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 Naïve Mantle Germinal center Marginal zone

Morphology

• Blast Small mature Large transformed plasma cell

Markers

• CD34/TdT CD5 CD20/CD10 CD20 only

Homing

• BM Peripheral LN LN/extralymphatic

Symptoms

• BM suppression Leukemia LN involve mass

Patterns

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