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

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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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*[[Fever]]
*[[Fever]]
*[[Weight loss]]
*[[Weight loss]]
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| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |–
| align="center" style="background:#F5F5F5;" + |
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*Painless swelling in the neck, [[axilla]], [[groin]], [[thorax]], and [[abdomen]].
*Painless swelling in the neck, [[axilla]], [[groin]], [[thorax]], and [[abdomen]].
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| align="left" style="background:#F5F5F5;" + |
*Chest pain
*Chest pain
*[[Bone pain]]
*[[Bone pain]]
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*Epithelial histocytes
*Epithelial histocytes
*Plasmacytic differentiation of neoplastic cells
*Plasmacytic differentiation of neoplastic cells
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*[[Hepatitis C]] infection
*[[Hepatitis C]] infection
|-
|-
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*Stimulation of antigen receptor by autoantigen and co-stimulatory molecule CD40
*Stimulation of antigen receptor by autoantigen and co-stimulatory molecule CD40
*[[Mutation|Mutations]] in [[KMT2D]], PTTPRD, [[NOTCH2]], [[KLF2]]
*[[Mutation|Mutations]] in [[KMT2D]], PTTPRD, [[NOTCH2]], [[KLF2]]
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*[[Fever]]
*[[Fever]]
*[[Weight loss]]
*[[Weight loss]]
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* Mutation of the [[MYD88|MYD88 gene]] (L265P)  
* Mutation of the [[MYD88|MYD88 gene]] (L265P)  
* [[Nonsense mutation|Nonsense]] or [[Frameshift mutation|frameshift mutations]] in the CXR4 gene
* [[Nonsense mutation|Nonsense]] or [[Frameshift mutation|frameshift mutations]] in the CXR4 gene
| align="center" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
*[[Weakness]]
*[[Weakness]]
*[[Anorexia]]
*[[Anorexia]]
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* Generalized and local [[lymphadenopathy]]
* Generalized and local [[lymphadenopathy]]
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| align="left" style="background:#F5F5F5;" + |
*Retinal [[hemorrhage]] with [[Blurred vision|blurring of vision]]
*Retinal [[hemorrhage]] with [[Blurred vision|blurring of vision]]
*[[Vertigo]]
*[[Vertigo]]
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*[[Ataxia]]
*[[Ataxia]]
*[[Bleeding]]
*[[Bleeding]]
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| align="left" style="background:#F5F5F5;" + |
* Express pan B-cell antigens ([[CD19]], [[CD20]], [[CD22]], [[CD79A]]) and [[CD5]]
* Express pan B-cell antigens ([[CD19]], [[CD20]], [[CD22]], [[CD79A]]) and [[CD5]]
* Variable expression of [[CD11c]], [[CD43]], and [[CD25]]
* Variable expression of [[CD11c]], [[CD43]], and [[CD25]]
* Most express [[IgM]] surface immunoglobulin, while fewer express [[IgG]] or [[Immunoglobulin A|IgA]] and lack [[Immunoglobulin D|IgD]]
* Most express [[IgM]] surface immunoglobulin, while fewer express [[IgG]] or [[Immunoglobulin A|IgA]] and lack [[Immunoglobulin D|IgD]]
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* Russell bodies (intracytoplasmic inclusions) and Dutcher bodies (intranuclear inclusions)
* Russell bodies (intracytoplasmic inclusions) and Dutcher bodies (intranuclear inclusions)
* Prominent epithelioid histiocytes
* Prominent epithelioid histiocytes

Revision as of 16:09, 21 January 2019

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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[34][35][36][37][38][39][40][41][42][43]
  • Mature B-cell Lymphoma
  • Recurrent translocation of s such as:
    • t(1;14)(p22;q32)
    • t(11;18)(q21;q21)
    • t(14;18)(q32;q21)
    • t(3;14)(p14.1;q32)
  • B symptoms may or may not be present
± + +
  • Presence of dense diffuse lymphoid infiltrate of marginal‐zone cells in lamina propria
  • prominent lymphoepithelial lesions and consisting of small atypical cells with monocytoid features.
Splenic marginal zone lymphoma[44][45][46][47][48][49][50]
  • 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[51][52]
  • Mature B-cell Lymphoma
  • Stimulation of antigen receptor by autoantigen and co-stimulatory molecule CD40
  • Mutations in KMT2D, PTTPRD, NOTCH2, KLF2
+
  • 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)[53][54][55]:

[56][57]

+
  • Russell bodies (intracytoplasmic inclusions) and Dutcher bodies (intranuclear inclusions)
  • Prominent epithelioid histiocytes
Hairy cell leukemia[58][59][60][61][62]
  • 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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