Non-Hodgkin lymphoma (differentiating types of NHL): Difference between revisions

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! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
! colspan="6" rowspan="2" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="6" rowspan="2" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Paraclinical findings
! colspan="2" |Paraclinical findings
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
|-
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! colspan="2" |Lab findings
|-
|-
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! colspan="2" style="background:#4479BA; color: #FFFFFF;" + |Signs
! colspan="2" style="background:#4479BA; color: #FFFFFF;" + |Signs
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |CBC
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" + |WBC
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hb
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
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*Skin blushing or [[flushing]]
*Skin blushing or [[flushing]]
*[[Bone pain]]
*[[Bone pain]]
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:* Nodular lymphocyte predominant: [[CD19]]+, [[CD20]]+, [[CD22]]+, [[CD15]]-, [[CD30]]-
:* Nodular lymphocyte predominant: [[CD19]]+, [[CD20]]+, [[CD22]]+, [[CD15]]-, [[CD30]]-
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* [[EBV infection]]  
* [[EBV infection]]  
|-
|-
! colspan="16" align="center" style="background:#7d7d7d; color: #FFFFFF;" + |Non-Hodgkin's Lymphoma
! colspan="13" align="center" style="background:#7d7d7d; color: #FFFFFF;" + |Non-Hodgkin's Lymphoma
|-
|-
| rowspan="11" |B Cell Lymphoma
| rowspan="11" |B Cell Lymphoma
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| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Extranodal involvement of GI tract, lungs, and CNS
* Extranodal involvement of GI tract, lungs, and CNS
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* CD20
* CD20
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* Extranodal involvement of GI tract, lungs, and CNS
* Extranodal involvement of GI tract, lungs, and CNS
* Mental Retardation
* Mental Retardation
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* Lymphocytosis > 4000/µL
*
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* CD5<sup>+</sup>  
* CD5<sup>+</sup>  
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*[[Dyspnea]]
*[[Dyspnea]]
*Joint pain
*Joint pain
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* CD20+
* CD20+
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*[[Cough]]
*[[Cough]]
*[[Dyspnea]]
*[[Dyspnea]]
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* CD21
* CD21
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* Peripheral nerve compression
* Peripheral nerve compression
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Burkitt lymphoma]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Burkitt's lymphoma]]<ref>Burkitt's Lymphoma. Wikibooks. https://en.wikibooks.org/wiki/Radiation_Oncology/NHL/Burkitt_lymphoma#Pathology Accessed on October,5 2015</ref><ref name="pmid12610094">{{cite journal |author=Bellan C, Lazzi S, De Falco G, Nyongo A, Giordano A, Leoncini L |title=Burkitt's lymphoma: new insights into molecular pathogenesis |journal=J. Clin. Pathol. |volume=56 |issue=3 |pages=188–92 |year=2003 |month=March |pmid=12610094 |pmc=1769902 |doi= |url=http://jcp.bmj.com/cgi/pmidlookup?view=long&pmid=12610094}}</ref><ref name="ChuangYe2007">{{cite journal|last1=Chuang|first1=Shih-Sung|last2=Ye|first2=Hongtao|last3=Du|first3=Ming-Qing|last4=Lu|first4=Chin-Li|last5=Dogan|first5=Ahmet|last6=Hsieh|first6=Pin-Pen|last7=Huang|first7=Wan-Ting|last8=Jung|first8=Yun-Chih|title=Histopathology and Immunohistochemistry in Distinguishing Burkitt Lymphoma From Diffuse Large B-Cell Lymphoma With Very High Proliferation Index and With or Without a Starry-Sky Pattern|journal=American Journal of Clinical Pathology|volume=128|issue=4|year=2007|pages=558–564|issn=0002-9173|doi=10.1309/EQJR3D3V0CCQGP04}}</ref><ref name="pmid977186">{{cite journal| author=Magrath IT, Simon RM| title=Immunosuppression in Burkitt's lymphoma. II. Peripheral blood lymphocyte populations related to clinical status. | journal=Int J Cancer | year= 1976 | volume= 18 | issue= 4 | pages= 399-408 | pmid=977186 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=977186  }}</ref><ref name="pmid25856946">{{cite journal| author=Basavaraj A, Shinde A, Kulkarni R, Kadam DB, Chugh A| title=HIV associated Burkitt's lymphoma. | journal=J Assoc Physicians India | year= 2014 | volume= 62 | issue= 8 | pages= 723-7 | pmid=25856946 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25856946  }}</ref><ref name="RoweFitzsimmons2014">{{cite journal|last1=Rowe|first1=Martin|last2=Fitzsimmons|first2=Leah|last3=Bell|first3=Andrew I|title=Epstein-Barr virus and Burkitt lymphoma|journal=Chinese Journal of Cancer|year=2014|issn=1000467X|doi=10.5732/cjc.014.10190}}</ref><ref name="pmid30290813">{{cite journal| author=Ekemen S, Uzay A, Bassullu N, Dikicioglu-Cetin E, Matsuda K, Ince U et al.