PATHOLOGY OF BLOOD

VESSELS.

HAEMATOPATHOLOGY.

II. practical training

3rd year General Medicine

Myeloproliferative syndrome, polycytemia vera

Myeloproliferative syndrome, polycytemia vera

Extramedullary haematopoiesis

Extramedullary haematopoiesis

Myeloproliferative syndrome, chronic myeloid leukaemia

(Ph+), liver

Myeloproliferative syndrome, chronic myeloid leukaemia

(Ph+), liver

Chronic myeloid leukaemia, lymph node

Myelodysplastic syndrome, bone marrow

Myelodysplastic syndrome, bone marrow

Chronic lymphocytic leukaemia, liver

Malignant lymphoma - classification

Hodgkin’s

non- Hodgkin’s lymphomas

o precursor cells

B

T/NK

o Mature cells

B

T/NK

Follicle center lymphoma

Morphology Mixture of germinal center blasts and cleaved cells (centroblasts and centrocytes). Immunology Surface Ig + CD5 – CD10 ± CD19, 20, 22, 79a + BCL-2 + Genetics t(14;18) & BCL-2 rearrange- ment in majority of cases. Clinical Adults. Indolent course (median survival 7-9 yrs).

Equivalent to

“centroblastic / centrocytic”

and “follicular centroblastic”

lymphomas in Kiel

scheme

H&E

BCL-2

Follicular lymphoma – nodal infiltration,

(Van Gieson staining)

1 1

1

1 nodules of tumour infiltrate

2 capsule of lymph node

2

Follicular lymphoma – nodal infiltration, detail

Centroblasts

Centrocytes

Follicular lymphoma – nodal infiltration (anti-CD 20)

Mantle cell lymphoma

Morphology Small irregularly shaped centrocyte-like cells. Immunology Surface Ig (l>k) + CD5 – CD10 ± CD19, 20, 22, 79a + CD23 – Cyclin D1 + Genetics t(11;14). BCL-1 rearrangement. Clinical Adults. Moderately aggressive course (median survival 3-4 yrs). Equivalent to

“centrocytic lymphoma”

in Kiel scheme

Giemsa

Diffuse large B cell lymphoma

Morphology Monomorphous large cells with prominent nucleoli and basophilic cytoplasm. Immunology Surface Ig +/- Cytoplasmatic Ig -/+ CD5, 10 -/+ CD19, 20, 22, 79a + Genetics t(14;18) in approw 30%. BCL-6 rearranged (40%) and/or mutated (75%). Clinical Chidren or adults. Aggressive course, but may be curable.

Combines

“centroblastic” and

“immunoblastic” categorie

from Kiel scheme

Diffuse large B cell lymphoma

1

2 3

1 gastric foveoles

2 gastric glands

3 tumour infiltrate

4 reactive lymphoid nodule

4

Diffuse large B cell lymphoma – detail

Normal lymphocytes

Tumour centroblasts

Hodgkin’s lymphoma

Classical – diagnostic cells, non-tumorous backround:

o Nodular sclerosis

o Mixed cellularity

o Lymphocyte depleted

o Lymphocyte rich

Nodular lymphocyte predominant: background with

lymphocytes and histiocytes

Diagnostic cells in classical Hodgkin’s lymphoma

Hodgkin’s cells – one nucleus with a large

eosinophilic nucleolus

Reed-Sternberg cells – two nuclei with nucleoli

Sternberg cells – multiple nuclei and nucleoli

Lacunar cells – clear large cytoplasma, small

nucleus

CD20-, CD 79a-, CD 30+, CD 15+, CD 45-, Ig-

Diagnostic cells

Hodgkin

Reed-Sternberg Lacunar

Sternberg

Nodular sclerosis

1

1

1

2

2

Lacunar cells

Mixed cellularity

HD – background

Plasmocyt

Lymfocytes

Eosinophils

Histiocyt

Fibroblast

Spleen infiltration by lymphoma