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[[File:Subtrochanteric-neck-of-femur-fracture.jpg|400px|thumb|left|xray showing femur fracture [https://radiopaedia.org/cases/spiral-fracture-of-femur source:Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 25704 ]]]
[[File:Subtrochanteric-neck-of-femur-fracture.jpg|400px|thumb|left|xray showing femur fracture [https://radiopaedia.org/cases/spiral-fracture-of-femur source:Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 25704]]]
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==Differentiating NHL==
==Differentiating NHL==
{|
{|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Etiology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Constitutional symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Constitutional symptoms
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! align="center" style="background:#4479BA; color: #FFFFFF;" + |WBC
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hb
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
Line 30: Line 27:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
|-
! rowspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |T cell lymphoma
! rowspan="12" align="center" style="background:#4479BA; color: #FFFFFF;" + |T cell lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |Precursor T-cell lymphoblastic leukemia/lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |Precursor T-cell lymphoblastic leukemia/lymphoma<ref name="pmid28892922">{{cite journal| author=Shelly D, Gujral S| title=Early T-Cell Precursor Acute Lymphoblastic Leukaemia/Lymphoma: Immunohistochemical Evaluation of Four Lymph Node Biopsies. | journal=J Clin Diagn Res | year= 2017 | volume= 11 | issue= 7 | pages= EL01-EL02 | pmid=28892922 | doi=10.7860/JCDR/2017/29352.10164 | pmc=5583929 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28892922  }}</ref><ref name="pmid26276771">{{cite journal| author=You MJ, Medeiros LJ, Hsi ED| title=T-lymphoblastic leukemia/lymphoma. | journal=Am J Clin Pathol | year= 2015 | volume= 144 | issue= 3 | pages= 411-22 | pmid=26276771 | doi=10.1309/AJCPMF03LVSBLHPJ | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26276771  }}</ref>
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Precursor T-cell Lymphomas
* Precursor T-cell Lymphomas
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* [[Fever]]
* [[Fatigue]]
* [[Weight loss]]
* [[Night sweats]]
* [[Skin rash]]
* [[Chest pain]]
| align="center" style="background:#F5F5F5;" + |
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| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* CD3
* CD7
* TDT
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
** Blast-like cells with scant cytoplasm, convoluted nuclei, fine chromatin, indistinct nucleoli,
*** Some lymphoblasts have cytoplasmic pseudopods
| 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;" + |
* males in their teens to early twenties
| align="center" style="background:#F5F5F5;" + |
* lymphadenopathy in cervical, supraclavicular,  axillary ,and mediastinum
| align="center" style="background:#F5F5F5;" + |
* In most patients the mediastinal mass is anterior; associated with pleural effusions.  Can produce such complications as superior vena cava syndrome, tracheal obstruction, and pericardial effusions
|-
! colspan="2" |T-cell granular lymphocytic<ref name="Rose2004">{{cite journal|last1=Rose|first1=M. G.|title=T-Cell Large Granular Lymphocyte Leukemia and Related Disorders|journal=The Oncologist|volume=9|issue=3|year=2004|pages=247–258|issn=1083-7159|doi=10.1634/theoncologist.9-3-247}}</ref><ref name="pmid22800517">{{cite journal| author=Liu EB, Chen HS, Zhang PH, Li ZQ, Sun Q, Yang QY et al.| title=[Hematopathologic features of T-cell large granular lymphocytic leukemia]. | journal=Zhonghua Bing Li Xue Za Zhi | year= 2012 | volume= 41 | issue= 4 | pages= 229-33 | pmid=22800517 | doi=10.3760/cma.j.issn.0529-5807.2012.04.004 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22800517  }}</ref><ref name="pmid15958859">{{cite journal| author=Osuji N, Matutes E, Catovsky D, Lampert I, Wotherspoon A| title=Histopathology of the spleen in T-cell large granular lymphocyte leukemia and T-cell prolymphocytic leukemia: a comparative review. | journal=Am J Surg Pathol | year= 2005 | volume= 29 | issue= 7 | pages= 935-41 | pmid=15958859 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15958859  }}</ref>
!
