==
*Abbreviated ''ALCL''.
*Abbreviated ''ALCL''.
 
{{Main|Anaplastic large cell lymphoma}}
===General===
*May look a lot like a carcinoma.
**Often subcapsular in LNs.
*Usually T-cell derived.
*May be isolated to the [[skin]] - good prognosis.
 
Subtypes:
* Systemic ALCL.
* Cutaneous ALCL -- ALK -ve.
 
ALK IHC - systemic form:
* +ve = good prognosis.
* -ve = bad prognosis.
 
===Microscopic===
Features:
*Large cells with eosinophilic cytoplasm.
*Usually appear cohesive.
*May be subcapsular in a [[lymph node]] and mimic a carcinoma.
*''Hallmark cells'' = "horseshoe-shaped or donut-shaped nucleus + eosinophilic paranuclear region"<ref name=pmid17941004>{{Cite journal  | last1 = Rapkiewicz | first1 = A. | last2 = Wen | first2 = H. | last3 = Sen | first3 = F. | last4 = Das | first4 = K. | title = Cytomorphologic examination of anaplastic large cell lymphoma by fine-needle aspiration cytology. | journal = Cancer | volume = 111 | issue = 6 | pages = 499-507 | month = Dec | year = 2007 | doi = 10.1002/cncr.23120 | PMID = 17941004 | url=http://onlinelibrary.wiley.com/doi/10.1002/cncr.23120/full}}</ref><ref name=pmid12419758>{{Cite journal  | last1 = Ponzoni | first1 = M. | last2 = Terreni | first2 = MR. | last3 = Ciceri | first3 = F. | last4 = Ferreri | first4 = AJ. | last5 = Gerevini | first5 = S. | last6 = Anzalone | first6 = N. | last7 = Valle | first7 = M. | last8 = Pizzolito | first8 = S. | last9 = Arrigoni | first9 = G. | title = Primary brain CD30+ ALK1+ anaplastic large cell lymphoma ('ALKoma'): the first case with a combination of 'not common' variants. | journal = Ann Oncol | volume = 13 | issue = 11 | pages = 1827-32 | month = Nov | year = 2002 | doi =  | PMID = 12419758 }}</ref> - '''key feature'''.
**The donut-shaped version is also known as a "wreath cell"<ref>{{Cite journal  | last1 = Amin | first1 = HM. | last2 = Lai | first2 = R. | title = Pathobiology of ALK+ anaplastic large-cell lymphoma. | journal = Blood | volume = 110 | issue = 7 | pages = 2259-67 | month = Oct | year = 2007 | doi = 10.1182/blood-2007-04-060715 | PMID = 17519389 | url=http://bloodjournal.hematologylibrary.org/content/110/7/2259.full.html}}</ref> - large (multi-nucleated) cells with (morphologically) one toroidal-shaped nucleus.
 
DDx:
*[[Hodgkin's lymphoma]].
*Carcinoma.
 
Images:
*[[WC]]:
**[http://commons.wikimedia.org/wiki/File:Anaplastic_large_cell_lymphoma_-_very_high_mag.jpg ALCL - very high mag. (WC)].
**[http://commons.wikimedia.org/wiki/File:Anaplastic_large_cell_lymphoma_-_cropped_-_very_high_mag.jpg ALCL - cropped - very high mag. (WC)].
*www:
**[http://path.upmc.edu/cases/case363.html ALCL - several images (upmc.edu)].
**[http://path.upmc.edu/cases/case557.html Small cell variant of ALCL - several images (upmc.edu)].
 
===IHC===
Features:
*CD30 +ve.
*ALK-1 -ve/+ve; strongly supports ALCL Dx if +ve.
*CD45 +ve.
*CD4 +ve.
*CD3 -ve/+ve.
*CD7 -ve/+ve.
*EMA +ve.
 
