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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. | ||
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]]''. | 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"<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=== | ||
*Acute lymphoid leukemia (ALL) - predominantly in '''smALL''' people, i.e. children. | *Acute lymphoid leukemia (ALL) - predominantly in '''smALL''' people, i.e. children. | ||
*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). | ||
*Reed-Sternberg cells = Hodgkin's lymphoma. | **Not pathognomonic. | ||
*Reed-Sternberg cells = [[Hodgkin's lymphoma]]. | |||
**Large cell - very large nucleus. | **Large cell - very large nucleus. | ||
***Classically binucleated. | ***Classically binucleated. | ||
*Russell bodies = | *Russell bodies = [[plasmacytoma]] (+others). | ||
**Eosinophilic, large, homogenous immunoglobulin-containing inclusions.<ref name=pmid3979421>{{cite journal |author=Alanen A, Pira U, Lassila O, Roth J, Franklin RM |title=Mott cells are plasma cells defective in immunoglobulin secretion |journal=Eur. J. Immunol. |volume=15 |issue=3 |pages=235–42 |year=1985 |month=March |pmid=3979421 |doi= |url=}}</ref> | **Eosinophilic, large, homogenous immunoglobulin-containing inclusions.<ref name=pmid3979421>{{cite journal |author=Alanen A, Pira U, Lassila O, Roth J, Franklin RM |title=Mott cells are plasma cells defective in immunoglobulin secretion |journal=Eur. J. Immunol. |volume=15 |issue=3 |pages=235–42 |year=1985 |month=March |pmid=3979421 |doi= |url=}}</ref> | ||
***''Mott cell'' is a cell that contains Russell bodies.<ref name=pmid3979421/> | ***''Mott cell'' is a cell that contains Russell bodies.<ref name=pmid3979421/> | ||
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**AKA ''common lymphocyte antigen''. | **AKA ''common lymphocyte antigen''. | ||
**Useful to differentiate from carcinomas (e.g. small cell carcinoma). | **Useful to differentiate from carcinomas (e.g. small cell carcinoma). | ||
Others: | |||
*[[AE1/AE3]] -ve -- to r/o carcinoma. | |||
====T cell markers==== | ====T cell markers==== | ||
*CD2 -- T cell marker (all T cells). | *CD2 -- T cell marker (all T cells). | ||
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*CD43 -- +ve in mantle cell lymphoma | *CD43 -- +ve in mantle cell lymphoma | ||
*ALK1<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/601284 http://www.ncbi.nlm.nih.gov/omim/601284]. Accessed on: 31 August 2010.</ref> - prognostic in anaplastic large cell lymphoma (ALCL).<ref name=pmid9250148>{{cite journal |author=Pittaluga S, Wlodarska I, Pulford K, ''et al.'' |title=The monoclonal antibody ALK1 identifies a distinct morphological subtype of anaplastic large cell lymphoma associated with 2p23/ALK rearrangements |journal=Am. J. Pathol. |volume=151 |issue=2 |pages=343–51 |year=1997 |month=August |pmid=9250148 |pmc=1858018 |doi= |url=}}</ref> | |||
*TIA1 - cytotoxic T-cell.<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/603518 http://www.ncbi.nlm.nih.gov/omim/603518]. Accessed on: 18 August 2010.</ref> | |||
*Granzyme B. | |||
====B cell markers==== | ====B cell markers==== | ||
*CD20 -- B cell marker. | *CD20 -- B cell marker. | ||
**CD19 -- B cell marker - used for [[flow cytometry]]. | **CD19 -- B cell marker - used for [[flow cytometry]]. | ||
* | *PAX5 -- nuclear staining.<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/167414 http://www.ncbi.nlm.nih.gov/omim/167414]. Accessed on: 18 August 2010.</ref> | ||
