Lymphoma: Difference between revisions
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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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===B symptoms=== | ===B symptoms=== | ||
*May be seen in [[Hodgkin lymphoma]] and | *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> | 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> | ||
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==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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==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> | |||
**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==== | |||
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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*[[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 | ||