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Non-Hodgkin Lymphoma

Dr. Raid Jastania


Dec 2006

By the end of this session you should be


able to:
Classify Non-Hodgkin lymphoma
Know the clinical and pathological features of
common Non-Hodgkin B-cell lymphomas
(ALL, CLL, Mantle cell lymphoma, Follicular
lymphoma, Marginal zone lymphoma, DLBCL,
and Burkitt lymphoma)

Classification of Non-Hodgkin
Lymphoma

Classification of Non-Hodgkin
Lymphoma (selected common entities)
Precursor B cell
Acute lymphoblastic
lymphoma

Peripheral B cell
Small lymphocytic
lymphoma SLL, Chronic
lymphocytic leukemia CLL
Mantle cell lymphoma
Follicular lymphoma
Marginal zone lymphoma
Diffuse large B cell
lymphom
Burkitt lymphoma

Precursor T cell
Acute lymphoblastic
lymphoma

Peripheral T cell
Anaplastic large T cell
lymphoma
Peripheral T cell lymphoma

B cell
Precursor

Nave

Morphology
Blast

Small mature

Markers
CD34/TdT
Homing
BM

CD5

Peripheral

Symptoms
BM suppression
Patterns

Mantle

Germinal center Marginal zone

Large transformed

plasma cell

CD20/CD10

CD20 only

LN

Leukemia

LN/extralymphatic

LN involve

mass

Acute lymphoblastic
lymphoma/leukemia (ALL)
Clinical: children, young adults, leukemic,
mediastianl mass (T cell ALL), Bone
marrow involvement, high grade
Pathology: medium size Blasts, uniform
Immuno: TdT, CD 34, CD10, (CD20 or
CD3)

Small lymphocytic lymphoma SLL,


Chronic lymphocytic leukemia CLL
Clinical: low grade, asymptomatic, nodal
and leukemic, elderly 7th, 8th decade
Pathology: small cells, vague nodularity,
proliferation centers
Immuno: CD20, CD23, CD5
Can transform to large cell lymphoma
(Richter transformation)

Mantle cell lymphoma


Clinical: Variable (low grade to aggressive)
>50 year, nodal, GI tract
Pathology: small uniform cells
Immuno: CD20, CD5, CyclinD1
T(11;14) cyclinD1
Transformation to large cell lymphoma is
very rare

Follicular lymphoma
Clinical: Low grade, Nodal, > 40 years
Pathology: large malignant follicles,
mixture of small (centrocytes) and large
cells (centroblasts)
Immuno: CD20, CD10, Bcl-2
T(14;18) Bcl-2 over expression
30% transform to large cell lymphoma

Marginal zone lymphoma


Clinical: nodal or extranodal (MALT), low
grade
Pathology: mixture of small, large
lymphocytes and plasma cells
Immuno: CD20 only
Can transform to large cell lymphoma
Treatment

Diffuse large B-cell lymphoma


Heterogenous group: Denovo, or
transformed low grade lymphoma (FL)
Nodal or extranodal, Intermediate grade
Pathology: Sheets of large cells, mitosis,
apoptosis
Immuno: CD20, most CD10+

Burkitt lymphoma
Clinical: 3 types
1. Endemic: African EBV
2. Sporadic: North America
3. Immunosuppressed (HIV)

Aggressive tumor
Pathology: medium size, high mitosis, apoptosis,
Starry sky pattern
Immuno: CD20, CD10
T(8;14) C-myc over expression

Test