* clonal proliferation of CD8 T cells
* Constant immune stimulation
* Absence of homeostatic apoptosis
!
* Fatigue
* Lymphadenopathy
* Fever
* Enlarged liver and/or spleen
* Frequent infections
* Night sweats
!
!
!
!
!
!
* CD8
* CD57
* '''TCRαβ'''
* CD3
* CD16
* Granzyme b
* TIA1
!Medium / large lymphocytes with abundant cytoplasm having azurophilic granules
!
!
|-
! colspan="2" |T-cell prolymphocytic leukemia<ref name="pmid23382603">{{cite journal| author=Graham RL, Cooper B, Krause JR| title=T-cell prolymphocytic leukemia. | journal=Proc (Bayl Univ Med Cent) | year= 2013 | volume= 26 | issue= 1 | pages= 19-21 | pmid=23382603 | doi= | pmc=3523759 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23382603  }}</ref>
!
* Abnormal proliferation of mature T cells (post thymic)
!
* [[Fever]]
* [[Fatigue]]
* [[Weight loss]]
* [[Night sweats]]
* [[Skin rash]]
* Hepatomegaly
* Splenomegaly
* Lymphadenopathy
!
!
!
!
!
!
* CD2
* CD3
* CD4
* CD5
* CD7
* CD56
* TCL1
!
** lymphocytes with abundant basophilic, nongranular cytoplasm, atypical nucleus
** cytoplasmic protrusions (blebs)
!
!
|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |Adult T cell leukemia/lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Adult T-cell leukemia|Adult T cell leukemia/lymphoma]]<ref name="pmid18042693">{{cite journal |vauthors=Matutes E |title=Adult T-cell leukaemia/lymphoma |journal=J. Clin. Pathol. |volume=60 |issue=12 |pages=1373–7 |year=2007 |pmid=18042693 |pmc=2095573 |doi=10.1136/jcp.2007.052456 |url=}}</ref><ref name="pmid180426932">Matutes E (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18042693 Adult T-cell leukaemia/lymphoma.] ''J Clin Pathol'' 60 (12):1373-7. [http://dx.doi.org/10.1136/jcp.2007.052456 DOI:10.1136/jcp.2007.052456] PMID: [http://pubmed.gov/18042693 18042693]</ref><ref name="pmid1751370">{{cite journal| author=Shimoyama M| title=Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Group (1984-87). | journal=Br J Haematol | year= 1991 | volume= 79 | issue= 3 | pages= 428-37 | pmid=1751370 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1751370  }}</ref>
| align="left" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
* Human T-lymphotrophic virus 1 infection
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* Hepatospleanomagaly
* Hypercalcemia
* Skin lesions
* Lytic bone lesions
* Elevated LDH
* T-cell deficiency leading immunodeficiency causing opportunistic infection
| align="center" style="background:#F5F5F5;" + | +
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* Adult T-cell leukemia cells are typically [[CD2]], [[CD4]], [[CD5]], and [[CD8]] positive
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* Charecterstic leukemia cells with sharp [[nuclear]] indentations and a prominent [[nucleoli]]
* "Cloverleaf" or "flower" cells
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Hypercalcemia
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| align="center" style="background:#F5F5F5;" + |
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|-
|-
! colspan="2" align="center" style="background:#DCDCDC;" + |Anaplastic large cell lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Anaplastic large cell lymphoma]]<ref name="Al-AhmadMaertens2017">{{cite journal|last1=Al-Ahmad|first1=Selma|last2=Maertens|first2=Vincent|last3=Libeer|first3=Christophe|last4=Schelfhout|first4=Vera|last5=Vanhoenacker|first5=Filip|last6=Boeckx|first6=Nancy|last7=Vandevenne|first7=Marleen|title=The masquerading presentation of a systemic anaplastic large cell lymphoma, ALK positive: a case report and review of the literature|journal=Acta Clinica Belgica|volume=72|issue=6|year=2017|pages=454–460|issn=1784-3286|doi=10.1080/17843286.2017.1312057}}</ref><ref name="pmid25197351">{{cite journal| author=Yu L, Yan LL, Yang SJ| title=Sarcomatoid variant of ALK- anaplastic large cell lymphoma involving multiple lymph nodes and both lungs with production of proinflammatory cytokines: report of a case and review of literature. | journal=Int J Clin Exp Pathol | year= 2014 | volume= 7 | issue= 8 | pages= 4806-16 | pmid=25197351 | doi= | pmc=4152041 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25197351  }}</ref><ref name="pmid28652989">{{cite journal| author=de Campos FPF, Zerbini MCN, Felipe-Silva A, Simões AB, Lovisolo SM, da Fonseca LG et al.