Difference between revisions of "Lymphoma"
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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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A general introduction to haematopathology is in the ''[[haematopathology]]'' article. | A general introduction to haematopathology is in the ''[[haematopathology]]'' article. | ||
==General== | |||
The presentations are variable and similar to that of other malignancies. They may include: | |||
*Mass effect. | |||
*Weight loss. | |||
*Fever. | |||
*Night sweats. | |||
*Infection. | |||
*Incidental: | |||
**Routine blood work for something unrelated. | |||
**Life insurance work-up. | |||
===B symptoms=== | |||
*May be seen in [[Hodgkin lymphoma]] and non-Hodgkin lymphoma. | |||
*Presence correlates with higher stage. | |||
*Predictor of poor prognosis independent of stage. | |||
All of 'em are required to call "B symptoms"<ref name=pmid5121694>{{Cite journal | last1 = Carbone | first1 = PP. | last2 = Kaplan | first2 = HS. | last3 = Musshoff | first3 = K. | last4 = Smithers | first4 = DW. | last5 = Tubiana | first5 = M. | title = Report of the Committee on Hodgkin's Disease Staging Classification. | journal = Cancer Res | volume = 31 | issue = 11 | pages = 1860-1 | month = Nov | year = 1971 | doi = | PMID = 5121694 | URL = http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=5121694 }}</ref> - mnemonic ''These '''B'''othersome features cause '''W'''ednesday '''N'''ight '''F'''ever'':<ref>URL: [http://www.internalizemedicine.com/2011/12/bury-buzzword-b-symptoms.html http://www.internalizemedicine.com/2011/12/bury-buzzword-b-symptoms.html]. Accessed on: 28 March 2012.</ref> | |||
*Weight loss - >10% in 6 months. | |||
*Night sweats. | |||
*Fever - 38 degree C that is unexplained. | |||
Note: | |||
*''A symptoms'' do '''not''' exist. The term comes from the staging system. In the "A" of the staging system the above symptoms are '''a'''bsent. | |||
==Lymphoma classification== | ==Lymphoma classification== | ||
Lymphomas can be divided into: | Lymphomas can be divided into: | ||
*Hodgkin's lymphoma. | *[[Hodgkin's lymphoma]]. | ||
*Non-Hodgkin's lymphoma (NHL). | *Non-Hodgkin's lymphoma (NHL). | ||
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Two most common NHLs: | Two most common NHLs: | ||
*Follicular lymphoma (FL). | *[[Follicular lymphoma]] (FL). | ||
*Diffuse large B-cell lymphoma (DLBCL). | *[[Diffuse large B-cell lymphoma]] (DLBCL). | ||
===Leukemia as a med student=== | ===Leukemia as a med student=== | ||
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*[[Acute myeloid leukemia]] (AML). | *[[Acute myeloid leukemia]] (AML). | ||
*[[Chronic myeloid leukemia]] (CML). | *[[Chronic myeloid leukemia]] (CML). | ||
*Chronic | *[[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 = | *[[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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====Follicular dendritic cells==== | ====Follicular dendritic cells==== | ||
*CD23 -- follicular dendritic cells. | *CD23 -- follicular dendritic cells. | ||
*CD21 -- follicular dendritic cells. | *CD21 -- follicular dendritic cells, considered more sensitive than CD23.<ref name=pmid16280657>{{Cite journal | last1 = Troxell | first1 = ML. | last2 = Schwartz | first2 = EJ. | last3 = van de Rijn | first3 = M. | last4 = Ross | first4 = DT. | last5 = Warnke | first5 = RA. | last6 = Higgins | first6 = JP. | last7 = Natkunam | first7 = Y. | title = Follicular dendritic cell immunohistochemical markers in angioimmunoblastic T-cell lymphoma. | journal = Appl Immunohistochem Mol Morphol | volume = 13 | issue = 4 | pages = 297-303 | month = Dec | year = 2005 | doi = | PMID = 16280657 }}</ref> | ||
====Hodgkin's lymphoma==== | ====Hodgkin's lymphoma==== | ||
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*TdT. | *TdT. | ||
*CD34. | *CD34. | ||
===Molecular pathology=== | |||
{{Main|Molecular pathology}} | |||
{{Main|Molecular pathology tests}} | |||
*T cell clonality study. | |||
*B cell clonality study. | |||
====Chromosomal translocations==== | |||
{{Main|Chromosomal_translocations#Lymphoma}} | |||