**Image: [http://www.pathologypics.com/PictView.aspx?ID=529 PAX5 in Hodgkin's lymphoma]. | |||
*CD79a. | *CD79a. | ||
*CD10 -- | *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<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/116930 http://www.ncbi.nlm.nih.gov/omim/116930]. Accessed on: 31 August 2010.</ref> -- also +ve in NK/T cell lymphomas. | |||
*CD57 -- +ve in [[T-cell large granular lymphocytic leukemia]].<ref>URL: [http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html]. Accessed on: 31 August 2010.</ref>. | |||
*CD138. | |||
====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==== | ||
=====Classic===== | =====Classic===== | ||
*CD30 -- Hodgkin's lymphoma (most sensitive). | *CD30 +ve -- Hodgkin's lymphoma (most sensitive). | ||
*CD15. | *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=== | |||
{{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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#*T lymphocytes only (no mix of cells). | #*T lymphocytes only (no mix of cells). | ||
#Lymphocyte-depleted CHL - rare. | #Lymphocyte-depleted CHL - rare. | ||
#*May be associated with HIV infection.<ref name=pmid20138008/> | #*May be associated with [[HIV]] infection.<ref name=pmid20138008/> | ||
Memory device: | Memory device: | ||
Line 156: | Line 228: | ||
*[http://commons.wikimedia.org/wiki/File:Popcorn_cell_in_nodular_lymphocyte_predominant_Hodgkin_lymphoma_-_very_high_mag_cropped.jpg Popcorn cell (WC)]. | *[http://commons.wikimedia.org/wiki/File:Popcorn_cell_in_nodular_lymphocyte_predominant_Hodgkin_lymphoma_-_very_high_mag_cropped.jpg Popcorn cell (WC)]. | ||
== | ==Small cell lymphomas== | ||
{{main|Small cell lymphomas}} | {{main|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== | ==Diffuse large B-cell lymphoma== | ||
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Notes: | Notes: | ||
*Large bizarre cells can occasionally mimic Reed-Sternberg cells, seen in [[Hodgkin lymphoma]]. | *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.<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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Image: [http://en.wikipedia.org/wiki/File:Burkitt_lymphoma,_H%26E.jpg Starry-sky pattern - Ed Uthman (WC)]. | Image: [http://en.wikipedia.org/wiki/File:Burkitt_lymphoma,_H%26E.jpg Starry-sky pattern - Ed Uthman (WC)]. | ||
== | ==Plasma cell neoplasms== | ||
{{Main|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== | ==Acute myeloid leukemia== | ||
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===Complications=== | ===Complications=== | ||
*Chloroma - soft tissue mass. | *[[Chloroma]] - soft tissue mass. | ||
*Leukostasis. | *Leukostasis. | ||
**Occurs - lungs and brain.<ref>AML. Harrison's 16th Ed.</ref> | **Occurs - lungs and brain.<ref>AML. Harrison's 16th Ed.</ref> | ||
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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). | |||
{{Main|Enteropathy-associated T-cell lymphoma}} | |||
* | |||
==Angioimmunoblastic T-cell lymphoma== | ==Angioimmunoblastic T-cell lymphoma== | ||
*Abbreviated ''AITL''. | |||
===General=== | |||
*Rare. | |||
**Common among T-cell lymphomas. | |||
*Middle age ''or'' elderly. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Clear cytoplasm. | *Intermediate size cells with: | ||
