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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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| *[[Acute myeloid leukemia]] (AML). | | *[[Acute myeloid leukemia]] (AML). |
| *[[Chronic myeloid leukemia]] (CML). | | *[[Chronic myeloid leukemia]] (CML). |
| *Chronic lymphoid leukemia (CLL) - relatively good prognosis. | | *[[Chronic lymphocytic leukemia]] (CLL) - relatively good prognosis. |
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| ===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 = Acute myeloid leukemia. | | *[[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. |
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| ====T cell markers==== | | ====T cell markers==== |
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| ==Intravascular lymphoma== | | ==Intravascular lymphoma== |
| | *[[AKA]] ''angiotropic lymphoma'', ''intravascular malignant lymphomatosis'', ''malignant angioendotheliomatosis'' |
| *Rare. | | *Rare. |
| *Usually B-cell lineage (see below ''intravascular large B-cell lymphoma''). | | *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> |
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| ===Intravascular large B-cell lymphoma===
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| ====General====
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| *[[AKA]] ''angiotropic lymphoma'', ''intravascular malignant lymphomatosis'', ''malignant angioendotheliomatosis''.
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| =====Clinical=====
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| *Often a non-specific presentation.<ref name=pmid11579120>{{cite journal |author=Lapkuviene O, Forchetti D, Roepke JE |title=Unusual sites of involvement by hematologic malignancies. Case 1. Intravascular large B-cell lymphoma presenting with CNS symptoms |journal=J. Clin. Oncol. |volume=19 |issue=19 |pages=3988–91 |year=2001 |month=October |pmid=11579120 |doi= |url=http://jco.ascopubs.org/content/19/19/3988.full}}</ref>
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| **+/-Fever.
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| **+/-Multiple infarcts.
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| **+/-Non-specific skin lesions.
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| ====Microscopic====
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| Features:
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| *Abundant atypical intravascular lymphoid cells that are:
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| **Large (~2-3X size of a mature lymphocyte or RBC).
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| **Nucleolus prominent.
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| Notes:
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| *It may be hard to find RBCs in the vessels.
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| *Looks sorta like a [[DLBCL]] -- but is intravascular.
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| =====Images=====
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| <gallery>
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| Image:Intravascular_lymphoma_-_high_mag.jpg | Intravascular lymphoma - high mag. (WC/Nephron)
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| Image:Intravascular_lymphoma_-_very_high_mag.jpg | Intravascular lymphoma - very high mag. (WC/Nephron)
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| </gallery>
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| www:
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| *[http://jco.ascopubs.org/content/19/19/3988/F1.expansion.html ILBCL (ascopubs.org)].<ref name=pmid11579120/>
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| *[http://theoncologist.alphamedpress.org/cgi/content/full/11/8/923/F1 ILBCL in bone marrow (alphamedpress.org)].
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| *[http://annonc.oxfordjournals.org/content/13/9/1503/F1.expansion.html ILBCL - various images (oxfordjournals.org)].
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| *[http://path.upmc.edu/cases/case473/images/fig01a.jpg ILBCL (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case473.html http://path.upmc.edu/cases/case473.html]. Accessed on: 21 January 2012.</ref>
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| *[http://path.upmc.edu/cases/case697.html ILBCL - several images (upmc.edu)].
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| ====IHC====
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| Features:<ref name=pmid11579120/>
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| *CD20 +ve - '''key feature'''.
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| *CD3 -ve.
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| *CD34 -ve.
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| ==Burkitt's lymphoma== | | ==Burkitt's lymphoma== |
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| *Abbreviated ''EATL''. | | *Abbreviated ''EATL''. |
| *[[AKA]] ''enteropathy-type T-cell lymphoma'' (ETTL). | | *[[AKA]] ''enteropathy-type T-cell lymphoma'' (ETTL). |
| ===General===
| | {{Main|Enteropathy-associated T-cell lymphoma}} |
| *T cell lymphoma due to [[celiac sprue]].
