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  • lymphoid neoplasms lymphoid neoplasms Rasha M. Abd-Rabh lecturer of pathology faculty of medicine Benha university
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  • Histology Bean shaped structure Bean shaped structure Cortex Cortex paracortex paracortex Medulla Medulla
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  • Lymph nodes are usually bean-shaped, with an indented region known as the hilum. Lymph nodes are usually bean-shaped, with an indented region known as the hilum. They are covered by a collagenous capsule that extends into the body of the node as trabeculae. The body of the lymph node is divided into an outer cortex and an inner medulla. They are covered by a collagenous capsule that extends into the body of the node as trabeculae. The body of the lymph node is divided into an outer cortex and an inner medulla. The cortex contains a high concentration of lymphocytes while the inner medulla is less cellular. The cortex contains a high concentration of lymphocytes while the inner medulla is less cellular.
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  • In the cortex, B-lymphocytes are localized in lymphoid follicles just beneath the capsule. In absence of an active immune response, these follicles are known as. In the cortex, B-lymphocytes are localized in lymphoid follicles just beneath the capsule. In absence of an active immune response, these follicles are known as primary lymphoid follicles. When an immune response is underway, focal points of intense B-cell proliferation known as germinal centers can be found in some follicles. These follicles then become known as secondary lymphoid follicles. When an immune response is underway, focal points of intense B-cell proliferation known as germinal centers can be found in some follicles. These follicles then become known as secondary lymphoid follicles.
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  • The T-lymphocytes are located deeper within the cortex and are diffusely distributed in the paracortical area. The T-lymphocytes are located deeper within the cortex and are diffusely distributed in the paracortical area. In the medulla, parts of the cortical cell mass extends as the medullary cords. This region contains macrophages and antibody-secreting plasma cells. In the medulla, parts of the cortical cell mass extends as the medullary cords. This region contains macrophages and antibody-secreting plasma cells.
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  • Definition include a diverse group of tumors of B-cell, include a diverse group of tumors of B-cell, T-cell, and NK-cell origin. In many instances the phenotype of the In many instances the phenotype of the neoplastic cell closely resembles that of a particular stage of normal lymphocyte differentiation, a feature that is used in the diagnosis and classification of these disorders.
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  • The vast majority (85% to 90%) of lymphoid neoplasms are of B-cell origin, with most of the remainder being T-cell tumors; only rarely are tumors of NK cell origin encountered.
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  • Origin of lymphoid neoplasms
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  • WHO Classifications The WHO 2008 classifications uses morphologic, immunophenotypic, genotypic, and clinical features to sort the lymphoid neoplasms into five broad categories,which are separated according to the cell of origin: The WHO 2008 classifications uses morphologic, immunophenotypic, genotypic, and clinical features to sort the lymphoid neoplasms into five broad categories,which are separated according to the cell of origin: 1. Precursor B-cell neoplasms (neoplasms of immature B cells) 1. Precursor B-cell neoplasms (neoplasms of immature B cells) 2. Peripheral B-cell neoplasms (neoplasms of mature B cells) 2. Peripheral B-cell neoplasms (neoplasms of mature B cells) 3. Precursor T-cell neoplasms (neoplasms of immature T cells) 3. Precursor T-cell neoplasms (neoplasms of immature T cells) 4. Peripheral T-cell and NK-cell neoplasms (neoplasms of mature T cells and NK cells) 4. Peripheral T-cell and NK-cell neoplasms (neoplasms of mature T cells and NK cells) 5. Hodgkin lymphoma (neoplasms of Reed-Sternberg cells and variants) 5. Hodgkin lymphoma (neoplasms of Reed-Sternberg cells and variants)
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  • Pathogenesis Chromosomal translocations and other acquired mutations. Chromosomal translocations and other acquired mutations. Viruses. Viruses. Chronic Immune Stimulation. Chronic Immune Stimulation. Iatrogenic Factors. Iatrogenic Factors.
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  • To diagnose Clinical dataGross examination Microscopic picture Immunophenotyping & cytogenetic
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  • Clinical data: Age, Sex, Site and pattern of involvement, Blood picture. Clinical data: Age, Sex, Site and pattern of involvement, Blood picture. Gross examination: size of lymph node, homogenous, nodular. Gross examination: size of lymph node, homogenous, nodular.