**+/-[[Vesicular nuclei]]. | |||
**Clear, moderate cytoplasm. | |||
*"Empty" sinus; subcapsular sinuses "open". | *"Empty" sinus; subcapsular sinuses "open". | ||
Images: | |||
*[http://www.ijpmonline.org/viewimage.asp?img=IndianJPatholMicrobiol_2010_53_4_640_72010_f4.jpg AITL (ijpmonline.org)].<ref name=pmid21045384>{{Cite journal | last1 = Bal | first1 = M. | last2 = Gujral | first2 = S. | last3 = Gandhi | first3 = J. | last4 = Shet | first4 = T. | last5 = Epari | first5 = S. | last6 = Subramanian | first6 = PG. | title = Angioimmunoblastic T-Cell lymphoma: a critical analysis of clinical, morphologic and immunophenotypic features. | journal = Indian J Pathol Microbiol | volume = 53 | issue = 4 | pages = 640-5 | month = | year = | doi = 10.4103/0377-4929.72010 | PMID = 21045384 | URL = http://www.ijpmonline.org/text.asp?2010/53/4/640/72010 }}</ref> | |||
*[http://path.upmc.edu/cases/case650.html AITL - several images (upmc.edu)] | |||
===IHC=== | ===IHC=== | ||
Features - positives:<ref name=pmid21045384/> | |||
*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;<ref>URL: [http://path.upmc.edu/cases/case650/dx.html http://path.upmc.edu/cases/case650/dx.html]. Accessed on: 27 January 2012.</ref> tumour cell not +ve. | |||
Negatives: | |||
*CD30 -ve.<ref name=pmid21045384/> | |||
*CD15 -ve.<ref name=pmid21045384/> | |||
*CD7 -ve. | *CD7 -ve. | ||
*TIA-1 -ve. | *TIA-1 -ve. | ||
==Primary mediastinal B-cell lymphoma== | |||
*Abbreviated ''PMBL''. | |||
*[[AKA]] ''primary mediastinal large B-cell lymphoma''. | |||
{{Main|Primary mediastinal B-cell lymphoma}} | |||
==Anaplastic large cell lymphoma== | ==Anaplastic large cell lymphoma== | ||
*Abbreviated ''ALCL''. | |||
{{Main|Anaplastic large cell lymphoma}} | |||
==Cutaneous T cell lymphoma== | |||
:''See [[Dermatologic_neoplasms#Cutaneous_T_cell_lymphoma|Dermatologic neoplasms]]''. | |||
===General=== | |||
*Abbreviated as ''CTCL''. | |||
**''Sézary syndrome'' is a subset of CTCL. | |||
===Microscopic=== | |||
Features:<ref>URL: [http://emedicine.medscape.com/article/209091-overview http://emedicine.medscape.com/article/209091-overview]. Accessed on: 19 August 2010.</ref> | |||
*Cerebriform nucleus (Sézary cell):<ref>URL: [http://emedicine.medscape.com/article/204529-diagnosis http://emedicine.medscape.com/article/204529-diagnosis]. Accessed on: 19 August 2010.</ref> | |||
**Hyperchromatic. | |||
**"Convoluted" = twisted, coiled.<ref>URL: [http://dictionary.reference.com/browse/convoluted http://dictionary.reference.com/browse/convoluted]. Accessed on: 19 August 2010.</ref> | |||
Images: | |||
*[http://www.flickr.com/photos/32549645@N02/3040759595/ Sézary cell (flickr.com)]. | |||
*[http://www.wadsworth.org/chemheme/heme/glass/cytopix/slide015_sezary2.jpg Sézary cell (wadsworth.org)]. | |||
==T-cell large granular lymphocytic leukemia== | |||
===General=== | |||
*May be seen in the context of [[Felty syndrome]]. | |||
===Microscopic=== | |||
Features: | |||
*Large cell lymphoma. | |||
Images: | |||
*[http://path.upmc.edu/cases/case695.html T-cell large granular lymphocytic leukemia (upmc.edu)]. | |||
===IHC=== | |||
*CD57 +ve -- '''important'''. | |||
*CD3 +ve. | |||
*CD5 +ve. | |||
*CD45 +ve. | |||
==Lymphoplasmacytic lymphoma== | |||
:''Waldenström macroglobulinemia'' redirects here. | |||
===General=== | ===General=== | ||
* | Features:<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | ||
* | *B cell neoplasm. | ||
