Non-Hodgkin lymphoma classification: Difference between revisions

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__NOTOC__
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{{Non-Hodgkin lymphoma}}  
{{Non-Hodgkin lymphoma}}  
{{CMG}}; {{AE}} {{AS}}
{{CMG}}; {{AE}} {{Preeti}}
==Overview==
==Overview==
Non-Hodgkin lymphoma may be classified according to updated REAL/WHO classification into 2 groups: B-cell neoplasms and T-cell and putative NK-cell neoplasms. Non-Hodgkin lymphoma may be classified based on rate of growth into 2 Groups:low-grade or indolent lymphoma and high-grade or aggressive lymphoma.
Non-Hodgkin lymphoma may be classified into subtypes according to updated [[WHO]] classification and rate of growth.
==Classification of Non-Hodgkin lymphoma==
==Classification==
===A. Updated REAL/WHO classification===
===A. Updated WHO classification (2016)===
* Non-Hodgkin lymphoma may be classified according to updated REAL/WHO classification into 2 groups:<ref name=”cancergov”>National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/publications/pdq</ref>
* Non-Hodgkin lymphoma may be classified according to updated [[WHO]] classification into 2 groups:<ref name="pmid26980727">{{cite journal |vauthors=Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES |title=The 2016 revision of the World Health Organization classification of lymphoid neoplasms |journal=Blood |volume=127 |issue=20 |pages=2375–90 |date=May 2016 |pmid=26980727 |pmc=4874220 |doi=10.1182/blood-2016-01-643569 |url=}}</ref><ref name="”cancer">National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/publications/pdq</ref>
* B-cell neoplasms
:* B-cell neoplasms
* T-cell and putative NK-cell neoplasms
:* T-cell and putative NK-cell neoplasms
{| class="wikitable"
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! style="text-align: center; font-weight: bold;" | B-cell neoplasms
|+ '''Updated WHO classification of Non-Hodgkin lymphoma'''
! style="text-align: center; font-weight: bold;" | T-cell and putative NK-cell neoplasms
! style="background: #4479BA; color:#FFF; text-align: center; font-weight: bold;" | B-cell neoplasms
! style="background: #4479BA; color:#FFF; text-align: center; font-weight: bold;" | T-cell and putative NK-cell neoplasms
|-
|-
| style="text-align: center; font-weight: bold;" | Precursor B-cell neoplasm
| style="padding: 5px 5px; background: #DCDCDC; text-align: center;" | '''Precursor B-cell neoplasm'''
| style="text-align: center; font-weight: bold;" | Precursor T-cell neoplasm
| style="padding: 5px 5px; background: #DCDCDC; text-align: center;" | '''Precursor T-cell neoplasm'''
|-
|-
| Precursor B-acute lymphoblastic leukemia/[[lymphoblastic lymphoma]] (LBL)
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Precursor B-acute lymphoblastic leukemia / [[lymphoblastic lymphoma]] (LBL)
| Precursor T-acute lymphoblastic leukemia / [[lymphoblastic lymphoma]] (LBL)
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Precursor T-acute lymphoblastic leukemia / [[lymphoblastic lymphoma]] (LBL)
|-
|-
| style="text-align: center; font-weight: bold;" | Peripheral B-cell neoplasms
| style="padding: 5px 5px; background: #DCDCDC; text-align: center; font-weight: bold;" | Mature B-cell neoplasms
| style="text-align: center; font-weight: bold;" | Peripheral T-cell and NK-cell neoplasms
| style="padding: 5px 5px; background: #DCDCDC; text-align: center; font-weight: bold;" | Peripheral T-cell and NK-cell neoplasms
|-
|-
| B-cell CLL / [[small lymphocytic lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Chronic lymphocytic leukemia]] / [[Chronic lymphocytic leukemia|small lymphocytic lymphoma]]
| T-cell CLL / prolymphocytic leukemia
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[T-cell prolymphocytic leukemia]]
|-
|-
| B-cell pro lymphocytic leukemia
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Monoclonal B-cell lymphocytosis]]
| [[T-cell granular lymphocytic leukemia]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[T-cell granular lymphocytic leukemia]]
|-
|-
| [[Lymphoplasmacytic lymphoma]] / immunocytoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[B-cell prolymphocytic leukemia]]
| [[Mycosis fungoides]] / [[Sézary syndrome]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Chronic lymphoproliferative disorder of NK cells]]
|-
|-
| [[Mantle cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Splenic marginal zone lymphoma]] (± villous lymphocytes)
| [[Peripheral T-cell lymphoma]], not otherwise characterized
 
