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Transcript of Lymphoma Dr: Abdelaty Shawky Dr. Gehan Mohamed. Learning objectives Recognizing the definition of...
![Page 1: Lymphoma Dr: Abdelaty Shawky Dr. Gehan Mohamed. Learning objectives Recognizing the definition of lymphoma. Listing the classification of lymphoma. Understanding.](https://reader036.fdocuments.net/reader036/viewer/2022062518/56649e0b5503460f94af27aa/html5/thumbnails/1.jpg)
LymphomaLymphoma
Dr: Abdelaty Shawky Dr. Gehan Mohamed
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Learning objectivesLearning objectives
• Recognizing the definition of lymphoma.• Listing the classification of lymphoma.• Understanding the pathological features of non-
Hodgkin's and Hodgkin's lymphoma.• Understanding the Diagnosis and staging of
lymphoma.
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Normal structure of reactive lymph node
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Microscopic picture of reactive lymphoid follicles
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LymphomaLymphoma• Definition: malignant neoplasm of lymphoid origin,
typically causing solid tissue mass usually in form of
lymphadenopathy but may be presented as extra
nodal mass as in brain or intestine.
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Epidemiology of lymphoma
• 5th most frequently diagnosed cancer in both sexes.
• Males > females.
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* Causes of lymphoma:
• Genetic alterations causing mutations in chromosomes.
• Infection specially with viruses as Human T- cell leukemia Lymphoma virus, Epstein Bar virus.
• Immunosuppression.
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* WHO classification of lymphoid neoplasms:
I. Non-Hodgkin’s lymphoma:I. Non-Hodgkin’s lymphoma:a. B cell lymphoma.b. T cell lymphoma.
II. Hodgkin lymphoma.II. Hodgkin lymphoma.
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I. Non-Hodgkin’s I. Non-Hodgkin’s lymphomalymphoma
(NHL)(NHL)
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B. Cell lymphomasB. Cell lymphomasA. Precursor B. cell lymphoma: • Lymphoblastic leukemia/ Iymphoma
B. Peripheral B. Cell lymphoma:• Chronic Iymphocytic leukemia/small Iymphocytic Iymphoma.• Lymphoplasmacytic lymphoma• Mantle cell Iymphoma:• Follicular Iymphoma• Marginal Zone Lymphoma.• Burkitt Iymphoma
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• B-cell lymphomas constitute the vast majority of lymphomas, accounting for nearly 90% of all lymphomas.
• Immunosuppression, specifically due to HIV infection and immunosuppressive therapy, is associated with a markedly increased incidence of developing mature B-cell lymphomas, particularly diffuse large B-cell lymphoma and Burkitt's lymphoma.
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• Diffuse large B-cell lymphoma and follicular lymphoma are the most common types.
• Follicular lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma. marginal zone B-cell lymphoma and lymphoplasmacytic lymphoma, which are generally indolent, but incurable and usually present in a disseminated stage with bone marrow involvement.
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• Mantle cell lymphoma and diffuse large B-cell lymphoma represent “intermediate-grade B-cell lymphomas” that generally show a more aggressive clinical behavior, but are potentially curable.
• Burkitt's lymphoma and precursor B-lymphoblastic leukemia/lymphoma are high-grade B-cell lymphomas.
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T. CELL and NK cell lymphomasT. CELL and NK cell lymphomasA. Precursor T cell lymphoma: - Lymphoblastic leukemia/lymphoma.
B. Peripheral T-cell and NK cells lymphomas:• Aggressive NK cell leukemia• Nasal and nasal-type NK/T cell Iymphoma.• Mycosis fungoides and sezary syndrome .• Angio-immunoblastic T-cell Iymphoma.• Adult T-cell leukemia/lymphoma (HTLV1+).• anaplastic large cell Iymphoma (ALCL).• Peripheral T. cell lymphoma, unspecified.