** | *Secretes monoclonal IgM. | ||
* | |||
* | Note: | ||
** | *''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. | |||
*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=== | |||
Features:<ref name=Ref_PCPBoD8_325>{{Ref PCPBoD8|325}}</ref> | |||
*Plasmacytoid lymphocytes. | |||
*Mixed inflammatory infiltrate with [[mast cell]]s, [[plasma cell]]s, lymphocytes. | |||
DDx: | DDx: | ||
* | *[[Plasma cell neoplasm]]. | ||
===IHC=== | |||
Features:<ref name=pmid20654153>{{Cite journal | last1 = Liu | first1 = EB. | last2 = Zhang | first2 = PH. | last3 = Li | first3 = ZQ. | last4 = Sun | first4 = Q. | last5 = Yang | first5 = QY. | last6 = Fang | first6 = LH. | last7 = Sun | first7 = FJ. | last8 = Qiu | first8 = LG. | title = [Clinicopathologic features of lymphoplasmacytic lymphoma]. | journal = Zhonghua Bing Li Xue Za Zhi | volume = 39 | issue = 5 | pages = 308-12 | month = May | year = 2010 | doi = | PMID = 20654153 }}</ref> | |||
*PAX5 +ve. | |||
*CD20 +ve. | |||
*CD38 +ve. | |||
*CD138 +ve. | |||
Others:<ref name=pmid20654153/> | |||
*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).<ref name=Ref_PCPBoD8_327>{{Ref PCPBoD8|327}}</ref> | |||
*Poor prognosis ~ 1 year survival with treatment. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features:<ref name=Ref_PCPBoD8_328>{{Ref PCPBoD8|328}}</ref> | ||
* | *Cloverleaf nuclei. | ||
* | **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=== | ||
Features: | Features:<ref name=pmid19165640>{{Cite journal | last1 = Bittencourt | first1 = AL. | last2 = Barbosa | first2 = HS. | last3 = Vieira | first3 = MD. | last4 = Farré | first4 = L. | title = Adult T-cell leukemia/lymphoma (ATL) presenting in the skin: clinical, histological and immunohistochemical features of 52 cases. | journal = Acta Oncol | volume = 48 | issue = 4 | pages = 598-604 | month = | year = 2009 | doi = 10.1080/02841860802657235 | PMID = 19165640 |URL = http://informahealthcare.com/doi/pdf/10.1080/02841860802657235 }}</ref> | ||
* | *CD3 +ve. | ||
*CD45 +ve. | *CD5 +ve. | ||
*CD25 +ve. | |||
*CD45 +ve. | |||
*HTLV-1 +ve. | |||
Others:<ref name=pmid19165640/> | |||
*CD7 -ve. | |||
*CD20 -ve. | |||
*CD79a -ve. | |||
==Hepatosplenic T-cell lymphoma== | |||
{{Main|Hepatosplenic T-cell lymphoma}} | |||
==Extranodal NK/T-cell lymphoma, nasal type== | |||
*Abbreviated as ''ENKL'' or ''ENKTCL''. | |||
*[[AKA]] ''extranodal natural kill lymphoma'' | |||
*[[AKA]] ''angiocentric lymphoma''. | |||
{{Main|Extranodal NK/T-cell lymphoma, nasal type}} | |||
==Table of | ==Table of lymphoma== | ||
===B cell lymphomas=== | |||
{| class="wikitable" | {| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | ||
! Name | ! Name | ||
! Size of cells | ! Size of cells | ||
! Site | |||
! Histomorphology | |||
! IHC | ! IHC | ||
! Translocations | ! [[Translocations]] | ||
! Clinical | ! Clinical | ||
! | ! Prevalence | ||
! DDx | |||
|- | |- | ||
| Follicular lymphoma | | [[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+<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | | CD10+, bcl-6+<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | ||
| t(14,18) | | t(14,18) | ||
| | | usually indolent, may transform to DLBCL | ||
| | | very common | ||
| DLBCL, other small cell lymphomas | |||
|- | |- | ||
| Mantle cell lymphoma | | [[Mantle cell lymphoma]] | ||
| | | small, monomorphic | ||
| | | lymph node, mantle zone | ||
