Lymphomas
Lymphomas+ Multiple Choice QuestionsBy Mojgan Talebian1
DefinitionSolid tumors of the immune systemArise from cells of
lymphoid tissues; lymphocytes, histiocytes, and reticulum
cellsAnywhere in the immune system, but usually in lymph nodes,
spleen, marrow, and tonsilsLocation and the behavior of lymphomas
separate them from leukemiasThe malignancy starts and restricted to
lymphoid tissues and progress to involve the BM and appears in PB,
at this stage it may be named, lymphosarcoma cell leukemia2
Classifications of Lymphomas
A heterogeneous disorder
Hodgkin lymphoma or Hodgkin disease Lymphocytic lymphomas or
referred to as non-Hodgkins lymphoma (NHLs), most cases are
fatal
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Staging of LymphomasBased on the following categoriesPhysical
examination, measurement of the enlarged lymph node/spleenBone
marrow examination, Aspirate/biopsyRadiology studies/CT
scansHematology studiesChemistry tests; pr electrophoresis, kidney
and liver function testsLapratomy to determine the spread of the
diseaseLymph node biopsy/histological features
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Ann arbor stagingStage Ionly 1 lymph node area or lymphoid organ
(I)1 area of a single organ outside of the lymph system (IE)Stage
IIon the same side of the diaphragm(above or below)in 2 or more
groups of lymph nodes ( II)extends from a single group of lymph
node(s) into a nearby organ (IIE)Stage IIIin lymph node areas on
both sides of (above and below) the diaphragmIt may also have
spread into an area or organ next to the lymph nodes (IIIE), into
the spleen (IIIS), or both (IIISE).Stage IVspread outside the lymph
system into an organ that is not right next to an involved
node.spread to the bone marrow(IVM ) , liver ( IVL), brain or
spinal cord, or the pleura (thin lining of the lungs
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Staging SubscriptsA, asymptomatic B, presence of any or all of
the following signs:Greater than 10% of total body weight loss in
the last 6 monthsUnexplained fever above 38 C, night sweats6
Hodgkin Lymphoma
A malignant lymphoma with clonal proliferation Unknown etiology
majority of cases both classical HL(CHL) and nodular lymphocyte
predominant HL(NLPHL) are clonal proliferation of B cellsmay caused
by infectious transmission in the host:Epidemiologic evidence
Presence of two peaks period of onsetRecovery of the EB Virus DNA
from lesions of approximately 80% of cases of HLcertain RNA tumor
virusesCMV, herpes virus 6Presence of Reed-Sternberg cells
accompanied with H-cells (malignant histiocytes), these cells are
surrounded by lymphocytes, plasma cells, and eosinophils 7
Reed Sternberg CellsThe hallmark of the HLVery large cells, 50
-100 m, irregular with abundant pale acidophilic cytoplasm, usually
with 2 lobulated nuclei each contains a gigantic azurophilic
nucleolus with a perinuclear haloThe usual immunophenotypes:
CD45-,CD30+, CD15+These cells can be found in other diseases:
Rubella, EBV, IMN, Toxoplasmosis, T-cell lymphoma, multiple
myeloma8
Morphological Variants of RS Cells
Classical LacunarPopcorn cellsSarcomatous
Each type of these variants is associated with a specific
histological type of HLImmunophenotypes:
More types of RS cells are HLA-DR + expressing T-cell null
lineage receptors for IL-2(CD25+), CD13 +, CD15+, CD45-,CD30+Not
reactive to B-cell antigensClonal T-cell rearrangement T zone
distributionLymphocyte predominant form of HDRS variant typically
displays Pan B-cell antigens, tendency of invasion to B-cell
areaSome RS variants have feature of monocyte-macrophage lineage;
phagocytic and contain lysozyme and alpha -naphthyl esterase
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Variant of Reed-Sternberg cells (Nondiganostic)
10Mononuclear Hodgkin cell
L& H (popcorn cell)Characteristic cell in NLPHL
Pleomorphic Reed-Sternberg cell
Lacunar cell
Rye classification SystemHistological classification of HD is
based on histological examination of a lymph nodeRye classification
system is a modification of Lukes and Butler systemLymphocyte
predominant, * WHO recognizes it as a distinct form of HD Nodular
sclerosingMixed cellularityLymphocyte depleted* Each classification
is based on: the amount of Lymphocyte presents, the type of RS
cells, and the degree of fibrosis
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WHO ClassificationLymphocyte predominant Classic HDNodular
sclerosing Mixed cellularityLymphocyte rich Lymphocyte
depletion12
WHO:Lymphocyte PredominantPatients: usually young, asymptomatic
and commonly in stage I or II, good prognosis The lymph node:Small
lymphocytes, mature B-cellsVarying number of histiocytesA few
plasma cells
There is no: neutrophils, eosinophils, necrosis and fibrosis RS
variant cells: Popcorn cells/L&H cells in large numbers: small
cells with lobulated nuclei and small nucleoliL&H cells relates
to proliferating germinal center (centroblast) cells
Intra-follicular patternB cells; CD30+ and CD15-
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WHOLymphocyte Predominant
Two types of LPNodular patternMalignant cells surrounded by
lymphocytesMale predominantIn younger patients
Diffuse patternCluster of malignant cells surrounded by loosely
arranged non- malignant reactive T cells
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NLPHLhttp://www.pathpedia.com/
WHO: Classic HD Nodular Sclerosing (NSHL) Common type of HD, 60%
to 80% cases of HLMore common in female patient less than
50Invasion to mediastinumGood prognosis because of the patients
fibrogenic defense Lymph node:Histological pattern: follicular,
birefringent collagenous sclerosisNodules of H-cellsVariable number
of lymphocytes separated by thick bands of collagenT, B, Null
cells; CD30+ and CD15+Classic Reed-Sternberg cellsLacunar RS
cellsAn empty space /lacuna around the nucleusBecause of cytoplasm
shrinkage duringformalin fixation
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Nodular Sclerosis HL
16Nodular Sclerosis HL, Collagen bands between the lymphoid
tissue
Classic HD:Mixed Cellularity (MCHL)15% to 30% cases of
HLPatients usually present in stage III or IV, poor
prognosisHeterogeneous mixed Cellularity:Diffuse or follicular
histologic patternNeoplastic cells outnumber the reactive
cellsNumerous classical RS and RS variants
(mononuclear)Lymphocytes, macrophages, eosinophils and plasma
cells, histiocytesPresence of fibrosis but no collagenT, B and Null
cells;CD30+ and CD15+
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MCHL
Classic HD:Lymphocyte- Rich5% of HL casesRich in small
lymphocytesSmall numbers of classic RS and H cellsClinical and
pathological features more close to Mixed Cellularity HD
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Classic HD:Lymphocyte DepletionRarest (