==Hodgkin's lymphoma== | ==Hodgkin's lymphoma== | ||
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==Intravascular lymphoma== | ==Intravascular lymphoma== | ||
*[[AKA]] ''angiotropic lymphoma'', ''intravascular malignant lymphomatosis'', ''malignant angioendotheliomatosis'' | |||
*Rare. | *Rare. | ||
*Usually B-cell lineage (see | *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> | ||
==Burkitt's lymphoma== | ==Burkitt's lymphoma== | ||
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**Images: [http://en.wikipedia.org/wiki/File:Auer_rods.PNG Auer rods (WP)], [http://www.healthsystem.virginia.edu/internet/hematology/HessImages/Acute-myelogenous-leukemia-M4-100x-Auer-rods-website-arrow.jpg Auer rods (virginia.edu)]. | **Images: [http://en.wikipedia.org/wiki/File:Auer_rods.PNG Auer rods (WP)], [http://www.healthsystem.virginia.edu/internet/hematology/HessImages/Acute-myelogenous-leukemia-M4-100x-Auer-rods-website-arrow.jpg Auer rods (virginia.edu)]. | ||
==Enteropathy-associated T cell lymphoma | ==Enteropathy-associated T-cell lymphoma== | ||
*Abbreviated ''EATL''. | *Abbreviated ''EATL''. | ||
*[[AKA]] ''enteropathy-type T cell lymphoma'' (ETTL). | *[[AKA]] ''enteropathy-type T-cell lymphoma'' (ETTL). | ||
{{Main|Enteropathy-associated T-cell lymphoma}} | |||
==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}} | |||
==Anaplastic large cell lymphoma== | ==Anaplastic large cell lymphoma== | ||
*Abbreviated ''ALCL''. | *Abbreviated ''ALCL''. | ||
{{Main|Anaplastic large cell lymphoma}} | |||
==Cutaneous T cell lymphoma== | ==Cutaneous T cell lymphoma== | ||
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===IHC=== | ===IHC=== | ||
* | *CD57 +ve -- '''important'''. | ||
*CD3 +ve. | |||
*CD5 +ve. | |||
*CD45 +ve. | |||
==Lymphoplasmacytic lymphoma== | ==Lymphoplasmacytic lymphoma== | ||
:''Waldenström macroglobulinemia'' redirects here. | |||
===General=== | ===General=== | ||
Features:<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | Features:<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | ||
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*Secretes monoclonal IgM. | *Secretes monoclonal IgM. | ||
Clinical:<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | Note: | ||
*Symptoms of blood hyperviscosity | *''Waldenström macroglobulinemia'' is a type of lymphoplasmacytic lymphoma<ref name=pmid22507796>{{Cite journal | last1 = Gertz | first1 = MA. | title = Waldenström macroglobulinemia. | journal = Hematology | volume = 17 Suppl 1 | issue = | pages = 112-6 | month = Apr | year = 2012 | doi = 10.1179/102453312X13336169156212 | PMID = 22507796 }}</ref> - it is characterized by: | ||
**''Hyperviscosity syndrome''. | |||
**Bony destruction (seen in [[multiple myeloma]]) is absent.<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | |||
====Clinical==== | |||
Features:<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | |||
*Symptoms of blood hyperviscosity - these include: | |||
**Visual impairment. | |||
**Neurologic impairment. | |||
**Bleeding. | |||
**[[Cryoglobulinemia]] - may have ''Raynaud phenomenon''. | |||
*Hemolysis. | *Hemolysis. | ||
*Bence-Jones proteinuria - seen in over half of patients.<ref name=pmid11797112>{{Cite journal | last1 = Kyrtsonis | first1 = MC. | last2 = Vassilakopoulos | first2 = TP. | last3 = Angelopoulou | first3 = MK. | last4 = Siakantaris | first4 = P. | last5 = Kontopidou | first5 = FN. | last6 = Dimopoulou | first6 = MN. | last7 = Boussiotis | first7 = V. | last8 = Gribabis | first8 = A. | last9 = Konstantopoulos | first9 = K. | title = Waldenström's macroglobulinemia: clinical course and prognostic factors in 60 patients. Experience from a single hematology unit. | journal = Ann Hematol | volume = 80 | issue = 12 | pages = 722-7 | month = Dec | year = 2001 | doi = 10.1007/s00277-001-0385-8 | PMID = 11797112 }}</ref> | |||
Treatment: | |||
*Watchful waiting or chemotherapy. | |||
*Hyperviscosity syndrome: plasmapheresis. | |||
===Microscopic=== | ===Microscopic=== | ||
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*Plasmacytoid lymphocytes. | *Plasmacytoid lymphocytes. | ||