| title=Unusual clinical presentation of anaplastic large cell lymphoma. | journal=Autops Case Rep | year= 2014 | volume= 4 | issue= 1 | pages= 21-27 | pmid=28652989 | doi=10.4322/acr.2014.004 | pmc=5470561 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28652989  }}</ref><ref name="pmid17965727">{{cite journal |author=Watanabe M, Ogawa Y, Itoh K |title=Hypomethylation of CD30 CpG islands with aberrant JunB expression drives CD30 induction in Hodgkin lymphoma and anaplastic large cell lymphoma |journal=Lab. Invest. |volume=88 |issue=1 |pages=48–57 |date=January 2008 |pmid=17965727 |doi=10.1038/labinvest.3700696|display-authors=etal}}</ref>
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| align="left" style="background:#F5F5F5;" + |
* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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| align="center" style="background:#F5F5F5;" + |
** [[Fever]]
** [[Weight loss]]
** [[Night sweats]]
** Skin rash
** Chest pain
** [[Abdominal pain]]
** [[Bone pain]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
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* Strongly immunoreactive for [[CD30]], Anaplastic lymphoma kinase (ALK), EMA, and [[vimentin]]
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
*
* Nucleoli tend to be more prominent
* The cytoplasm may be either [[basophilic]] or [[eosinophilic]] and the cell might have many nuclei with dispersed or clumped [[chromatin]]
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Painless swelling in the neck, axilla, groin, thorax, and abdomen
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| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
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|-
|-
! align="center" style="background:#DCDCDC;" + |Cutaneous T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |Cutaneous T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |[[Mycosis fungoides]] / [[Sézary syndrome]]
! align="center" style="background:#DCDCDC;" + |[[Mycosis fungoides]] / [[Sézary syndrome]]<ref name="FossGirardi2017">{{cite journal|last1=Foss|first1=Francine M.|last2=Girardi|first2=Michael|title=Mycosis Fungoides and Sezary Syndrome|journal=Hematology/Oncology Clinics of North America|volume=31|issue=2|year=2017|pages=297–315|issn=08898588|doi=10.1016/j.hoc.2016.11.008}}</ref><ref name="CampbellClark2010">{{cite journal|last1=Campbell|first1=J. J.|last2=Clark|first2=R. A.|last3=Watanabe|first3=R.|last4=Kupper|first4=T. S.|title=Sezary syndrome and mycosis fungoides arise from distinct T-cell subsets: a biologic rationale for their distinct clinical behaviors|journal=Blood|volume=116|issue=5|year=2010|pages=767–771|issn=0006-4971|doi=10.1182/blood-2009-11-251926}}</ref><ref name="VonderheidBernengo2002">{{cite journal|last1=Vonderheid|first1=Eric C.|last2=Bernengo|first2=Maria Grazia|last3=Burg|first3=Günter|last4=Duvic|first4=Madeleine|last5=Heald|first5=Peter|last6=Laroche|first6=Liliane|last7=Olsen|first7=Elise|last8=Pittelkow|first8=Mark|last9=Russell-Jones|first9=Robin|last10=Takigawa|first10=Masahiro|last11=Willemze|first11=Rein|title=Update on erythrodermic cutaneous T-cell lymphoma: Report of the international society for cutaneous lymphomas|journal=Journal of the American Academy of Dermatology|volume=46|issue=1|year=2002|pages=95–106|issn=01909622|doi=10.1067/mjd.2002.118538}}</ref>
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| align="left" style="background:#F5F5F5;" + |
* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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* It is understood that cutaneous t cell lymphoma (maycosis fungoides, Sezary sydrome ) is the result of malignant T cell that derived from a mature CD41 CD45RO1 memory T cells.