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• Mature T. cell and natural killer (NK). cell lymphomas are rare, accounting for only 10% to 12% of all Non-Hodgkin lymphoma, and usually are more aggressive than B-cell lymphomas.
• The most common subtypes are peripheral T-cell lymphoma, unspecified and anaplastic large cell lymphoma.
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• In general, T-cell and NK-cell malignancies are much more common in Asia and are linked to viral infection with EBV (NK-cell lymphomas) and human T-cell leukemia virus (HTLV-1) (adult T-cell leukemia/lymphoma).
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* Sites for non Hodgkin lymphoma:
A. Nodal lymphoma:- Start in the lymph nodes.
B. Extra-nodal lymphoma: - Intestine - Central nervous system - Skin - Brain - testis - spleen - ovary
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* Clinical manifestations:• Asymptomatic.• Weight loss, anorexia.• Local manifestations:
• lymphadenopathy, splenomegaly most common• any tissue can be infiltrated .e.g brain, intestine,
testis,……
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* Diagnosis of lymphoma:
A. Gross examination:- The affected tissue (lymph node, spleen, others are enlarged, soft fleshy, grayish with foci of hemorrhage and necrosis)
B. Microscopic examination: requires an adequate biopsy before treatment is initiated so we do :
- Haematoxylin and eosin stained sections.
- immunohistochemical stained sections using tumor markers.
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NHL, Lymph nodes
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NHL, Spleen
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NHL, small intestine
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* Microscopic picture of Non Hodgkin lymphoma:• Lost normal histologic architecture of the lymph
nodes.• Diffuse infiltration of the lymph node by
monoclonal type of malignant lymphocytes.• Immunohistochemical staining can help in the
diagnosis as: - T cell lymphoma are +ve for CD3.- B cell Lymphoma are +ve for CD20
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Microscopic picture of reactive lymphoid follicles
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Non Hodgkin Lymphoma (H&E)
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Intestinal lymphoma
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Immuno-histochemical diagnosis for NHL using CD20 for B cell lymphoma
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Hodgkin lymphoma
Thomas Hodgkin(1798-1866)
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* Epidemiology of Hodgkin’s lymphoma:
• Less frequent than non-Hodgkin lymphoma.• Peak incidence: two peaks; 15-35 and 50-70
years. • The patients usually presented by enlarged
lymph nodes and may be associated with systemic manifestations in advanced cases.
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Classical Hodgkin Lymphoma
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* Etiology of Hodgkin’s lymphoma:
• Epstein Bar Virus infection.• May associate Human Immunodeficiency Virus
infection.• possible genetic predisposition.
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* A possible model of pathogenesis:
germinalcentreB cell
transformingevent(s)
loss of apoptosis
RS cellinflammatory
response
EBV?
cytokines
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* Cell of origin: •B-lymphocyte present in germinal centre can change to Reed-Sternberg cells which is the malignant cell. •The surrounding white blood cells in the affected lymph node are reactive cells ( polyclonal) not neoplastic cells.
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Hodgkin lymphoma
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Reed-Sternberg cell
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* Microscopic picture of Hodgkin lymphoma:
• Lost normal histologic architecture of the lymph node and replacement by:
• Reed sternberg giant cells. • Reactive mixed inflammatory cells. • Immunohistochemically: • R.S cell is +ve for CD15, CD30.
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* Classification of Hodgkin's lymphoma:
A. Nodular lymphocyte predominance Hodgkin Iymphoma.B. Classical Hodgkin Iymphoma which include:
– Nodular sclerosis HL.– lymphocyte predominance HL.- Lymphocyte depleted HL.– Mixed cellularity HL.
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RS cell and variants
popcorn celllacunar cellclassic RS cell(mixed cellularity
Hodgkin lymphoma)(nodular sclerosisHodgkin lymphoma)
(lymphocytePredominanceHodgkin lymphoma)
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Stage I Stage II Stage III Stage IV
* Staging of Hodgkin lymphoma:
A: absence of B symptomsB: fever, night sweats, weight loss
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