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(→Adult T-cell leukemia/lymphoma: fix ref.) |
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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 |
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