* It is understood that cutaneous t cell lymphoma (maycosis fungoides, Sezary sydrome ) is the result of malignant T cell that derived from a mature CD41 CD45RO1 memory T cells.
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* [[Epidermis (skin)|Epidermal]] [[atrophy]] or poikiloderma
* Generalized [[itching]]([[pruritus]])
* [[Pain]] in the affected area of the skin.
* [[Insomnia]]
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]
* [[Weight loss]]
* [[Weight loss]]
* [[Lymphadenopathy]]
* [[Lymphadenopathy]]
* [[Malaise]] and [[fatigue]]
* [[Malaise]] and [[fatigue]]
* [[Anemia]]
* [[Anemia]]
* May progress to [[Sezary syndrome]] (Skin involvement plus hematogenous dissemination)
* May progress to [[Sezary syndrome]]  
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| align="center" style="background:#F5F5F5;" + | +
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* Cutaneous manifestations
* Cutaneous manifestations
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |Beta F1+, [[CD2]]-/+, [[CD3]]+, [[CD3]]- ([[CD4]]-positive variant), [[CD4]]+ ([[CD4]]-positive variant), [[CD4]]-, [[CD5]]-, [[CD7]]+/-, [[CD8]]+, [[CD8]]- ([[CD4]]-positive variant), [[Granzyme B|Granzyme B+]], and [[perforin]]+
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
:* polymorphous inflammatory infiltrate in the dermis that contains small numbers of frankly atypical [[lymphoid]] cells
:* These cells may line up individually along the epidermal basal layer
:* The presence of spongiosis is highly suggestive of mycosis fungoides
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* [[Epidermis (skin)|Epidermal]] [[atrophy]] or poikiloderma
| align="center" style="background:#F5F5F5;" + |
* Generalized [[itching]]([[pruritus]])
| align="center" style="background:#F5F5F5;" + |
* [[Pain]] in the affected area of the skin.