*Mixed inflammatory infiltrate with [[mast cell]]s, [[plasma cell]]s, lymphocytes. | *Mixed inflammatory infiltrate with [[mast cell]]s, [[plasma cell]]s, lymphocytes. | ||
DDx: | |||
*[[Plasma cell neoplasm]]. | |||
===IHC=== | ===IHC=== | ||
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*Cloverleaf nuclei. | *Cloverleaf nuclei. | ||
**Nuclei with multiple lobulations. | **Nuclei with multiple lobulations. | ||
Image: | |||
*[http://www.pathpedia.com/education/eatlas/histopathology/blood_cells/adult_t-cell_leukemia_htlv1-positive_acute_form/adult-t-cell-leukemia-htlv1-%5B2-bl095-2%5D.jpeg?Width=600&Height=450&Format=4 Cloverleaf nucleus (pathpedia.com)].<ref>URL: [http://www.pathpedia.com/education/eatlas/histopathology/blood_cells/adult_t-cell_leukemia_htlv1-positive_acute_form.aspx http://www.pathpedia.com/education/eatlas/histopathology/blood_cells/adult_t-cell_leukemia_htlv1-positive_acute_form.aspx]. Accessed on: 7 February 2012.</ref> | |||
===IHC=== | ===IHC=== | ||
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*CD3 +ve. | *CD3 +ve. | ||
*CD5 +ve. | *CD5 +ve. | ||
*CD25 +ve. | *CD25 +ve. | ||
*CD45 +ve. | *CD45 +ve. | ||
*HTLV-1 +ve. | |||
Others:<ref name=pmid19165640/> | Others:<ref name=pmid19165640/> | ||
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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}} | |||
==Table of lymphoma== | ==Table of lymphoma== | ||
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| lymph node usually, germinal center | | lymph node usually, germinal center | ||
| sheets of large discohesive cells; if only nodular = follicular lymphoma | | sheets of large discohesive cells; if only nodular = follicular lymphoma | ||
| | | MIB1 >40% | ||
| none / like follicular lymphoma t(14,18) / c-MYC (like Burkitt lymphoma) | | none / like follicular lymphoma t(14,18) / c-MYC (like Burkitt lymphoma) | ||
| poor prognosis | | poor prognosis |
Latest revision as of 19:37, 31 July 2016
Lymphoma is almost a specialty for itself. It can be subclassified a number of ways.
![](/w/images/thumb/9/9d/Lymphoma_macro.jpg/200px-Lymphoma_macro.jpg)
This article is an introduction to lymphoma. An introduction to lymph nodes and lymph node pathology that is not lymphoma are in the articles lymph node and lymph node pathology.
A general introduction to haematopathology is in the haematopathology article.
General
The presentations are variable and similar to that of other malignancies. They may include:
- Mass effect.
- Weight loss.
- Fever.
- Night sweats.
- Infection.
- Incidental:
- Routine blood work for something unrelated.
- Life insurance work-up.
B symptoms
- May be seen in Hodgkin lymphoma and non-Hodgkin lymphoma.
- Presence correlates with higher stage.
- Predictor of poor prognosis independent of stage.
All of 'em are required to call "B symptoms"[1] - mnemonic These Bothersome features cause Wednesday Night Fever:[2]
- Weight loss - >10% in 6 months.
- Night sweats.
- Fever - 38 degree C that is unexplained.
Note:
- A symptoms do not exist. The term comes from the staging system. In the "A" of the staging system the above symptoms are absent.
Lymphoma classification
Lymphomas can be divided into:
- Hodgkin's lymphoma.
- Non-Hodgkin's lymphoma (NHL).
Other categorizations:
- T cell lymphomas (rare).
- B cell lymphomas (more common).
Two most common NHLs:
- Follicular lymphoma (FL).
- Diffuse large B-cell lymphoma (DLBCL).
Leukemia as a med student
- Acute lymphoid leukemia (ALL) - predominantly in smALL people, i.e. children.
- Acute myeloid leukemia (AML).
- Chronic myeloid leukemia (CML).
- Chronic lymphocytic leukemia (CLL) - relatively good prognosis.
Histologic classification
- "Size".
- Nodularity.
"Size"
- The single most important factor for classifying lymphomas.
- Not really based on size.
"Large" | "Small" | Utility | |
Nucleoli | present | absent | most discriminative |
Size | >2x RBC dia. | <2x RBC dia. | moderate |
Chromatin pattern | "open" (pale) | "closed" | moderate/minimal |
Cytoplasm | mold-minimal basophilic cytoplasm |
scant cytoplasm | minimal |
Histologic terms
- Lymphomas = cells look discohesive, may be difficult to differentiate from poor differentiated carcinoma.