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  • Microscpoic examination: Microscpoic examination: -L.N architecture. -L.N architecture. -Pattern of growth; diffuse, nodular, sinusal. -Pattern of growth; diffuse, nodular, sinusal. -monomorphic or pleomorphic cellular infiltrate. -monomorphic or pleomorphic cellular infiltrate. -Cellular feature -Cellular feature -cell size -cell size -cytoplasm -cytoplasm - Nucleus &chromatin - Nucleus &chromatin -Nucleoli -Nucleoli - mitosis - mitosis - characteristic feature - characteristic feature
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  • Immunophenotping : Immunophenotping : -Monoclonal or polyconal. Clonal rearrangement of IG gene B-cell lymphoma Clonal rearrangement of T cell receptorsT cell lymphoma
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  • PRIMARILY T-CELL ASSOCIATED CD1 :Thymocytes and Langerhans cells CD1 :Thymocytes and Langerhans cells CD3 :Thymocytes, mature T cells CD3 :Thymocytes, mature T cells CD4 :Helper T cells, subset of thymocytes CD4 :Helper T cells, subset of thymocytes CD5 :T cells and a small subset of B cells CD5 :T cells and a small subset of B cells CD8 :Cytotoxic T cells, subset of thymocytes, and some NK cells CD8 :Cytotoxic T cells, subset of thymocytes, and some NK cells PRIMARILY B-CELL ASSOCIATED CD10: Pre-B cells and germinal-center B cells CD10: Pre-B cells and germinal-center B cells CD19: Pre-B cells and mature B cells but not plasma cells CD19: Pre-B cells and mature B cells but not plasma cells CD20 :Pre-B cells after CD19 and mature B cells but not plasma cells CD20 :Pre-B cells after CD19 and mature B cells but not plasma cells CD21:EBV receptor; mature B cells and follicular dendritic cells CD21:EBV receptor; mature B cells and follicular dendritic cells CD23:Activated mature B cells CD23:Activated mature B cells CD79aMarrow pre-B cells and mature B cells CD79aMarrow pre-B cells and mature B cells
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  • 1-Acute Lymphoblastic Leukemia/Lymphoma
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  • (ALLs) are neoplasms composed of immature B (pre-B) or T (pre-T) cells which are referred to as lymphoblasts children and adolescents, but it also occurs in adults (About 50% of the cases present as a mediastinal mass).
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  • Morphology Diffuse &paracortical region. Diffuse &paracortical region. Scant basophilic cytoplasm. Scant basophilic cytoplasm. nuclei somewhat larger than those of small lymphocytes The nuclear chromatin is delicate and finely stippled. In many cases the nuclear membrane is deeply subdivided, imparting a convoluted appearance. nuclei somewhat larger than those of small lymphocytes The nuclear chromatin is delicate and finely stippled. In many cases the nuclear membrane is deeply subdivided, imparting a convoluted appearance. nucleoli are either absent or inconspicuous. nucleoli are either absent or inconspicuous. the mitotic rate is high. the mitotic rate is high. As with other rapidly growing lymphoid tumors, interspersed macrophages ingesting apoptotic tumor cells may impart a starry sky appearance As with other rapidly growing lymphoid tumors, interspersed macrophages ingesting apoptotic tumor cells may impart a starry sky appearance
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  • Differential diagnosis 1- Burkitt lymphoma 2- blastoid variant of mantle cell lymphoma
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  • Immunophenotyping All express TDT ( am marker of thymocytes) 80-85% show T cell markers (CD1, CD2, CD7). 15-20% show B-cell markers (CD19, CD20,). CD99+ve CD34 +ve
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  • 2-Small lymphocytic lymphoma
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  • Low grade B cell lymphoma. Affects middle aged and elderly individuals. It is the most common of the B cell neoplasms to involve the spleen.
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  • - Diffuse effacement of the nodal architecure. - Diffuse effacement of the nodal architecure. -monotonous population. -monotonous population. - -small round mature appearing lymphocytes -clumped chromatin. -clumped chromatin. -inconspicuous nucleoli. -inconspicuous nucleoli. -barely visible cytoplasm. -barely visible cytoplasm. -Scanty mitotic activity. -Scanty mitotic activity. as well as scattered pro-lymphocytes/paraimmunoblasts(large cell with vesicular nuclei and distinct nucleoli, singly or in small aggregates that simulate germinal centers. These formations (known as proliferative centers, growth centers, or pseudofollicles) have an increased number of Ki-67-positive
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  • Diffuse Small sized Scanty cytoplasm Clumped chromatin Inconspicious nucl

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