Splenic B-cell lymphoma/leukemia, unclassifiable
 
1. Splenic diffuse red pulp small B-cell lymphoma
 
2. Hairy cell leukemia-variant
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Aggressive NK-cell leukemia]]
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Hairy cell leukemia]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Systemic EBV positive T-cell lymphoma of childhood
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Lymphoplasmacytic lymphoma
[[Waldenström's macroglobulinemia|Waldenström's macroglubulinemia]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Hydroa vacciniforme like lymphoproliferative disorder
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Monoclonal gammopathy of undetermined significance]] (MGUS),
* IgM
* IgG/A
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Adult T-cell leukemia/lymphoma]]
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Heavy chain disease]]
* µ heavy-chain disease
* ɣ heavy-chain disease
* α heavy-chain disease
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Extranodal T/NK-cell lymphoma, nasal type
|-
|-
| [[Follicular lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Multiple myeloma|Plasma cell myeloma]] (multiple myloma)
| Hepatosplenic gamma / delta T-cell lymphoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Enteropathy-type intestinal T-cell lymphoma|Enteropathy associated intestinal T-cell lymphoma]]
|-
|-
| Extra nodal marginal zone B-cell lymphoma of mucosa-associated lymphatic tissue (MALT) type
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Solitary plasmacytoma of bone
| [[Subcutaneous panniculitis-like T-cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Monomorphic epitheliotropic intestinal T-cell lymphoma
 
|-
|-
| [[Nodal marginal zone B-cell lymphoma]] (± mono cytoid B-cells)
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Extraosseous plasmacytoma
| Angio immunoblastic T-cell lymphoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Indolent T-cell lymphoproliferative disorder of the GI tract
|-
|-
| [[Splenic marginal zone lymphoma]] (± villous lymphocytes)
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Monoclonal immunoglobulin deposition diseases
| Extranodal T-/NK-cell lymphoma, nasal type
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Hepatosplenic T cell lymphoma|Hepatosplenic T-cell lymphoma]]
|-
|-
| [[Hairy cell leukemia]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Extranodal marginal zone lymphoma of [[MALT lymphoma|mucosa-associated lymphoid tissue]] (MALT lymphoma)
| [[Enteropathy-type intestinal T-cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Subcutaneous panniculitis-like T-cell lymphoma]]
|-
|-
| Plasmacytoma / [[plasma cell myeloma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Nodal marginal zone B-cell lymphoma]] (± monocytoid B-cells)
| Adult T-cell lymphoma / leukemia (human T-lymphotrophic virus [HTLV] 1+)
pediatric
 
[[Nodal marginal zone B-cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Mycosis fungoides]]  
|-
|-
| [[Diffuse large B-cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Follicular lymphoma]]
| [[Anaplastic large cell lymphoma]], primary systemic type
* In situ follicular neoplasia
* Duodenal-type follicular lymphoma
* Pediatric-type follicular lymphoma
 
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Sézary syndrome]]
|-
|-
| [[Burkitt lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Large B-cell lymphoma with IRF4 rearrangement
| Anaplastic large cell lymphoma, primary cutaneous type
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Primary cutaneous CD30 T-cell lymphoproliferative disorders
* Lymphomatoid papulosis
* Primary cutaneous anaplastic large cell lymphoma
|-
|-
|  
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Primary cutaneous follicle centre lymphoma|Primary cutaneous follicle center lymphoma]]
| [[Aggressive NK-cell leukemia]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Primary cutaneous gamma delta T-cell lymphoma
Primary cutaneous CD8 aggressive epidermotropic cytotoxic T-cell lymphoma
 
Primary cutaneous acral CD8 T-cell lymphoma
 
Primary cutaneous CD4 small/medium T-cell lymphoproliferative disorder
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Mantle cell lymphoma]]
In situ mantle cell neoplasia
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Peripheral T-cell lymphoma, NOS  *
[[Peripheral T-cell lymphoma]], not otherwise characterized
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Diffuse large B-cell lymphoma]] (DLBCL), NOS
*Germinal center B-cell type
*Activated B-cell type
*Primary DLBCL of the central nervous system (CNS)
*Primary cutaneous DLBCL, leg type
*DLBCL associated with chronic inflammation
*HHV81 DLBCL, NOS
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Angioimmunoblastic T-cell lymphoma]]
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |T-cell/histiocyte-rich large B-cell lymphoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Follicular T-cell lymphoma
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | EBV1 DLBCL, NOS
EBV1 mucocutaneous ulcer
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Nodal peripheral T-cell lymphoma with TFH phenotype
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Lymphomatoid granulomatosis]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Anaplastic large cell lymphoma]]
* ALK positive
* ALK negitive
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Primary mediastinal large B-cell lymphoma|Primary mediastinal (thymic) large B-cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | Breast implant associated anaplastic large-cell lymphoma
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Intravascular large B-cell lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |ALK1 large B-cell lymphoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |Plasmablastic lymphoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |[[Primary effusion lymphoma]]
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" | [[Burkitt lymphoma]]
Burkitt-like lymphoma with 11q aberration
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
High-grade B-cell lymphoma, NOS*
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|-
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma
| style="padding: 5px 5px; background: #F5F5F5; text-align: left;" |
|}
|}