- Auer rods = acute myeloid leukemia.
- Granular cytoplasmic rod (0.5-1 x4-6 micrometres).
- Not pathognomonic.
- Reed-Sternberg cells = Hodgkin's lymphoma.
- Large cell - very large nucleus.
- Classically binucleated.
- Large cell - very large nucleus.
- Russell bodies = plasmacytoma (+others).
- Effacement of nodal architecture.
- Loss of proliferation centers.
IHC
General
- CD45.
- AKA common lymphocyte antigen.
- Useful to differentiate from carcinomas (e.g. small cell carcinoma).
Others:
- AE1/AE3 -ve -- to r/o carcinoma.
T cell markers
- CD2 -- T cell marker (all T cells).
- CD3 -- T cell marker (all T cells).
- CD4 -- subset of T cells.
- CD8 -- subset of T cells.
- CD7 -- often lost first in T cell lymphomas.
- CD5 -- +ve in CLL & mantle cell lymphoma.
- CD43 -- +ve in mantle cell lymphoma
- ALK1[4] - prognostic in anaplastic large cell lymphoma (ALCL).[5]
- TIA1 - cytotoxic T-cell.[6]
- Granzyme B.
B cell markers
- CD20 -- B cell marker.
- CD19 -- B cell marker - used for flow cytometry.
- PAX5 -- nuclear staining.[7]
- Image: PAX5 in Hodgkin's lymphoma.
- CD79a.
- CD10 -- follicle center.
- BCL6 -- follicle center.
- BCL2 -- normally negative in germinal centers (GCs), marks T cell; +ve in small B cell lymphomas.
- MUM1 -- -ve in follicular lymphoma, +ve in DLBCL that did not arise from follicular lymphoma.
Plasma cell
- Kappa -- usu. slightly stronger than lambda.
- Lambda.
- CD56[8] -- also +ve in NK/T cell lymphomas.
- CD57 -- +ve in T-cell large granular lymphocytic leukemia.[9].
- CD138.
Follicular dendritic cells
- CD23 -- follicular dendritic cells.
- CD21 -- follicular dendritic cells, considered more sensitive than CD23.[10]
Hodgkin's lymphoma
Classic
- CD30 +ve -- Hodgkin's lymphoma (most sensitive).
- CD15 +ve.
- PAX5 +ve.
- EMA -ve.
- EBER +ve/-ve.
Others:
- CD20, CD45: weak +ve or -ve.
NLPHL
- CD20 +ve.
- CD30 -ve, CD15 -ve.
- EMA +ve/-ve.
- EBER -ve.
Others
- Myeloperoxidase - in PMNs.
- Glycophorin C.
- CD61 -- megakaryocytes.
- TdT.
- CD34.
Molecular pathology
- T cell clonality study.
- B cell clonality study.
Chromosomal translocations
Hodgkin's lymphoma
General
- Abbreviated HL.
Microscopic
By definition, HL has Reed-Sternberg cells (RSCs).
Classical HL
Features (classic HL):
- Reed-Sternberg cell.
- Large binucleated cell.
- May be multinucleated.
- May have a horseshoe-like shape.
- Macronucleolus - approximately the size of a RBC (~8 micrometers).
- Well-defined cell border.
- Large binucleated cell.
Notes:
- Large mononuclear cells are common (so called "mononuclear RSCs") but not diagnostic.
Images (classic HL):
- HL mixed cellularity - cytology (WC).
- HL mixed cellularity - cytology (WC).
- HL mixed cellularity (WC).
Subtypes
There are four CHL subtypes:[11]
- Nodular sclerosis CHL - ~70% of CHL.
- Mixed cellular background - T cell, plasma cells, eosinophils, neutrophils and histiocytes.
- Nodular sclerosing fibrosis - thick strands fibrosis.
- Mixed cellularity CHL - ~20-25% of CHL.
- Like nodular sclerosis - but no fibrosis.
- May be associated with HIV infection.[12]
- Lymphocyte-rich CHL - rare.
- T lymphocytes only (no mix of cells).
- Lymphocyte-depleted CHL - rare.
Memory device:
- The subtypes prevalence is in reverse alphabetical order.
Nodular lymphocyte-predominant HL
Features (nodular lymphocyte-predominant Hodgkin's lymphoma):
- Popcorn cell (previously known as Lymphocytic & histiocytic cell (L&H cell)[13]) - variant of RSC:
- Cells (relatively) small (compared to classic RSCs).
