Non-Hodgkin lymphoma pathophysiology: Difference between revisions

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Revision as of 21:24, 12 December 2018

Non-Hodgkin lymphoma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Non Hodgkin's Lymphoma represents a heterogeneous group of diseases with varied clinical presentation and histological appearance.It arises from cell of the lymphoid system, tumors are mainly derived from B lymphocytes, but are also from T lymphocytes, or natural killer cells. Lymphomas rise from different stages of B and T cell differentiation. Aberrations in the tightly controlled steps of B cell development can lead to oncogenesis. These aberrations are mainly seen in form of chromosomal translocation.


Pathophysiology

=Pathogenesis

  • Lymphomas can arise from different stages of B cell devevlopment:
  • B cell development starts in the primary lymphoid tissue, the bone marrow and subsequent maturation takes place in secondary lymphoid tissue (spleen and lymph nodes).
  • At the germinal centers of secondary lymphoid tissue B cells encounter antigens via T cells and then undergo affinity maturation to produce immunoglobulins of high affinity.
  • It supports rapid B-cell proliferation for immunoglobulin affinity maturation and production of antibody diversity through two processes know as somatic hypermutation (SHM) and immunoglobulin class switching.
  • Both of these processes require rapid cell turnover and multiple double stranded DNA breaks, which is error-prone.
  • Somatically acquired genetic alterations ( mainly translocations) of these processes is probably the underlying cause of lymphomagenesis.[1][2]
  • The major subtypes of non-hodgkin lymphoma include the following:[3][4]
    • Mature B-cell neoplasms:
      • Burkitt lymphoma
      • Diffuse large B cell lymphoma
      • Mantle cell lymphoma
      • Small lymphocytic lymphoma
      • Follicular lymphoma
      • Extranodal marginal zone lymphoma
      • Splenic marginal zone lymphoma
      • Lymphoplasmacytic lymphoma
    • Mature T and NK neoplasms:
      • Adult T-cell lymphoma
      • Mycosis fungoides
      • Sezary syndrome
      • Peripheral T cell lymphoma

Genetics

NHL Subtype Translocations Genes involves
Burkitt lymphoma t(3q27)

t(11;14)(q13;q32)

Diffuse large B cell lymphoma
Mantle cell lymphoma
Small lymphocytic lymphoma
Follicular lymphoma
Extranodal marginal zone lymphoma
Splenic marginal zone lymphoma
Lymphoplasmacytic lymphoma

[Disease name] is transmitted in [mode of genetic transmission] pattern.

OR

Genes involved in the pathogenesis of [disease name] include:

  • [Gene1]
  • [Gene2]
  • [Gene3]

OR

The development of [disease name] is the result of multiple genetic mutations such as:

  • [Mutation 1]
  • [Mutation 2]
  • [Mutation 3]

Associated Conditions

Conditions associated with [disease name] include:

  • [Condition 1]
  • [Condition 2]
  • [Condition 3]

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

References

  1. Basso K, Dalla-Favera R (March 2015). "Germinal centres and B cell lymphomagenesis". Nat. Rev. Immunol. 15 (3): 172–84. doi:10.1038/nri3814. PMID 25712152.
  2. Nardini E, Aiello A, Giardini R, Colnaghi MI, Ménard S, Balsari A (February 2000). "Detection of aberrant isotype switch recombination in low-grade and high-grade gastric MALT lymphomas". Blood. 95 (3): 1032–8. PMID 10648419.
  3. Coupland SE (2011). "The challenge of the microenvironment in B-cell lymphomas". Histopathology. 58 (1): 69–80. doi:10.1111/j.1365-2559.2010.03706.x. PMID 21261684.
  4. . doi:10.1182/blood-2016- 01-643569 Check |doi= value (help). Missing or empty |title= (help)

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Genetics

The development of Non-Hodgkin lymphoma is the result of multiple genetic mutations such as:[1][2]

  • Mutations of the B-cell receptor genes and NFKB pathway
  • RNA splicing mutations in the small lymphocytic lymphoma
  • Genetic mutations in histone formation:[3]
    • MLL2
    • MEF2B
    • EZH2
    • CREBBP
    • EP300
    • MLL2

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

References

  1. Pasqualucci L, Trifonov V, Fabbri G, Ma J, Rossi D, Chiarenza A; et al. (2011). "Analysis of the coding genome of diffuse large B-cell lymphoma". Nat Genet. 43 (9): 830–7. doi:10.1038/ng.892. PMC 3297422. PMID 21804550.
  2. Lohr JG, Stojanov P, Lawrence MS, Auclair D, Chapuy B, Sougnez C; et al. (2012). "Discovery and prioritization of somatic mutations in diffuse large B-cell lymphoma (DLBCL) by whole-exome sequencing". Proc Natl Acad Sci U S A. 109 (10): 3879–84. doi:10.1073/pnas.1121343109. PMC 3309757. PMID 22343534.
  3. Green MR, Gentles AJ, Nair RV, Irish JM, Kihira S, Liu CL; et al. (2013). "Hierarchy in somatic mutations arising during genomic evolution and progression of follicular lymphoma". Blood. 121 (9): 1604–11. doi:10.1182/blood-2012-09-457283. PMC 3587323. PMID 23297126.


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