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| *Subdivided into type I and type II.<ref name=pmid21566094>{{cite journal |author=Delabie J, et al |title=Enteropathy-associated T-cell lymphoma: clinical and histological findings from the International Peripheral T-Cell Lymphoma Project|journal=Blood |volume=118|issue=148|pages= 148|year=2011|month=July}}</ref>
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| ===Microscopic===
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| Features:<ref name=pmid21323966>{{Cite journal | last1 = Takeshita | first1 = M. | last2 = Nakamura | first2 = S. | last3 = Kikuma | first3 = K. | last4 = Nakayama | first4 = Y. | last5 = Nimura | first5 = S. | last6 = Yao | first6 = T. | last7 = Urabe | first7 = S. | last8 = Ogawara | first8 = S. | last9 = Yonemasu | first9 = H. | title = Pathological and immunohistological findings and genetic aberrations of intestinal enteropathy-associated T cell lymphoma in Japan. | journal = Histopathology | volume = 58 | issue = 3 | pages = 395-407 | month = Feb | year = 2011 | doi = 10.1111/j.1365-2559.2011.03768.x | PMID = 21323966 }}</ref>
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| *Large ''or'' medium-sized lymphoid cells in the mucosa and submucosa.
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| **Large-sized cells ~ 2x RBC diameter = type 1.
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| **Medium sized cells ~ 1.5x RBC diameter = type 2.
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| *Intestinal epithelium usually preserved.
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Enteropathy-associated_T_cell_lymphoma_-_low_mag.jpg EATL (WC)].
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| ===IHC===
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| Features - type 1:<ref name=pmid21323966/>
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| *CD56 +ve.
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| Features - type 2:<ref name=pmid21323966/><ref name=pmid21921780>{{Cite journal | last1 = Chan | first1 = JK. | last2 = Chan | first2 = AC. | last3 = Cheuk | first3 = W. | last4 = Wan | first4 = SK. | last5 = Lee | first5 = WK. | last6 = Lui | first6 = YH. | last7 = Chan | first7 = WK. | title = Type II enteropathy-associated T-cell lymphoma: a distinct aggressive lymphoma with frequent γδ T-cell receptor expression. | journal = Am J Surg Pathol | volume = 35 | issue = 10 | pages = 1557-69 | month = Oct | year = 2011 | doi = 10.1097/PAS.0b013e318222dfcd | PMID = 21921780 }}</ref>
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| *CD3 +ve.
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| *CD5 -ve.
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| *CD8 -ve/+ve.
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| *CD56 -ve/+ve.
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| *CD30 +ve.
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| ==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}} |
| ===General===
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| Features:<ref name=pmid19074109 >{{Cite journal | last1 = Johnson | first1 = PW. | last2 = Davies | first2 = AJ. | title = Primary mediastinal B-cell lymphoma. | journal = Hematology Am Soc Hematol Educ Program | volume = | issue = | pages = 349-58 | month = | year = 2008 | doi = 10.1182/asheducation-2008.1.349 | PMID = 19074109 }}</ref><ref name=pmid20207294>{{Cite journal | last1 = Coso | first1 = D. | last2 = Rey | first2 = J. | last3 = Bouabdallah | first3 = R. | title = [Primary mediastinal B-cell lymphoma] | journal = Rev Pneumol Clin | volume = 66 | issue = 1 | pages = 32-5 | month = Feb | year = 2010 | doi = 10.1016/j.pneumo.2009.12.007 | PMID = 20207294 }}</ref>
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| *Rare.
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| *Young adults.
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| *[[Mediastinum]].
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| ===Microscopic===
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| Features:
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| *Atypical large lymphoid cells - see ''[[DLBCL]]''.
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| *Classically associated with:
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| **Fibrosis
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| **Clear cells.
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| Note:
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| *Neither fibrosis or clear cells are required for the [[diagnosis]] nor are they pathognomonic.<ref name=pmid11251018 >{{Cite journal | last1 = van Besien | first1 = K. | last2 = Kelta | first2 = M. | last3 = Bahaguna | first3 = P. | title = Primary mediastinal B-cell lymphoma: a review of pathology and management. | journal = J Clin Oncol | volume = 19 | issue = 6 | pages = 1855-64 | month = Mar | year = 2001 | doi = | PMID = 11251018 }}</ref>
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| DDx:
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| *Other types of [[DLBCL]].