- Lobulated nucleus - key feature.
- Small nucleoli.
- Subtle nodularity at low power (2.5x or 5x objective).
Images (NLPHL):
Small cell lymphomas
This grouping includes:
- Follicular lymphoma.
- Marginal zone lymphoma.
- Nodal marginal zone lymphoma.
- Extranodal marginal zone lymphoma (MALT lymphoma).
- Splenic marginal zone lymphoma.
- Mantle zone lymphoma.
- Small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL).
- Hairy cell leukemia.
Diffuse large B-cell lymphoma
General
- Abbreviated DLBCL.
Microscopic
Features:[14]
- Large cells -- 4-5 times the diameter of a small lymphocytes.
- Typically have marked cell-to-cell variation in size and shape.
- Cytoplasm usu. basophilic and moderate in abundance.
- +/-Prominent nucleoli, may be peripheral and/or multiple.
Notes:
- Large bizarre cells can occasionally mimic Reed-Sternberg cells, seen in Hodgkin lymphoma.
Intravascular lymphoma
- AKA angiotropic lymphoma, intravascular malignant lymphomatosis, malignant angioendotheliomatosis
- Rare.
- Usually B-cell lineage (see intravascular large B-cell lymphoma).
- May be T-cell lineage.[15]
Burkitt's lymphoma
General
- Abbreviated BL.
- Subtyped by etiology.
Microscopic
Features:
- "Starry-sky pattern":
- The stars in the pattern are: tingible-body macrophages.
- Tingible-body macrophages = macrophages containing apoptotic tumour cells.
- The tumour cells are the sky.
- The stars in the pattern are: tingible-body macrophages.
- Tumour cells:[16]
- Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- key feature.
- Round nucleus.
- Small nucleoli.
- Relatively abundant cytoplasm.
- Brisk mitotic rate.
Plasma cell neoplasms
- These arise from plasma cells.
- AKA plasma cell myeloma, plasmacytoma.
- Multiple myeloma (a clinical diagnosis) fits into this category.
Acute myeloid leukemia
General
- May afflicits young adult.
- Males>females.
Complications
- Chloroma - soft tissue mass.
- Leukostasis.
- Occurs - lungs and brain.[17]
- Hyperviscosity syndrome.
- Spontaneous bleeding with low platelet counts.
Classification
There are two classifications:
- FAB (French-American-British) - based on histologic appearance/maturation.
- WHO classification.
Histology
- Auer rods - not required to diagnose.[18]
- Cytoplasmic granular rods in blast cells.
- Dimensions: approx. 0.5-1 x 4-6 micrometres.
- Images: Auer rods (WP), Auer rods (virginia.edu).
- Cytoplasmic granular rods in blast cells.
Enteropathy-associated T-cell lymphoma
- Abbreviated EATL.
- AKA enteropathy-type T-cell lymphoma (ETTL).
Angioimmunoblastic T-cell lymphoma
- Abbreviated AITL.
General
- Rare.
- Common among T-cell lymphomas.
- Middle age or elderly.
Microscopic
Features:
- Intermediate size cells with:
- +/-Vesicular nuclei.
- Clear, moderate cytoplasm.
- "Empty" sinus; subcapsular sinuses "open".
Images:
IHC
Features - positives:[19]
- CD3 +ve.
- CD5 +ve.
- CD43 +ve.
Others:
- CD4 +ve and CD8 +ve with CD4>CD8.
- CD20 +ve/-ve!
- CD10 +ve/-ve!
- CD21 +ve -- prominent FDC meshworks;[20] tumour cell not +ve.
Negatives:
Primary mediastinal B-cell lymphoma
- Abbreviated PMBL.
- AKA primary mediastinal large B-cell lymphoma.
Anaplastic large cell lymphoma
- Abbreviated ALCL.
Cutaneous T cell lymphoma
General
- Abbreviated as CTCL.
- Sézary syndrome is a subset of CTCL.
Microscopic
Features:[21]
Images:
T-cell large granular lymphocytic leukemia
General
- May be seen in the context of Felty syndrome.
Microscopic
Features:
- Large cell lymphoma.
Images:
IHC
- CD57 +ve -- important.
- CD3 +ve.
- CD5 +ve.
- CD45 +ve.
Lymphoplasmacytic lymphoma
- Waldenström macroglobulinemia redirects here.
General
Features:[24]
- B cell neoplasm.
- Secretes monoclonal IgM.
Note:
- Waldenström macroglobulinemia is a type of lymphoplasmacytic lymphoma[25] - it is characterized by:
- Hyperviscosity syndrome.