===B. Classification based on rate of growth===
===B. Classification based on rate of growth===
* Non-Hodgkin lymphoma may be classified based on rate of growth into 2 Groups:<ref name=CCS>{{cite web | title = Canadian Cancer Society Grades of non-Hodgkin lymphoma
* Non-Hodgkin lymphoma may be classified based on rate of growth into 2 groups:<ref name="CCS">{{cite web | title = Canadian Cancer Society Grades of non-Hodgkin lymphoma
| url =http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/grading/?region=ab}}</ref>
| url =http://www.cancer.ca/en/cancer-information/cancer-type/non-hodgkin-lymphoma/grading/?region=ab}}</ref>
:* Low-grade or Indolent lymphoma
:* Low-grade or Indolent lymphoma
:* High-grade or Aggressive lymphoma
:* High-grade or Aggressive lymphoma


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ '''Non-Hodgkin lymphoma classification'''
|+ '''Non-Hodgkin lymphoma classification'''
! style="background: #4479BA;; color:#FFF;" | Grade
! style="background: #4479BA;; color:#FFF;" | Grade
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|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | Low-grade or Indolent lymphoma
| style="padding: 5px 5px; background: #F5F5F5;" | Low-grade or Indolent lymphoma
| style="padding: 5px 5px; background: #F5F5F5;" | Tend to grow very slowly, tend to widespread by the time they are diagnosed, often involving the bone marrow and spleen.<BR>Often treated only when symptoms appear.<BR>Can shrink or seem to disappear with treatment, but they tend to come back.<BR>Can change into more aggressive lymphomas.<BR>Have a fairly good prognosis.
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Tend to grow very slowly<BR>
* Tend to be widespread by the time they are diagnosed<BR>
 
* Often involving the [[bone marrow]] and [[spleen]]<BR>
* Often treated only when symptoms appear<BR>
* Can shrink or seem to disappear with treatment, but they tend to come back<BR>
* Can change into more aggressive lymphomas<BR>
* Have a fairly good prognosis
|-
|-
| style="padding: 5px 5px; background: #F5F5F5;" | High-grade or Aggressive lymphoma
| style="padding: 5px 5px; background: #F5F5F5;" | High-grade or Aggressive lymphoma
| style="padding: 5px 5px; background: #F5F5F5;" | Grow quickly and tend to spread to lymph nodes or other organs throughout the body.<BR>Cause symptoms and need treatment right away.<BR>Can frequently be successfully treated with intensive chemotherapy treatment.
| style="padding: 5px 5px; background: #F5F5F5;" |  
* Grow quickly and tend to spread to lymph nodes or other organs throughout the body<BR>
* Cause symptoms and need treatment right away<BR>
* Can frequently be successfully treated with intensive chemotherapy treatment
|}
|}


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Latest revision as of 20:31, 19 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 may be classified into subtypes according to updated WHO classification and rate of growth.

Classification

A. Updated WHO classification (2016)

  • Non-Hodgkin lymphoma may be classified according to updated WHO classification into 2 groups:[1][2]
  • B-cell neoplasms
  • T-cell and putative NK-cell neoplasms
Updated WHO classification of Non-Hodgkin lymphoma
B-cell neoplasms T-cell and putative NK-cell neoplasms
Precursor B-cell neoplasm Precursor T-cell neoplasm
Precursor B-acute lymphoblastic leukemia / lymphoblastic lymphoma (LBL) Precursor T-acute lymphoblastic leukemia / lymphoblastic lymphoma (LBL)
Mature B-cell neoplasms Peripheral T-cell and NK-cell neoplasms
Chronic lymphocytic leukemia / small lymphocytic lymphoma T-cell prolymphocytic leukemia
Monoclonal B-cell lymphocytosis T-cell granular lymphocytic leukemia
B-cell prolymphocytic leukemia Chronic lymphoproliferative disorder of NK cells
Splenic marginal zone lymphoma (± villous lymphocytes)