| title=Does it take three to tango? An unsuspected multimorbidity of CD8+ T cell lymphoproliferative disorder, malaria, and EBV infection. | journal=Malar J | year= 2018 | volume= 17 | issue= 1 | pages= 349 | pmid=30290813 | doi=10.1186/s12936-018-2497-9 | pmc=6173833 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30290813  }}</ref><ref name="pmid26437030">{{cite journal| author=Kretzmer H, Bernhart SH, Wang W, Haake A, Weniger MA, Bergmann AK et al.| title=DNA methylome analysis in Burkitt and follicular lymphomas identifies differentially methylated regions linked to somatic mutation and transcriptional control. | journal=Nat Genet | year= 2015 | volume= 47 | issue= 11 | pages= 1316-1325 | pmid=26437030 | doi=10.1038/ng.3413 | pmc=5444523 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26437030  }}</ref>
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| align="left" style="background:#F5F5F5;" + |
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
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* [[Night sweats]]
* [[Night sweats]]
* Unexplained [[weight loss]]
* Unexplained [[weight loss]]
| align="center" style="background:#F5F5F5;" + |–
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* [[Abdominal distension|Abdominal distention]]
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* [[Swollen lymph nodes]] in the neck, axilla, or groin
* [[Swollen lymph nodes]] in the neck, axilla, or groin
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* [[Ascites]]
* [[Ascites]]
* [[Proptosis]]
* [[Proptosis]]
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* [[CD19]]
* [[CD19]]
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* "Starry-sky pattern"
* "Starry-sky pattern"
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*[[Mononucleosis|EBV infection]]
*[[HIV AIDS|HIV infection]]
*[[Immunosuppression]]
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |B cell chronic lymphocytic leukemia/small lymphocytic lymphoma<ref name="KleinTu2001">{{cite journal|last1=Klein|first1=Ulf|last2=Tu|first2=Yuhai|last3=Stolovitzky|first3=Gustavo A.|last4=Mattioli|first4=Michela|last5=Cattoretti|first5=Giorgio|last6=Husson|first6=Hervé|last7=Freedman|first7=Arnold|last8=Inghirami|first8=Giorgio|last9=Cro|first9=Lilla|last10=Baldini|first10=Luca|last11=Neri|first11=Antonino|last12=Califano|first12=Andrea|last13=Dalla-Favera|first13=Riccardo|title=Gene Expression Profiling of B Cell Chronic Lymphocytic Leukemia Reveals a Homogeneous Phenotype Related to Memory B Cells|journal=The Journal of Experimental Medicine|volume=194|issue=11|year=2001|pages=1625–1638|issn=0022-1007|doi=10.1084/jem.194.11.1625}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |B cell chronic lymphocytic leukemia/small lymphocytic lymphoma<ref name="KleinTu2001">{{cite journal|last1=Klein|first1=Ulf|last2=Tu|first2=Yuhai|last3=Stolovitzky|first3=Gustavo A.|last4=Mattioli|first4=Michela|last5=Cattoretti|first5=Giorgio|last6=Husson|first6=Hervé|last7=Freedman|first7=Arnold|last8=Inghirami|first8=Giorgio|last9=Cro|first9=Lilla|last10=Baldini|first10=Luca|last11=Neri|first11=Antonino|last12=Califano|first12=Andrea|last13=Dalla-Favera|first13=Riccardo|title=Gene Expression Profiling of B Cell Chronic Lymphocytic Leukemia Reveals a Homogeneous Phenotype Related to Memory B Cells|journal=The Journal of Experimental Medicine|volume=194|issue=11|year=2001|pages=1625–1638|issn=0022-1007|doi=10.1084/jem.194.11.1625}}</ref>
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* Recurrent infections
* Recurrent infections
* Hepatosplenomegaly
* Hepatosplenomegaly
| align="center" style="background:#F5F5F5;" + |↑
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |↓
| align="center" style="background:#F5F5F5;" + |CD5
| align="center" style="background:#F5F5F5;" + |CD5