- Bony destruction (seen in multiple myeloma) is absent.[24]
Clinical
Features:[24]
- Symptoms of blood hyperviscosity - these include:
- Visual impairment.
- Neurologic impairment.
- Bleeding.
- Cryoglobulinemia - may have Raynaud phenomenon.
- Hemolysis.
- Bence-Jones proteinuria - seen in over half of patients.[26]
Treatment:
- Watchful waiting or chemotherapy.
- Hyperviscosity syndrome: plasmapheresis.
Microscopic
Features:[24]
- Plasmacytoid lymphocytes.
- Mixed inflammatory infiltrate with mast cells, plasma cells, lymphocytes.
DDx:
IHC
Features:[27]
- PAX5 +ve.
- CD20 +ve.
- CD38 +ve.
- CD138 +ve.
Others:[27]
- CD5 -ve.
- CD10 -ve.
- CD23 -ve.
- CyclinD1 -ve.
- CD3 -ve.
- CD7 -ve.
Adult T-cell leukemia/lymphoma
General
- Etiology: Human T-cell Lymphoma Virus 1 (HTLV-1).[28]
- Poor prognosis ~ 1 year survival with treatment.
Microscopic
Features:[29]
- Cloverleaf nuclei.
- Nuclei with multiple lobulations.
Image:
IHC
Features:[31]
- CD3 +ve.
- CD5 +ve.
- CD25 +ve.
- CD45 +ve.
- HTLV-1 +ve.
Others:[31]
- CD7 -ve.
- CD20 -ve.
- CD79a -ve.
Hepatosplenic T-cell lymphoma
Extranodal NK/T-cell lymphoma, nasal type
Table of lymphoma
B cell lymphomas
Name | Size of cells | Site | Histomorphology | IHC | Translocations | Clinical | Prevalence | DDx |
---|---|---|---|---|---|---|---|---|
Follicular lymphoma | small (centrocytes) | lymph node, germinal center | abundant atypical follicles (lack GC polarity, lack polar mantle zone), effaced sinuses, scattered large cells (centroblasts) | CD10+, bcl-6+[32] | t(14,18) | usually indolent, may transform to DLBCL | very common | DLBCL, other small cell lymphomas |
Mantle cell lymphoma | small, monomorphic | lymph node, mantle zone | monomorphic lymphoid, abundant mitoses. +/-scattered epithelioid histiocytes, sclerosed blood vessels | CD5+, CD23-, CD43+, cyclin D1+[32] | t(11;14)(q13;q32)[33] | indolent ??? | uncommon | other small cell lymphomas, PTGC, Castleman disease, Burkitt's lymphoma |
Extranodal marginal zone lymphoma (MALT lymphoma) | small | mucosa-associated lymphoid tissue, GI tract + elsewhere | +/- lymphepithelial lesion (cluster of 3+ cells in epithelium) | CD21+, CD11c+, CD5-, CD23-[32] | ??? | indolent ??? | common | other small cell lymphomas, neuroendocrine tumours |
Precursor B-cell lymphoblastic lymphoma/ leukemia | small | lymph node ???, bone marrow | nuclei slightly large than resting lymphocytes, scant basophilic cytoplasm, irregular nuclear membrane, no nucleoli, stippled chromatin[34] | CD10+, CD5-, TdT+, CD99+[32] | +/-t(12;21)[35] | aggressive ??? | uncommon | small cell lymphomas |
Hairy cell leukemia | small | bone marrow, peripheral blood | perinuclear clearing, clear cytoplasm, central nucleus | CD25+, CD103+, CD5-[36] | translocations ? | splenomegaly, no lymphadenopathy, pancytopenia, good prognosis with Tx | uncommon | small cell leukemias/lymphomas (e.g. SMZL) |
Burkitt's lymphoma | medium, monomorphic | lymph node, germinal center (???) | tingible-body macrophages ("starry sky" appearance), round nucleus, small nucleoli, mitoses +++ | CD10+, BCL6+, BCL2- | t(8;14) (q24;q32) | rapid growth, may be associated with EBV, HIV/AIDS | uncommon | DLBCL, mantle cell lymphoma |
Diffuse large B cell lymphoma | large cells (>2x RBC, often larger), variable size | lymph node usually, germinal center | sheets of large discohesive cells; if only nodular = follicular lymphoma | MIB1 >40% | none / like follicular lymphoma t(14,18) / c-MYC (like Burkitt lymphoma) | poor prognosis | very common | Burkitt lymphoma, ALCL, Hodgkin lymphoma |
