Lypmhomas

HL and NHL
· Hodgkin —> Better prognosis. Bimodal: 25-30s and >60s
· NHL -> Children and adults. Don’t have RS cells, spread non-contiguously. Involve extra
nodal sites. Skin, brain and GI tract.
HL

· Histology:
o RS cells. Binuclear. Neoplastic B-cells. Look like owl eyes.
§ Cytokines: IL-5, IL-10, M-CSF, catatoxin
§ NF-kb mutation may occur. Overexpression, Promotes growth, survival and
division of RS cells.
o Hodgkin cells: Large mononucleated version of RS. Surrounded by non-neoplastic
inflammatory cells (mostly T cells and eosinophils).
o Can activate fibroblasts Secretion of collagen PINK

· Classical Hodgkin Lymphoma (CHL)

o -Express CD15 and CD30
o 4 types
§ Nodular sclerosis: Most common. Nodules of collagen. Lacunar cells.
§ Mixed cellularity: Plasma cells, eosinophils, lymphocytes, neutrophils. Common
in immunocompromised patients.
§ Lymphocyte rich: RS cells surrounded by lymphocytes. Best prognosis.
§ Lymphocyte depleted: Least common. Abundance of Hodgkin and RS cells.
Common in immunocompromised patients.
· Non classical Nodular lymphocyte predominant HL.
o Abnormal B cells: Express CD20 and CD45. Don’t have CD15 and CD30
o Responds to Rituximab
o Lymphocyte predominant cells Variant of RS cells
§ Lobulated nucleus like popcorn Popcorn cells
§ Lymphocytes cluster around popcorn cells and form nodules

· NHL: Either B or T cells.

o B cells: More common, express CD20. Can be indolent, aggressive, or highly
aggressive.
· Follicular lymphoma: Indolent. Waxing/waning lymphadenopathy.
Chromosomal translocation t(14;18). BCL2 gene passes to
chromosome 14 which leads to an overexpression of the gene and
blocks apoptosis.
o Forms folicules
 § Centrocytes Majority of the cells. Irregular nuclei. Scant
cytoplasm. Condensed chromatin.
§ Centroblasts Larger. Several nuclei, open chromatin.

· Diffuse large B-cell lymphoma: Aggressive growth, most common NHL

in adults, BCL-6 and BCL 2 mutations.

· Burkitt lymphoma: Highly aggressive. Chromosomal translocation

t(8:14). MYC gene goes to chr. 14 and upregulates cell growth,
metabolism and cell division. Associated with EBV (incorporates AND
into host lymphocytes).
o Extranodal involvement
§ Africa: Jaw
§ Outside: Abdomen GI Ileocecal junction. Bowl
obstruction.
o Histology: Starry sky. B cells with little cytoplasm (sky= and tingle
body macrophages (contain dead neoplasic cells) (stars).

· Mantle cell lymphoma: Highly aggressive. Translocation t(11:14), BCL

gene overexpression, ­Cyclin D1 Stimulates cell growth and cell division
(promotes progression from G1 to S phase).

· Marginal zone lymphoma: Indolent, older people.

o MALT: Extranodal, arising in organs that contain lymphoma GI,
Thymys, Eyes, Lungs.
o Stomach: A risk factor is chronic inflammation (H. pylori, chronic
gastritis)
o Nodal marginal zone lymphoma
o Splenic marginal zone lymphoma Hepatitis C

· Lymphomasmocytic lymphoma: Indolent. Bone marrow, lymph nodes,

spleen.
o Neoplastic cells that produce Ig and increase Ig levels in blood
o Blood becomes slime (viscous)
§ Waldenstrom macroglobulinemia

NHL
· T-cell lymphoma (adult)
o Leukemia (abnormal leukocytes), aggressive, HTLV (Human T lymphotropic virus that
spreds through fluids like IV drugs with needles and breast feeding.
o Increased bone resorpcion.
o Severe hypercalcemia and bone lesions
· Mycosis fungoids
 o Lymphoma of the skin
o Path or plaque like lessions
§ Looks like fungal lessions
o Biopsy
§ Pautrier microabscesses in epidermis: Filled with neoplasic lymphocytes.
§ CD4* helper T cells with CEREBRIFORM nucleus
§ Sezary suncrome Itchy rash, erythema.

Symptoms

Hodgkin Both NHL

Localized lymphoadenopathy Lymphadenopathy Non-localizad most of the time.

· Cervical · Painless
· Supraclavicular · Rubery
· Axillary · Nonerythematous
· Mediastinal (with · Non tender
nodular sclerosis) · HL is the most frequent
with constitutional
symptoms but both
can have it.
Extranodal sites:
· GI tract Illeocecal
junction (Bowls
obstruction in Burkitt)
· Bone marrow:
Decrease in red cells
(anemia), fatigue,
recurrent infections,
easy bruising.
· Oropharyngeal
obstruction
· Spinal cord:
Weakness, loss of
sensation in legs.

DX

Excisional lymph node biopsy Essential first step

Chest CT, abdominal CT Determines staging
Bone marrow biopsy Strongest predictor of prognosis
CBC Normal Can be ­in lymphocytes when transforming to leukemias.