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|-
|-
! rowspan="3" align="center" style="background:#DCDCDC;" + |Marginal zone lymphoma
! rowspan="3" align="center" style="background:#DCDCDC;" + |Marginal zone lymphoma
! align="center" style="background:#DCDCDC;" + |Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type
! align="center" style="background:#DCDCDC;" + |Extranodal marginal zone B-cell lymphoma of [[MALT lymphoma|mucosa-associated lymphoid tissue]] (MALT) type
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| align="left" style="background:#F5F5F5;" + |
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
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** Deletion 7q21-32
** Deletion 7q21-32
** Translocations of the CDK6 gene located on 7q21  
** Translocations of the CDK6 gene located on 7q21  
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* Hemorrhage
* Hemorrhage
* Dyspepsia
* Dyspepsia
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* Follicular cells in reactive zone
* Follicular cells in reactive zone
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* Sjögren syndrome
* Sjögren syndrome
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Waldenström's macroglobulinemia|Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)]]
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* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
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* [[Petechiae]]
* [[Petechiae]]
* [[Splenomegaly]]
* [[Splenomegaly]]
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| align="left" style="background:#F5F5F5;" + |
* Tartrate-resistant acid phosphatase positive
* CBC
** Decreased [[hemoglobin]] concentration
** Decreased [[platelets]] count
**
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" + |WBC
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hb
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
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| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Precursor T-cell Lymphomas
* Precursor T-cell Lymphomas
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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| align="center" style="background:#F5F5F5;" + |
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* Cutaneous manifestations
* Cutaneous manifestations
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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Revision as of 01:29, 21 January 2019

Non-Hodgkin lymphoma Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Non-Hodgkin's Lymphoma

Differentiating Non-Hodgkin Lymphoma from Other Diseases
Differentiating Types of Non-Hodgkin's Lymphoma

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Case #1

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Overview

Non-Hodgkin lymphoma (differentiating types of NHL)

Differentiating different types of Non-Hodgkin lymphoma. Gold standard for differentiation different types of Non-Hodgkin lymphoma is Biopsy.

Category Disease Etiology Clinical manifestations Paraclinical findings Associated findings
Lab findings
Symptoms Signs Immunochemistry Histopathology
Constitutional symptoms Rash Abdominal pain Diarrhea Mass Other
Hodgkin's Lymphoma[1][2][3][4][5]
  • Activation of (NF-kB)
  • Mutations in JAK-STAT pathway
  • NF-kB leads to activation of many genes like:
- ± -
  • Painless lymphadenopathy with a rubbery consistency.
  • Mostly above the diaphram
  • Effacement of the lymph node architecture by Reed-Sternberg cells .
  • Reed-Sternberg cell is a large often bi-nucleated cells with prominent nucleoli and an unusual immuno phenotype.
Non-Hodgkin's Lymphoma
B Cell Lymphoma Diffuse large B cell lymphoma[6][7][8][9][10][11].
  • Mature B-cell Lymphoma
  • 8q24/MYC translocations
  • Hypermutated immunoglobulin genes
  • Mutation of BCL6, MYC, PAX5, PIM1, RhoH /TTFn, TP53 genes
  • Translocations involving c-MYC, BCL6, and IgH gene.
  • Fever
  • Night sweats
  • weight loss
- + +
  • Extranodal involvement of GI tract, lungs, and CNS
  • CD20
  • CD3
  • CD5
  • CD45
  • CD10
  • BCL-2
  • BCl-6
  • MYC
  • IRF-4/ MUM-1
  • Ki-67

Centroblastic

Immunoblastic

  • > 90% immunoblasts
  • Trapezoid shaped large lymphoid cells with significant basophilic cytoplasm