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| *Poorly differentiated carcinoma.
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| Images:
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:Primary_mediastinal_large_B-cell_lymphoma_-_very_high_mag.jpg PMBL - very high mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Primary_mediastinal_large_B-cell_lymphoma_-_intermed_mag.jpg PMBL - intermed. mag. (WC)].
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| *www:
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| **[http://path.upmc.edu/cases/case371.html PMBL - several images (upmc.edu)].
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| ===Sign out===
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| <pre>
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| MASS, ANTERIOR MEDIASTINAL, CORE BIOPSY:
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| - LARGE B-CELL LYMPHOMA IN A FIBROTIC BACKGROUND WITH NECROSIS, SEE COMMENT
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| COMMENT:
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| Morphology:
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| Tumour cells: size ~2x a mature lymphocyte, a moderate quantity of grey/basophilic
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| cytoplasm, no clear cells are identified.
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| Cells intermixed with tumour: mature lymphocytes, rare eosinophils.
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| Architecture: no gland formation, discohesive, no follicles apparent, extensive fibrosis.
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| Tumour cells:
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| POSITIVE: CD45, CD20, CD10, BCL-6, BCL-2.
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| NEGATIVE: pankeratin, PLAP, CD3, CD30.
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| Ki-67: 50% of large (lymphoid) cells.
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| </pre>
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| ==Anaplastic large cell lymphoma== | | ==Anaplastic large cell lymphoma== |
| *Abbreviated ''ALCL''. | | *Abbreviated ''ALCL''. |
| | | {{Main|Anaplastic large cell lymphoma}} |
| ===General===
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| *May look a lot like a carcinoma.
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| **Often subcapsular in LNs.
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| *Usually T-cell derived.
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| *May be isolated to the [[skin]] - good prognosis.
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| Subtypes:
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| * Systemic ALCL.
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| * Cutaneous ALCL -- ALK -ve.
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| ALK IHC - systemic form:
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| * +ve = good prognosis.
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| * -ve = bad prognosis.
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| ===Microscopic===
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| Features:
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| *Large cells with eosinophilic cytoplasm.
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| *Usually appear cohesive.
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| *May be subcapsular in a [[lymph node]] and mimic a carcinoma.
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| *''Hallmark cells'' = "horseshoe-shaped or donut-shaped nucleus + eosinophilic paranuclear region"<ref name=pmid17941004>{{Cite journal | last1 = Rapkiewicz | first1 = A. | last2 = Wen | first2 = H. | last3 = Sen | first3 = F. | last4 = Das | first4 = K. | title = Cytomorphologic examination of anaplastic large cell lymphoma by fine-needle aspiration cytology. | journal = Cancer | volume = 111 | issue = 6 | pages = 499-507 | month = Dec | year = 2007 | doi = 10.1002/cncr.23120 | PMID = 17941004 | url=http://onlinelibrary.wiley.com/doi/10.1002/cncr.23120/full}}</ref><ref name=pmid12419758>{{Cite journal | last1 = Ponzoni | first1 = M. | last2 = Terreni | first2 = MR. | last3 = Ciceri | first3 = F. | last4 = Ferreri | first4 = AJ. | last5 = Gerevini | first5 = S. | last6 = Anzalone | first6 = N. | last7 = Valle | first7 = M. | last8 = Pizzolito | first8 = S. | last9 = Arrigoni | first9 = G. | title = Primary brain CD30+ ALK1+ anaplastic large cell lymphoma ('ALKoma'): the first case with a combination of 'not common' variants. | journal = Ann Oncol | volume = 13 | issue = 11 | pages = 1827-32 | month = Nov | year = 2002 | doi = | PMID = 12419758 }}</ref> - '''key feature'''.