Primary mediastinal B-cell lymphoma | large (>2x RBC, often larger), variable size | mediastinum | histomorphology ? | IHC ? | translocations ? | predominantly young adults, better prognosis than DLBCL | uncommon | DLBCL |
B cell small lymphocytic lymphoma / chronic lymphocytic leukemia |
small | lymph node (???) | proliferation centres | CD5+, CD23+, CD43+, cyclin D1- | trisomy 12; deletions of 11q, 13q, 17p[37] | good prognosis / indolent course | common | other small cell lymphomas |
T cell lymphomas
Name | Size of cells | Site | Histomorphology | IHC | Translocations | Clinical | Prevalence | DDx |
---|---|---|---|---|---|---|---|---|
Angioimmunoblastic lymphoma | size of cells ? | site ? | histomorphology ? | IHC ? | translocations ? | clinical ? | prevalence ? | DDx ? |
Enteropathy-type T cell lymphoma | size of cells ? | site ? | histomorphology ? | IHC ? | translocations ? | clinical ? | prevalence ? | DDx ? |
Precursor lymphoblastic lymphoma / leukemia | size of cells ? | site ? | histomorphology ? | IHC ? | translocations ? | clinical ? | prevalence ? | DDx ? |
Adult T-cell lymphoma / leukemia | size of cells ? | site ? | cloverleaf nuclei (multilobular nuclei) | IHC ? | translocations ? | poor prognosis ~ 1 year survival w/ Tx; d/t HTLV-1 | prevalence ? | DDx ? |
Peripheral T cell lymphoma (NOS) | size of cells ? | site ? | histomorphology ? | TIA-1+ | translocations ? | clinical ? | prevalence ? | DDx ? |
Anaplastic large cell lymphoma | large | deep & subcapsular sinuses of LN | eosinophilic cytoplasm, nucleoli, often cohesive, wreath cell (C-shaped nucleus) | CD30+/-, Alk+/-, CD4+, CD3- | t(2,5)(p23;q35)[38] | clinical ? | uncommon | carcinoma |
Extranodal NK/T cell lymphoma nasal type | large ??? | nasal ??? | histomorphology ? | EBER+, CD16+, CD56+, CD57-, TIA-1+, Granzyme B+ | translocations ? | common in East Asia | uncommon | DDx ? |
Blastic NK cell lymphoma | size of cells ? | site ? | histomorphology ? | IHC ? | translocations ? | clinical ? | prevalence ? | DDx ? |
See also
- Haematopathology - introduction.
References
- ↑ Carbone, PP.; Kaplan, HS.; Musshoff, K.; Smithers, DW.; Tubiana, M. (Nov 1971). "Report of the Committee on Hodgkin's Disease Staging Classification.". Cancer Res 31 (11): 1860-1. PMID 5121694.
- ↑ URL: http://www.internalizemedicine.com/2011/12/bury-buzzword-b-symptoms.html. Accessed on: 28 March 2012.
- ↑ 3.0 3.1 Alanen A, Pira U, Lassila O, Roth J, Franklin RM (March 1985). "Mott cells are plasma cells defective in immunoglobulin secretion". Eur. J. Immunol. 15 (3): 235–42. PMID 3979421.
- ↑ URL: http://www.ncbi.nlm.nih.gov/omim/601284. Accessed on: 31 August 2010.
- ↑ Pittaluga S, Wlodarska I, Pulford K, et al. (August 1997). "The monoclonal antibody ALK1 identifies a distinct morphological subtype of anaplastic large cell lymphoma associated with 2p23/ALK rearrangements". Am. J. Pathol. 151 (2): 343–51. PMC 1858018. PMID 9250148. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1858018/.
- ↑ URL: http://www.ncbi.nlm.nih.gov/omim/603518. Accessed on: 18 August 2010.
- ↑ URL: http://www.ncbi.nlm.nih.gov/omim/167414. Accessed on: 18 August 2010.
- ↑ URL: http://www.ncbi.nlm.nih.gov/omim/116930. Accessed on: 31 August 2010.
- ↑ URL: http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html. Accessed on: 31 August 2010.
- ↑ Troxell, ML.; Schwartz, EJ.; van de Rijn, M.; Ross, DT.; Warnke, RA.; Higgins, JP.; Natkunam, Y. (Dec 2005). "Follicular dendritic cell immunohistochemical markers in angioimmunoblastic T-cell lymphoma.". Appl Immunohistochem Mol Morphol 13 (4): 297-303. PMID 16280657.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 567. ISBN 978-0781765275.
