Difference between revisions of "Small cell lymphomas"

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===General===
===General===
*A very common type of lymphoma.
*A very common type of lymphoma.
*Express 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>
*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>


===Microscopic===
===Microscopic===
Features:
Features:
*Abundant abnormal lymphoid follicles.
*Abundant abnormal 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).


====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.
*''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===
===IHC===
Features:<ref name=pmid18359244/>
Features:<ref name=pmid18359244/>

Revision as of 15:14, 17 August 2010

Small cell lymphomas are a collection of commonly seen lymphomas that have a near-identical histomorphologic appearance.

The group includes:

  1. Small lymphocytic lymphoma/chronic lymphocytic leukemia.
  2. Follicular lymphoma.
  3. Mantle cell lymphoma.
  4. Marginal zone lymphoma.
  5. Hairy cell leukemia.
  6. Immunoproliferative small intestinal disease (IPSID).[1]

Table of B-cell lymphoma

Small cell lymphomas:

Name Location Size of cells IHC Translocations Clinical Other
Follicular lymphoma Follicle Small, centrocytes, centroblasts CD10+, bcl-6+[2] t(14,18) Clinical ? Other ?
Mantle cell lymphoma Mantle zone Small CD5+, CD23-, CD43+, cyclin D1+[2] t(11;14)(q13;q32)[3] Clinical ? Other ?
Marginal zone lymphoma (MALT) Marginal zone Small CD21+, CD11c+, CD5-, CD23-[2] Translocations Clinical Other
Precursor lymphoblastic lymphoma/leukemia Location ? Small CD10+, CD5-, TdT+, CD99+[2] Translocations ? Clinical ? Other ?
Small lymphocytic lymphoma/chronic lymphocytic leukemia Location ? Small CD5+, CD23+, CD43+, cyclin D1- Translocations ? Good prognosis Other ?

Medium and large cell lymphomas:

Name Location Size of cells IHC Translocations Clinical Other
Burkitt's lymphoma Follicle Large cells CD10, bcl-6 t(8;14) (q24;q32) Rapid growth "Starry sky"
Diffuse large B cell lymphoma Follicle (?) Large 4-5X of lymphocyte MIB-1 >40% none/like follicular l. Poor prognosis Common among lymphomas
Name Location Size of cells IHC Translocations Clinical Other

Follicular lymphoma

General

  • A very common type of lymphoma.
  • Expresses BCL2.[4]

Microscopic

Features:

  • Abundant abnormal 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).

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:

The usual cut points mentioned by people with HPFitis are:[6]

  • Grade 1: 0-5 centroblasts / HPF.
  • Grade 2: 5-15 centroblasts / HPF.
  • Grade 3: >15 centroblasts / HPF.

IHC

Features:[4]

  • CD10 +ve/-ve.
  • 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.

Molecular

  • t(14;18)(q32;q21)/IGH-BCL2 in 70-95% of cases.[4]
    • Should not be confused with t(14;18)(q32;q21)/IGH-MALT1 seen in MALT lymphomas.[7]

Mantle cell lymphoma

General

  • Comes in different flavours.

Microscopic

Features:

  • See histomorphology of small cell lymphomas.

MALT lymphoma/Marginal zone lymphoma

General

  • Abbreviated as MZL.

Classification

  • Comes in different flavours:
    • Extranodal marginal zone lymphoma.
    • Splenic marginal zone lymphoma.

Microscopic

Features:

  • See histomorphology of small cell lymphomas.
  • "Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes.[8]
    • Features:
      1. Cluster of lymphocytes - three cells or more - key feature.
        • Single lymphocytes don't count.
      2. Clearing around the lymphocyte cluster.
    • Not specific for MALT lymphoma, i.e. may be seen in other types of lymphoma.[9]

Hairy cell leukemia

General

  • Name comes from appearance on blood smear - cell hairy.

Microscopic

Features:

  • See histomorphology of small cell lymphomas.

Images:

Small lymphocytic lymphoma/chronic lymphocytic leukemia

General

  • Very common.
  • Good prognosis.

Microscopic

Features:

  • See histomorphology of small cell lymphomas.

See also

References

  1. ↑ Al-Saleem T, Al-Mondhiry H (March 2005). "Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms". Blood 105 (6): 2274–80. doi:10.1182/blood-2004-07-2755. PMID 15542584. http://bloodjournal.hematologylibrary.org/cgi/content/long/105/6/2274.>
  2. ↑ 2.0 2.1 2.2 2.3 Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 95. ISBN 978-0443066450.
  3. ↑ URL: http://atlasgeneticsoncology.org/Anomalies/t1114ID2021.html. Accessed on: 10 August 2010.
  4. ↑ 4.0 4.1 4.2 Vitolo U, Ferreri AJ, Montoto S (June 2008). "Follicular lymphomas". Crit. Rev. Oncol. Hematol. 66 (3): 248–61. doi:10.1016/j.critrevonc.2008.01.014. PMID 18359244.
  5. ↑ DG. 17 August 2010.
  6. ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 813. ISBN 978-0781740517.
  7. ↑ Bacon CM, Du MQ, Dogan A (April 2007). "Mucosa-associated lymphoid tissue (MALT) lymphoma: a practical guide for pathologists". J. Clin. Pathol. 60 (4): 361–72. doi:10.1136/jcp.2005.031146. PMC 2001121. PMID 16950858. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001121/.
  8. ↑ Papadaki, L.; Wotherspoon, AC.; Isaacson, PG. (Nov 1992). "The lymphoepithelial lesion of gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT): an ultrastructural study.". Histopathology 21 (5): 415-21. PMID 1452124.
  9. ↑ DB. 6 August 2010.
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