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| **The donut-shaped version is also known as a "wreath cell"<ref>{{Cite journal | last1 = Amin | first1 = HM. | last2 = Lai | first2 = R. | title = Pathobiology of ALK+ anaplastic large-cell lymphoma. | journal = Blood | volume = 110 | issue = 7 | pages = 2259-67 | month = Oct | year = 2007 | doi = 10.1182/blood-2007-04-060715 | PMID = 17519389 | url=http://bloodjournal.hematologylibrary.org/content/110/7/2259.full.html}}</ref> - large (multi-nucleated) cells with (morphologically) one toroidal-shaped nucleus.
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| DDx:
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| *[[Hodgkin's lymphoma]].
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| *Carcinoma.
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| Images:
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:Anaplastic_large_cell_lymphoma_-_very_high_mag.jpg ALCL - very high mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Anaplastic_large_cell_lymphoma_-_cropped_-_very_high_mag.jpg ALCL - cropped - very high mag. (WC)].
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| *www:
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| **[http://path.upmc.edu/cases/case363.html ALCL - several images (upmc.edu)].
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| **[http://path.upmc.edu/cases/case557.html Small cell variant of ALCL - several images (upmc.edu)].
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| ===IHC===
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| Features:
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| *CD30 +ve.
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| *ALK-1 -ve/+ve; strongly supports ALCL Dx if +ve.
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| *CD45 +ve.
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| *CD4 +ve.
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| *CD3 -ve/+ve.
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| *CD7 -ve/+ve.
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| *EMA +ve.
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| ===Molecular===
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| *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> - can be detected with [[FISH]] break apart probe.
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| ==Cutaneous T cell lymphoma== | | ==Cutaneous T cell lymphoma== |
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| ===IHC=== | | ===IHC=== |
| *CF57 +ve. | | *CD57 +ve -- '''important'''. |
| | *CD3 +ve. |
| | *CD5 +ve. |
| | *CD45 +ve. |
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| ==Lymphoplasmacytic lymphoma== | | ==Lymphoplasmacytic lymphoma== |
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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}} |
| ===General===
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| *Common in east Asia.<ref name=pmid18283711>{{Cite journal | last1 = Suzuki | first1 = R. | last2 = Takeuchi | first2 = K. | last3 = Ohshima | first3 = K. | last4 = Nakamura | first4 = S. | title = Extranodal NK/T-cell lymphoma: diagnosis and treatment cues. | journal = Hematol Oncol | volume = 26 | issue = 2 | pages = 66-72 | month = Jun | year = 2008 | doi = 10.1002/hon.847 | PMID = 18283711 }}</ref>
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| *Strong association with [[EBV]].
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| ===Microscopic===
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| Features:
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| *Atypical lymphoid cells:
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| **[[Nucleoli]].
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| **[[Nuclear pleomorphism]].
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| **Cells centered around vessels (angiocentric).
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| ***May destroy small and medium sized arterioles.
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| Images:
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| *[http://path.upmc.edu/cases/case231/micro.html Extranodal NK/T-cell lymphoma, nasal type - case 1 - several images (upmc.edu)].
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| *[http://path.upmc.edu/cases/case310.html Extranodal NK/T-cell lymphoma, nasal type - case 2 - several images (upmc.edu)].
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| ===IHC===
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| Features:<ref name=pmid17064952>{{Cite journal | last1 = Al-Hakeem | first1 = DA. | last2 = Fedele | first2 = S. | last3 = Carlos | first3 = R. | last4 = Porter | first4 = S. | title = Extranodal NK/T-cell lymphoma, nasal type. | journal = Oral Oncol | volume = 43 | issue = 1 | pages = 4-14 | month = Jan | year = 2007 | doi = 10.1016/j.oraloncology.2006.03.011 | PMID = 17064952 }}</ref>
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| *CD2 +ve.
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| *CD3 +ve (cytoplasmic).
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| *CD56 +ve.
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| Others:<ref>URL: [http://path.upmc.edu/cases/case310.html http://path.upmc.edu/cases/case310.html]. Accessed on: 14 January 2012.</ref>
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| *TIA-1 +ve.
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| *CD7 +ve.
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| *EBER +ve.
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| ==Table of lymphoma== | | ==Table of lymphoma== |