- ↑ 12.0 12.1 Sissolak G, Sissolak D, Jacobs P (April 2010). "Human immunodeficiency and Hodgkin lymphoma". Transfus. Apher. Sci. 42 (2): 131–9. doi:10.1016/j.transci.2010.01.008. PMID 20138008.
- ↑ Küppers R, Rajewsky K, Braeuninger A, Hansmann ML (March 1998). "L&H cells in lymphocyte-predominant Hodgkin's disease". N. Engl. J. Med. 338 (11): 763–4; author reply 764–5. doi:10.1056/NEJM199803123381113. PMID 9499174.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 676 (???). ISBN 0-7216-0187-1.
- ↑ Wang L, Li C, Gao T (March 2010). "Cutaneous intravascular anaplastic large cell lymphoma". J Cutan Pathol. doi:10.1111/j.1600-0560.2010.01538.x. PMID 20337769.
- ↑ Bellan C, Lazzi S, De Falco G, Nyongo A, Giordano A, Leoncini L (March 2003). "Burkitt's lymphoma: new insights into molecular pathogenesis". J. Clin. Pathol. 56 (3): 188–92. PMC 1769902. PMID 12610094. http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=12610094.
- ↑ AML. Harrison's 16th Ed.
- ↑ AG. 8 July, 2009.
- ↑ 19.0 19.1 19.2 19.3 Bal, M.; Gujral, S.; Gandhi, J.; Shet, T.; Epari, S.; Subramanian, PG.. "Angioimmunoblastic T-Cell lymphoma: a critical analysis of clinical, morphologic and immunophenotypic features.". Indian J Pathol Microbiol 53 (4): 640-5. doi:10.4103/0377-4929.72010. PMID 21045384.
- ↑ URL: http://path.upmc.edu/cases/case650/dx.html. Accessed on: 27 January 2012.
- ↑ URL: http://emedicine.medscape.com/article/209091-overview. Accessed on: 19 August 2010.
- ↑ URL: http://emedicine.medscape.com/article/204529-diagnosis. Accessed on: 19 August 2010.
- ↑ URL: http://dictionary.reference.com/browse/convoluted. Accessed on: 19 August 2010.
- ↑ 24.0 24.1 24.2 24.3 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 325. ISBN 978-1416054542.
- ↑ Gertz, MA. (Apr 2012). "Waldenström macroglobulinemia.". Hematology 17 Suppl 1: 112-6. doi:10.1179/102453312X13336169156212. PMID 22507796.
- ↑ Kyrtsonis, MC.; Vassilakopoulos, TP.; Angelopoulou, MK.; Siakantaris, P.; Kontopidou, FN.; Dimopoulou, MN.; Boussiotis, V.; Gribabis, A. et al. (Dec 2001). "Waldenström's macroglobulinemia: clinical course and prognostic factors in 60 patients. Experience from a single hematology unit.". Ann Hematol 80 (12): 722-7. doi:10.1007/s00277-001-0385-8. PMID 11797112.
- ↑ 27.0 27.1 Liu, EB.; Zhang, PH.; Li, ZQ.; Sun, Q.; Yang, QY.; Fang, LH.; Sun, FJ.; Qiu, LG. (May 2010). "[Clinicopathologic features of lymphoplasmacytic lymphoma].". Zhonghua Bing Li Xue Za Zhi 39 (5): 308-12. PMID 20654153.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 327. ISBN 978-1416054542.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 328. ISBN 978-1416054542.
- ↑ URL: http://www.pathpedia.com/education/eatlas/histopathology/blood_cells/adult_t-cell_leukemia_htlv1-positive_acute_form.aspx. Accessed on: 7 February 2012.
- ↑ 31.0 31.1 Bittencourt, AL.; Barbosa, HS.; Vieira, MD.; Farré, L. (2009). "Adult T-cell leukemia/lymphoma (ATL) presenting in the skin: clinical, histological and immunohistochemical features of 52 cases.". Acta Oncol 48 (4): 598-604. doi:10.1080/02841860802657235. PMID 19165640.
- ↑ 32.0 32.1 32.2 32.3 Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 95. ISBN 978-0443066450.
- ↑ URL: http://atlasgeneticsoncology.org/Anomalies/t1114ID2021.html. Accessed on: 10 August 2010.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 315. ISBN 978-1416054542.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 317. ISBN 978-1416054542.
- ↑ URL: http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed&part=A34022&rendertype=table&id=A34029. Accessed on: 20 August 2010.
- ↑ Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 318. ISBN 978-1416054542.
- ↑ Lamant L, Meggetto F, al Saati T, et al. (January 1996). "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". Blood 87 (1): 284–91. PMID 8547653.