how to diagnose lymphoma - university of leeds€¦ · how to diagnose lymphoma author: blakelyh...
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HOW TO DIAGNOSE LYMPHOMA
Dr Mark Smith Derriford Hospital, Plymouth
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Normal lymphocyte function
Normal lymph node structure
General principles of lymphoma diagnosis
Specific lymphomas
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Lymphocytes produce antigen receptor to
recognise foreign antigen.
EXTERNAL foreign antigen – bacteria
INTERNAL foreign antigen - virus
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B Lymphocytes - Immunoglobulin
B
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Ag
Ag
Ab
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T lymphocytes – T cell receptor
T
MHC class 1
T cell receptor
processed pepticle
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memory
virgin
lymphocyte Centroblast Plasma cell
Foreign Ag
Ab
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HEV
HEV - High Endothelial Venules
Lymph
Lymph
HEV
HEV
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Foreign
antigen in
lymphatics
LYMPH NODE –
CONFLUENCE OF
TWO STREAMS
Lymphocytes
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Lymph Node
Foreign antigen
Lymphocytes
Supporting cells
Macrophages – enhance antigen presentation
Architectural units - factories
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SINUS
GC
PC
MC
MC
Lymph node compartments
GC – germinal centre
PC – paracortex
MC – medullary cord
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Lymphoma
Hodgkin Lymphoma Non-Hodgkin Lymphoma
B T
Low-grade High-grade
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Grade in B-cell NHL
Lymphocytes Blasts
All ‘cytes - low grade
Cytes/blasts – low grade
Blasts – high grade
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• C Y T O L O G I C A L
• A R C H I T E C T U R A L
Malignant Tumour
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Cytological
High nuclear / cytoplasmic ratio
Nuclear pleomorphism
Many mitoses / abnormal mitoses
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Architectural
Invasion
Destruction of normal tissues
Abnormal location
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Lymphoma Diagnosis
Cytologic abnormality
Architectural abnormality
Monotony
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Reactive Lymph Nodes
Polymorphic
Lymphocytes
Blasts
Macrophages
Eosinophils
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Monomorphic v Polymorphic
Sheets of same cell type
Monotony (monomorphic)
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Lymphoma Diagnosis
Morphology
Immunohistochemistry
Molecular biology
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Lymphocyte Antigens
B cell T cell
CD79a CD3
CD20 CD5
CD2
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Aberrant Phenotype
B-cell NHL
CD20 POS
CD5 POS
(CLL and mantle cell lymphoma)
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Aberrant Phenotype
T-cell NHL
CD2 POS
CD3 NEG
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Aberrant Phenotype
CLONALITY
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Immunoglobulin
LIGHT CHAINS
K L
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Reactive
K L K
L K K
K L
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B - NHL
L
L L L
L L
L
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B - NHL
K
K
K
K K
K
K
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Immunohistochemistry
B-cell NHL – aberrant pattern
B-cell NHL - light chain restriction
T-cell NHL - aberrant pattern
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Lymphoma Diagnosis
• Morphology
• Immunohistochemistry
• Molecular biology
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Follicular Hyperplasia
FOLLICULAR PATTERN with follicular dendritic cell (CD21 pos) scaffolding.
POLYMORPHIC
Centroblasts
Centrocytes
Tingible body macrophages
bcl-2 negative follicle centres
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Follicular Lymphoma (B-cell NHL)
Follicular pattern with CD21 scaffolding
Monomorphic
bcl-2 positive follicle centres
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Diffuse large B-cell NHL
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T-CELL NHL