PathophysioIogy

Most (80 to 85%) NHLs arise from B cells; the remainder arise from T cells or natural killer
cells. Either precursor or mature cells may be involved. Overlap exists between leukemia
and NHL because both involve proliferation of lymphocytes or their precursors. A leukemia-
like picture with peripheral lymphocytosis and bone marrow involvement may be present in
up to 50% of children and in about 20% of adults with some types of NHL. Differentiation
can be difficult, but generally patients with more extensive nodal involvement (especially
mediastinal), fewer circulating abnormal cells, and fewer blast forms in the marrow (< 25%)
are considered to have lymphoma. A prominent leukemic phase is less common in
aggressive lymphomas, except Burkitt's and lymphoblastic lymphomas.
Hypogammaglobulinemia caused by a progressive decrease in immunoglobulin production
occurs in 15% of patients and may predispose to serious bacterial infection
PathophysioIogy
NHLs are tumors originating from lymphoid tissues, mainly of lymph nodes. Various
neoplastic tumor cell lines correspond to each of the cellular components of antigen-
stimulated lymphoid follicles.
NHL represents a progressive clonal expansion of B cells or T cells and/or natural killer
(NK) cells arising from the accumulation of genetic lesions that affect proto-oncogenes or
tumor suppressor genes, resulting in cell immortalization. These oncogenes can be
activated by chromosomal translocations (ie, the genetic hallmark of lymphoid
malignancies), or tumor suppressor loci can be inactivated by chromosomal deletion or
mutation. n addition, the genome of certain lymphoma subtypes can be altered with the
introduction of exogenous genes by various oncogenic viruses. Several cytogenetic lesions
are associated with specific NHLs, reflecting the presence of specific markers of diagnostic
significance in subclassifying various NHL subtypes.
Most NHLs are of B-cell origin (almost 85%); only 15% are derived from T/NK cells, and the
small remainder stem from macrophages. These tumors are characterized by the level of
differentiation, the size of the cell of origin, the origin cell's rate of proliferation, and the
histologic pattern of growth. For many of the B-cell NHL subtypes, the pattern of growth and
cell size may be important determinants of tumor aggressiveness. Tumors that grow in a
nodular pattern, which vaguely recapitulate normal B-cell lymphoid follicular structures, are
generally less aggressive than lymphomas that proliferate in a diffuse pattern. Lymphomas
of small lymphocytes generally have a more indolent course than those of large
lymphocytes, which may have intermediate-grade or high-grade aggressiveness. However,
some subtypes of high-grade lymphomas are characterized by small cell morphology.


PathophysioIogy
The cause of NHL is unknown.
Exposures to viruses & immunosuppression Are thought to related to NHL.
Some believe that both Hodgkin disease & NHL result from an immune defect or
from the activation of an oncogentic virus .
Non-Hodgkin lymphoma cells
Non-Hodgkin lymphoma begins when a lymphocyte (usually a B cell) becomes
abnormal. The abnormal cell divides to make copies of itself