Splenic B-cell lymphoma/leukemia, unclassifiable

1. Splenic diffuse red pulp small B-cell lymphoma

2. Hairy cell leukemia-variant

Aggressive NK-cell leukemia
Hairy cell leukemia Systemic EBV positive T-cell lymphoma of childhood
Lymphoplasmacytic lymphoma

Waldenström's macroglubulinemia

Hydroa vacciniforme like lymphoproliferative disorder
Monoclonal gammopathy of undetermined significance (MGUS),
  • IgM
  • IgG/A
 Adult T-cell leukemia/lymphoma
Heavy chain disease
  • µ heavy-chain disease
  • ɣ heavy-chain disease
  • α heavy-chain disease
 Extranodal T/NK-cell lymphoma, nasal type
Plasma cell myeloma (multiple myloma) Enteropathy associated intestinal T-cell lymphoma
Solitary plasmacytoma of bone Monomorphic epitheliotropic intestinal T-cell lymphoma
Extraosseous plasmacytoma Indolent T-cell lymphoproliferative disorder of the GI tract
Monoclonal immunoglobulin deposition diseases Hepatosplenic T-cell lymphoma
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) Subcutaneous panniculitis-like T-cell lymphoma
Nodal marginal zone B-cell lymphoma (± monocytoid B-cells)

pediatric

Nodal marginal zone B-cell lymphoma

Mycosis fungoides
Follicular lymphoma
  • In situ follicular neoplasia
  • Duodenal-type follicular lymphoma
  • Pediatric-type follicular lymphoma
 Sézary syndrome
Large B-cell lymphoma with IRF4 rearrangement Primary cutaneous CD30 T-cell lymphoproliferative disorders
  • Lymphomatoid papulosis
  • Primary cutaneous anaplastic large cell lymphoma
Primary cutaneous follicle center lymphoma Primary cutaneous gamma delta T-cell lymphoma

Primary cutaneous CD8 aggressive epidermotropic cytotoxic T-cell lymphoma

Primary cutaneous acral CD8 T-cell lymphoma

Primary cutaneous CD4 small/medium T-cell lymphoproliferative disorder

Mantle cell lymphoma

In situ mantle cell neoplasia

Peripheral T-cell lymphoma, NOS *

Peripheral T-cell lymphoma, not otherwise characterized

Diffuse large B-cell lymphoma (DLBCL), NOS
  • Germinal center B-cell type
  • Activated B-cell type
  • Primary DLBCL of the central nervous system (CNS)
  • Primary cutaneous DLBCL, leg type
  • DLBCL associated with chronic inflammation
  • HHV81 DLBCL, NOS
 Angioimmunoblastic T-cell lymphoma
T-cell/histiocyte-rich large B-cell lymphoma Follicular T-cell lymphoma
EBV1 DLBCL, NOS

EBV1 mucocutaneous ulcer

Nodal peripheral T-cell lymphoma with TFH phenotype
Lymphomatoid granulomatosis Anaplastic large cell lymphoma
  • ALK positive
  • ALK negitive
Primary mediastinal (thymic) large B-cell lymphoma Breast implant associated anaplastic large-cell lymphoma
Intravascular large B-cell lymphoma
ALK1 large B-cell lymphoma
Plasmablastic lymphoma
Primary effusion lymphoma
Burkitt lymphoma

Burkitt-like lymphoma with 11q aberration

High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements

High-grade B-cell lymphoma, NOS*

B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma

B. Classification based on rate of growth

  • Non-Hodgkin lymphoma may be classified based on rate of growth into 2 groups:[3]
  • Low-grade or Indolent lymphoma
  • High-grade or Aggressive lymphoma
Non-Hodgkin lymphoma classification
Grade Description
Low-grade or Indolent lymphoma
  • Tend to grow very slowly
  • Tend to be widespread by the time they are diagnosed
  • Often involving the bone marrow and spleen
  • Often treated only when symptoms appear
  • Can shrink or seem to disappear with treatment, but they tend to come back
  • Can change into more aggressive lymphomas
  • Have a fairly good prognosis
High-grade or Aggressive lymphoma
  • Grow quickly and tend to spread to lymph nodes or other organs throughout the body
  • Cause symptoms and need treatment right away
  • Can frequently be successfully treated with intensive chemotherapy treatment

References

  1. ↑ Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES (May 2016). "The 2016 revision of the World Health Organization classification of lymphoid neoplasms". Blood. 127 (20): 2375–90. doi:10.1182/blood-2016-01-643569. PMC 4874220. PMID 26980727.
  2. ↑ National Cancer Institute. Physician Data Query Database 2015.http://www.cancer.gov/publications/pdq
  3. ↑ "Canadian Cancer Society Grades of non-Hodgkin lymphoma".

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