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{{B-cell lymphoma}}
{{CMG}}
==Overview==
B-cell lymphomas make up most (about 85%) of the non-Hodgkin lymphomas (NHL) in the United States.  It develops more frequently in immunocompromised individuals (such as those with [[AIDS]].)
== Classification ==
B-cell lymphomas include both [[Hodgkin's lymphoma]]s and most Non-Hodgkins lymphomas. They are typically divided into low and high grade, typically corresponding to indolent (slow-growing) lymphomas and aggressive lymphomas, respectively. . The most commonly used classification system is the WHO classification, a convergence of more than one, older classification systems.
===Most common===
Five account for nearly three out of four patients with non-Hodgkin lymphoma:<ref name="The Lymphomas">{{cite web |url=http://www.leukemia-lymphoma.org/attachments/National/br_1161891669.pdf|title=The Lymphomas |accessdate=2008-04-07 |author= |authorlink= |coauthors= |date=May 2006 |format=PDF |publisher=The Leukemia & Lymphoma Society |pages=p. 12}}</ref>
*[[Diffuse large B cell lymphoma]]
*[[Follicular lymphoma]]
*[[Mucosa-Associated Lymphatic Tissue lymphoma]] (MALT)
*[[Small cell lymphocytic lymphoma]] (overlaps with [[Chronic lymphocytic leukemia]])
*[[Mantle cell lymphoma]] (MCL)
===Rare===
The remaining forms are much less common:<ref name="The Lymphomas" />
*[[Burkitt lymphoma]]
*Mediastinal large B cell lymphoma
*[[Waldenström macroglobulinemia]]
*Nodal marginal zone B cell lymphoma (NMZL)
*[[Splenic marginal zone lymphoma]] (SMZL)
*[[Extranodal marginal zone B cell lymphoma]]
*Intravascular large B cell lymphoma
*[[Primary effusion lymphoma]]
*[[Lymphomatoid granulomatosis]]
*T cell/histiocyte-rich large B-cell lymphoma
*[[Primary central nervous system lymphoma]]
*Primary cutaneous diffuse large B-cell lymphoma, leg type (Primary cutaneous DLBCL, leg type)
*EBV positive diffuse large B-cell lymphoma of the elderly
* Diffuse large B-cell lymphoma associated with inflammation
*[[Intravascular large B-cell lymphoma]]
*ALK-positive large B-cell lymphoma
*Plasmablastic lymphoma
*Large B-cell lymphoma arising in HHV8-associated multicentric Castleman's disease
* B-cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma
*B-cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma
===Others===
Additionally, some researchers separate out lymphomas that appear result from other immune system disorders, such as [[AIDS-related lymphoma]]. Classic [[Hodgkin's lymphoma]] and [[nodular lymphocyte predominant Hodgkin's lymphoma]] are now considered forms of B-cell lymphoma.<ref name="urlHMDS: Hodgkins Lymphoma">{{cite web |url=http://www.hmds.org.uk/hl.html |title=HMDS: Hodgkin's Lymphoma |work= |accessdate=2009-02-01| archiveurl= http://web.archive.org/web/20090304001837/http://www.hmds.org.uk/hl.html| archivedate= 4 March 2009 <!--DASHBot-->| deadurl= no}}</ref>
== Pathophysiology ==
<br />
===Genetics===
[[Chromosomal translocation]]s involving the immunoglobulin heavy locus (IGH@) is a classic cytogenetic abnormality for many B-cell lymphomas, including [[follicular lymphoma]], [[mantle cell lymphoma]] and [[Burkitt's lymphoma]]. In these cases, The immunoglobulin heavy locus forms a [[fusion protein]] with another protein that has pro-proliferative or anti-apoptotic abilities. The enhancer element of the immunoglobulin heavy locus, which normally functions to make B cells produce massive production of antibodies, now induces massive transcription of the fusion protein, resulting in excessive pro-proliferative or anti-apoptotic effects on the B cells containing the fusion protein. In [[Burkitt's lymphoma]] and [[mantle cell lymphoma]], the other protein in the fusion is [[c-myc]] (on chromosome 8) and [[cyclin D1]]<ref name="jy">{{cite journal |author=Li JY, Gaillard F, Moreau A, ''et al.'' |title=Detection of translocation t(11;14)(q13;q32) in mantle cell lymphoma by fluorescence in situ hybridization |journal=Am. J. Pathol. |volume=154 |issue=5 |pages=1449–52 |year=1999 |month=May |pmid=10329598 |pmc=1866594 |doi= 10.1016/S0002-9440(10)65399-0|url=}}</ref> (on chromosome 11), respectively, which gives the [[fusion protein]] pro-proliferative ability. In [[follicular lymphoma]], the fused protein is [[Bcl-2]] (on chromosome 18), which gives the fusion protein anti-apoptotic abilities.
===Microscopic Pathology===
Shown below is a microscopic image of Hodgkins Lymphoma which is a type of B cell lymphoma.Lymph node FNA specimen(Field's stain) The micrograph shows a mixture of  cells commonly seen in Hodgkins lymphoma:
*Eosinophils
*Reed Sternberg cells
*Plasma cells
*Histiocytes
[[File:800px-Hodgkin_lymphoma_cytology_large.jpg|center|300x300px]]
<br />
<br />
== Treatment ==
=== Medical Therapy ===
*Treatment includes radiation and chemotherapy.
*Early-stage indolent B-cell lymphomas can often be treated with radiation alone, with long-term non-recurrence.
*Early-stage aggressive disease is treated with chemotherapy and often radiation, with a 70-90% cure rate.<ref name="mmhe">[http://www.merck.com/mmhe/sec14/ch177/ch177c.html Merck Manual home edition], Non-Hodgkin Lymphomas</ref>
* Late-stage indolent lymphomas are sometimes left untreated and monitored until they progress.
*Late-stage aggressive disease is treated with chemotherapy, with cure rates of over 70%.<ref name="mmhe">[http://www.merck.com/mmhe/sec14/ch177/ch177c.html Merck Manual home edition], Non-Hodgkin Lymphomas</ref><br />
==References==
{{reflist|2}}
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Revision as of 16:09, 6 November 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