===Molecular===
*t(2,5)(p23;q35)<ref name=pmid8547653>{{cite journal |author=Lamant L, Meggetto F, al Saati T, ''et al.'' |title=High incidence of the t(2;5)(p23;q35) translocation in anaplastic large cell lymphoma and its lack of detection in Hodgkin's disease. Comparison of cytogenetic analysis, reverse transcriptase-polymerase chain reaction, and P-80 immunostaining |journal=Blood |volume=87 |issue=1 |pages=284–91 |year=1996 |month=January |pmid=8547653 |doi= |url=}}</ref> - can be detected with [[FISH]] break apart probe.


==Cutaneous T cell lymphoma==
==Cutaneous T cell lymphoma==
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===IHC===
===IHC===
*CF57 +ve.
*CD57 +ve -- '''important'''.
*CD3 +ve.
*CD5 +ve.
*CD45 +ve.


==Lymphoplasmacytic lymphoma==
==Lymphoplasmacytic lymphoma==
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**''Hyperviscosity syndrome''.
**''Hyperviscosity syndrome''.
**Bony destruction (seen in [[multiple myeloma]]) is absent.<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref>
**Bony destruction (seen in [[multiple myeloma]]) is absent.<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref>
**Over 90% of patients have the MYD88 L265P somatic mutation.<ref name=pmid=22931316>{{cite journal |vauthors=Treon SP, Xu L, Yang G, Zhou Y, Liu X, Cao Y, Sheehy P, Manning RJ, Patterson CJ, Tripsas C, Arcaini L, Pinkus GS, Rodig SJ, Sohani AR, Harris NL, Laramie JM, Skifter DA, Lincoln SE, Hunter ZR |title=MYD88 L265P somatic mutation in Waldenström's macroglobulinemia |journal=N Engl J Med |volume=367 |issue=9 |pages=826–33 |date=August 2012 |pmid=22931316 |doi=10.1056/NEJMoa1200710 |url=}}</ref>


====Clinical====
====Clinical====
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*[[AKA]] ''extranodal natural kill lymphoma''
*[[AKA]] ''extranodal natural kill lymphoma''
*[[AKA]] ''angiocentric lymphoma''.
*[[AKA]] ''angiocentric lymphoma''.
 
{{Main|Extranodal NK/T-cell lymphoma, nasal type}}
===General===
*Common in east Asia.<ref name=pmid18283711>{{Cite journal  | last1 = Suzuki | first1 = R. | last2 = Takeuchi | first2 = K. | last3 = Ohshima | first3 = K. | last4 = Nakamura | first4 = S. | title = Extranodal NK/T-cell lymphoma: diagnosis and treatment cues. | journal = Hematol Oncol | volume = 26 | issue = 2 | pages = 66-72 | month = Jun | year = 2008 | doi = 10.1002/hon.847 | PMID = 18283711 }}</ref>
*Strong association with [[EBV]].
 
===Microscopic===
Features:
*Atypical lymphoid cells:
**[[Nucleoli]].
**[[Nuclear pleomorphism]].
**Cells centered around vessels (angiocentric).
***May destroy small and medium sized arterioles.
 
Images:
*[http://path.upmc.edu/cases/case231/micro.html Extranodal NK/T-cell lymphoma, nasal type - case 1 - several images (upmc.edu)].
*[http://path.upmc.edu/cases/case310.html Extranodal NK/T-cell lymphoma, nasal type - case 2 - several images (upmc.edu)].
 
===IHC===
Features:<ref name=pmid17064952>{{Cite journal  | last1 = Al-Hakeem | first1 = DA. | last2 = Fedele | first2 = S. | last3 = Carlos | first3 = R. | last4 = Porter | first4 = S. | title = Extranodal NK/T-cell lymphoma, nasal type. | journal = Oral Oncol | volume = 43 | issue = 1 | pages = 4-14 | month = Jan | year = 2007 | doi = 10.1016/j.oraloncology.2006.03.011 | PMID = 17064952 }}</ref>
*CD2 +ve.
*CD3 +ve (cytoplasmic).
*CD56 +ve.
 
Others:<ref>URL: [http://path.upmc.edu/cases/case310.html http://path.upmc.edu/cases/case310.html]. Accessed on: 14 January 2012.</ref>
*TIA-1 +ve.
*CD7 +ve.
*EBER +ve.


==Table of lymphoma==
==Table of lymphoma==
Maxwell
4

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