Anaplastic

  • Very large cells with a round, oval, or polygonal shape that may resemble Reed-Sternberg cells
_
Mantle cell lymphoma[12][13][14][15][16]
  • Fatigue
  • Night sweats
  • Weight Loss
Abdominal distention +
  • Palpable masses in skin, breast, and salivary glands
  • Generalized lymphadenopathy
  • Extranodal involvement of GI tract, lungs, and CNS
  • Mental Retardation
  • CD5+
  • B-cell antigen positive
  • Overexpression of Cyclin D1
  • Germinal centers filled by small-to-medium atypical lymphocytes
  • Nodular appearance
_
B-lymphoblastic leukemia/lymphoma[17][18][19]
  • Precursor B-cell Lymphoma
  • Unknown
  • Inherited mutations of PAX5, ETV6, and TP53
+
  • Painless mass at extranodal sites mainly of the skin, bone and lymphnode.
  • CD20+
  • CD10+
  • Consists of small to medium-sized lymphoid cells with blastic nuclear chromatin and a high mitotic rate.
  • Down syndrome
Follicular lymphoma[20][21][22][23][24]
  • Mature B-cell Lymphoma
  • Reciprocal translocation t(14;18)
  • Overexpression of BCL2
20% of patients present with: + + ±
  • Painless peripheral adenopathy in the cervical, axillary, inguinal, and/or femoral regions
  • Asymptomatic large abdominal mass
  • CD21
  • CD23
  • Nodular growth pattern
  • Most common clinically indolent NHL
  • Peripheral nerve compression
Burkitt's lymphoma[25][26][27][28][29][30][31][32]
  • Mature B-cell Lymphoma
  • Translocation of chromosome 8 myc locus such as:
    • t(8;14)
    • t(2;8)
    • t(8;22)
  • Round and small nucleoli
  • basophilic cytoplasm
  • "Starry-sky pattern"
B cell chronic lymphocytic leukemia/small lymphocytic lymphoma[33]
  • Mature B-cell Lymphoma
  • Ch 13 abnormalties

33% of patients present with:

  • Painless lymphadenopathy
  • May be asymptomatic
  • Fatigue
  • Recurrent infections
  • Hepatosplenomegaly
CD5

CD38

  • Monoclonal small well differentiated B cells.
  • Significant number of smudge cells or basket cells..
Marginal zone lymphoma Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type
  • Mature B-cell Lymphoma
Splenic marginal zone lymphoma
  • Mature B-cell Lymphoma
  • Clonal rearrangements of the immunoglobulin genes (heavy and light chains)
    • Deletion 7q21-32
    • Translocations of the CDK6 gene located on 7q21
  • Small lymphocytes
  • Transformed blasts
  • Epithelial histocytes
  • Plasmacytic differentiation of neoplastic cells
Nodal marginal zone B-cell lymphoma
  • Mature B-cell Lymphoma
  • Stimulation of antigen receptor by autoantigen and co-stimulatory molecule CD40
+
  • Hemorrhage
  • Dyspepsia
  • Follicular cells in reactive zone
  • Centrocyte like cells in marginal zone lymphoma
  • Chronic infectious conditions or autoimmune processes, such as
    • H pylori gastritis
  • Hashimoto thyroiditis
  • Sjögren syndrome
Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
  • Mature B-cell Lymphoma
Hairy cell leukemia
  • Production of cytokines, such as TNF alpha and IL-2R, provide important stimuli for malignant B cells proliferation in hairy cell leukemia.
    • The p38-MAPK-JNK cascade
    • The MEK-ERK cascade
    • The Phosphatidylinositol 3 kinase (PI3K)-AKT cascade
  • Small cells with "fried egg"-like appearance
  • Well-demarcated thread-like cytoplasmic extensions
  • Clear cytoplasm
  • Central round nucleus
  • Peri-nuclear clearing ("water-clear rim" appearance)
Category Disease Etiology Constitutional symptoms Rash Abdominal pain Diarrhea Mass Other Immunochemistry Histopathology Associated findings
T cell lymphoma Precursor T-cell lymphoblastic leukemia/lymphoma
  • Precursor T-cell Lymphomas
Adult T cell leukemia/lymphoma
  • Mature T-cell Lymphoma
Anaplastic large cell lymphoma
  • Mature T-cell Lymphoma
Cutaneous T-cell lymphoma Mycosis fungoides / Sézary syndrome
  • Cutaneous manifestations
Peripheral T-cell lymphoma Subcutaneous panniculitis-like T-cell lymphoma
  • Mature T-cell Lymphoma
Hepatosplenic gamma-delta T-cell lymphoma
  • Mature T-cell Lymphoma
Enteropathy-type intestinal T-cell lymphoma
  • Mature T-cell Lymphoma
Extranodal T-cell lymphoma, nasal type
  • Mature T-cell Lymphoma
Angioimmunoblastic T-cell lymphoma
  • Mature T-cell Lymphoma
Peripheral T-cell lymphoma, unspecified
  • Mature T-cell Lymphoma

References

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