B-cell lymphomas make up most (about 85%) of the non-Hodgkin lymphomas (NHL) in the United States. It develops more frequently in immunocompromised individuals (such as those with AIDS.)

Classification

B-cell lymphomas include both Hodgkin's lymphomas and most Non-Hodgkins lymphomas. They are typically divided into low and high grade, typically corresponding to indolent (slow-growing) lymphomas and aggressive lymphomas, respectively. . The most commonly used classification system is the WHO classification, a convergence of more than one, older classification systems.

Most common

Five account for nearly three out of four patients with non-Hodgkin lymphoma:[1]

Rare

The remaining forms are much less common:[1]

Others

Additionally, some researchers separate out lymphomas that appear result from other immune system disorders, such as AIDS-related lymphoma. Classic Hodgkin's lymphoma and nodular lymphocyte predominant Hodgkin's lymphoma are now considered forms of B-cell lymphoma.[2]

Pathophysiology


Genetics

Chromosomal translocations involving the immunoglobulin heavy locus (IGH@) is a classic cytogenetic abnormality for many B-cell lymphomas, including follicular lymphoma, mantle cell lymphoma and Burkitt's lymphoma. In these cases, The immunoglobulin heavy locus forms a fusion protein with another protein that has pro-proliferative or anti-apoptotic abilities. The enhancer element of the immunoglobulin heavy locus, which normally functions to make B cells produce massive production of antibodies, now induces massive transcription of the fusion protein, resulting in excessive pro-proliferative or anti-apoptotic effects on the B cells containing the fusion protein. In Burkitt's lymphoma and mantle cell lymphoma, the other protein in the fusion is c-myc (on chromosome 8) and cyclin D1[3] (on chromosome 11), respectively, which gives the fusion protein pro-proliferative ability. In follicular lymphoma, the fused protein is Bcl-2 (on chromosome 18), which gives the fusion protein anti-apoptotic abilities.

Microscopic Pathology

Shown below is a microscopic image of Hodgkins Lymphoma which is a type of B cell lymphoma.Lymph node FNA specimen(Field's stain) The micrograph shows a mixture of cells commonly seen in Hodgkins lymphoma:

  • Eosinophils
  • Reed Sternberg cells
  • Plasma cells
  • Histiocytes



Treatment

Medical Therapy

  • Treatment includes radiation and chemotherapy.
  • Early-stage indolent B-cell lymphomas can often be treated with radiation alone, with long-term non-recurrence.
  • Early-stage aggressive disease is treated with chemotherapy and often radiation, with a 70-90% cure rate.[4]
  • Late-stage indolent lymphomas are sometimes left untreated and monitored until they progress.
  • Late-stage aggressive disease is treated with chemotherapy, with cure rates of over 70%.[4]

References

  1. ↑ 1.0 1.1 "The Lymphomas" (PDF). The Leukemia & Lymphoma Society. May 2006. pp. p. 12. Retrieved 2008-04-07.
  2. ↑ "HMDS: Hodgkin's Lymphoma". Archived from the original on 4 March 2009. Retrieved 2009-02-01.
  3. ↑ Li JY, Gaillard F, Moreau A; et al. (1999). "Detection of translocation t(11;14)(q13;q32) in mantle cell lymphoma by fluorescence in situ hybridization". Am. J. Pathol. 154 (5): 1449–52. doi:10.1016/S0002-9440(10)65399-0. PMC 1866594. PMID 10329598. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 Merck Manual home edition, Non-Hodgkin Lymphomas


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