| monomorphic lymphoid, abundant mitoses. +/-scattered epithelioid histiocytes, sclerosed blood vessels | |||
| CD5+, CD23-, CD43+, cyclin D1+<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | | CD5+, CD23-, CD43+, cyclin D1+<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | ||
| t(11;14)(q13;q32)<ref>URL: [http://atlasgeneticsoncology.org/Anomalies/t1114ID2021.html http://atlasgeneticsoncology.org/Anomalies/t1114ID2021.html]. Accessed on: 10 August 2010.</ref> | | t(11;14)(q13;q32)<ref>URL: [http://atlasgeneticsoncology.org/Anomalies/t1114ID2021.html http://atlasgeneticsoncology.org/Anomalies/t1114ID2021.html]. Accessed on: 10 August 2010.</ref> | ||
| | | 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-<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | | CD21+, CD11c+, CD5-, CD23-<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | ||
| | | ??? | ||
| | | indolent ??? | ||
| | | common | ||
| other small cell lymphomas, neuroendocrine tumours | |||
|- | |- | ||
| Precursor lymphoblastic lymphoma/leukemia | | 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<ref name=Ref_PCPBoD8_315>{{Ref PCPBoD8|315}}</ref> | |||
| CD10+, CD5-, TdT+, CD99+<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | | CD10+, CD5-, TdT+, CD99+<ref name=Ref_Lester95>{{Ref Lester|95}}</ref> | ||
| | | +/-t(12;21)<ref name=Ref_PCPBoD8_317>{{Ref PCPBoD8|317}}</ref> | ||
| | | aggressive ??? | ||
| | | uncommon | ||
| [[small cell lymphomas]] | |||
|- | |||
| [[Hairy cell leukemia]] | |||
| small | |||
| bone marrow, peripheral blood | |||
| perinuclear clearing, clear cytoplasm, central nucleus | |||
| CD25+, CD103+, CD5-<ref>URL: [http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed&part=A34022&rendertype=table&id=A34029 http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed&part=A34022&rendertype=table&id=A34029]. Accessed on: 20 August 2010.</ref> | |||
| 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 /<br>chronic lymphocytic leukemia | |||
| small | |||
| lymph node (???) | |||
| proliferation centres | |||
| CD5+, CD23+, CD43+, cyclin D1- | |||
| trisomy 12; deletions of 11q, 13q, 17p<ref>{{Ref PCPBoD8|318}}</ref> | |||
| good prognosis / indolent course | |||
| common | |||
| other [[small cell lymphomas]] | |||
|- <!-- | |||
| Name | |||
| size of cells ? | |||
| site ? | |||
| histomorphology ? | |||
| IHC ? | |||
| translocations ? | |||
| clinical ? | |||
| prevalence ? | |||
| DDx ? --> | |||
|} | |} | ||
===T cell lymphomas=== | |||
{| class="wikitable" | {| class="wikitable sortable" style="margin-left:auto;margin-right:auto" | ||
! Name | ! Name | ||
! Size of cells | ! Size of cells | ||
! Site | |||
! Histomorphology | |||
! IHC | ! IHC | ||
! Translocations | ! Translocations | ||
! Clinical | ! 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 leukemia/lymphoma|Adult T-cell lymphoma / leukemia]] | ||
| | | size of cells ? | ||
| | | site ? | ||
| | | cloverleaf nuclei (multilobular nuclei) | ||
| t( | | 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)<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> | |||
| clinical ? | |||
| uncommon | |||
| carcinoma | |||
|- | |- | ||
| | | [[Extranodal NK/T-cell lymphoma, nasal type|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 ? | ||
| IHC | | histomorphology ? | ||
| | | IHC ? | ||
| | | translocations ? | ||
| | | clinical ? | ||
| prevalence ? | |||
| DDx ? | |||
|} | |} | ||
edits