| align="center" style="background:#F5F5F5;" + |
* [[Insomnia]]
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]
|-
|-
! rowspan="6" align="center" style="background:#DCDCDC;" + |Peripheral T-cell lymphoma
! rowspan="6" align="center" style="background:#DCDCDC;" + |Peripheral T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |Subcutaneous panniculitis-like T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |[[Subcutaneous panniculitis-like T-cell lymphoma]]<ref name="seer.cancer.gov">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016</ref><ref name="seer.cancer.gov2">Subcutaneous panniculitis-like T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52df/. Accessed on March 08, 2016</ref><ref name="pmid191959752">{{cite journal| author=Parveen Z, Thompson K| title=Subcutaneous panniculitis-like T-cell lymphoma: redefinition of diagnostic criteria in the recent World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. | journal=Arch Pathol Lab Med | year= 2009 | volume= 133 | issue= 2 | pages= 303-8 | pmid=19195975 | doi=10.1043/1543-2165-133.2.303 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19195975  }}</ref>
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
** [[Fever]]
** [[Chills]]
** [[Weight loss]]
** [[Night sweats]]
** [[Myalgias]]
** Painless swellings on extremities and trunk
| align="center" style="background:#F5F5F5;" + |
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* Positive: BetaF1; [[CD8]]; [[CD30]]; [[CLA]]; T-cell intracellular antigen (T1A1); and [[perforin]]
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
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* atypical lymphoid cells
| align="center" style="background:#F5F5F5;" + |
* [[fat necrosis]]
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* [[karyorrhexis]]
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|-
|-
! align="center" style="background:#DCDCDC;" + |Hepatosplenic gamma-delta T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |[[Hepatosplenic T cell lymphoma|Hepatosplenic  T-cell lymphoma]]<ref name="pmid28058028">{{cite journal| author=van de Meeberg MM, Derikx LA, Sinnige HA, Nooijen P, Schipper DL, Nissen LH| title=Hepatosplenic T-cell lymphoma in a 47-year-old Crohn's disease patient on thiopurine monotherapy. | journal=World J Gastroenterol | year= 2016 | volume= 22 | issue= 47 | pages= 10465-10470 | pmid=28058028 | doi=10.3748/wjg.v22.i47.10465 | pmc=5175260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28058028  }}</ref><ref name="ShiWang2015">{{cite journal|last1=Shi|first1=Yang|last2=Wang|first2=Endi|title=Hepatosplenic T-Cell Lymphoma: A Clinicopathologic Review With an Emphasis on Diagnostic Differentiation From Other T-Cell/Natural Killer–Cell Neoplasms|journal=Archives of Pathology & Laboratory Medicine|volume=139|issue=9|year=2015|pages=1173–1180|issn=0003-9985|doi=10.5858/arpa.2014-0079-RS}}</ref><ref name="pmid22379294">{{cite journal| author=Alsohaibani FI, Abdulla MA, Fagih MM| title=Hepatosplenic T-cell lymphoma. | journal=Indian J Hematol Blood Transfus | year= 2011 | volume= 27 | issue= 1 | pages= 39-42 | pmid=22379294 | doi=10.1007/s12288-010-0051-1 | pmc=3102508 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22379294  }}</ref>
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
* Inflammatory bowel disease
** Organ transplant patients (reciever)
** Immunosuppresent medications
** Thiopurines
** Infliximab
** Cyclophosphamide
** Vincristine
** Doxorubicin
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| align="center" style="background:#F5F5F5;" + |
* [[Fever]]
* [[Fatigue]]
* [[Weight loss]]
* [[Night sweats]]
* [[Skin rash]]
* [[Chest pain]]
* [[Abdominal pain]]
* [[Bone pain]]
* Painless swelling in the neck, axilla, groin, thorax, and abdomen
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* CD2, CD3, CD7, CD16 , CD56  or CD57, TIA1, Granzyme m, Fas ligand,
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* Intermediate sized  tumor cells with clear cytoplasm,  oval nuclei, slightly dispersed condensed chromatin, inconspicuous nucleoli
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|-
|-
! align="center" style="background:#DCDCDC;" + |Enteropathy-type intestinal T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |[[Enteropathy-associated T-cell lymphoma|Enteropathy-type intestinal T-cell lymphoma]]<ref name="DelabieHolte2011">{{cite journal|last1=Delabie|first1=J.|last2=Holte|first2=H.|last3=Vose|first3=J. M.|last4=Ullrich|first4=F.|last5=Jaffe|first5=E. S.|last6=Savage|first6=K. J.|last7=Connors|first7=J. M.|last8=Rimsza|first8=L.|last9=Harris|first9=N. L.|last10=Muller-Hermelink|first10=K.|last11=Rudiger|first11=T.|last12=Coiffier|first12=B.|last13=Gascoyne|first13=R. D.|last14=Berger|first14=F.|last15=Tobinai|first15=K.|last16=Au|first16=W. Y.|last17=Liang|first17=R.|last18=Montserrat|first18=E.|last19=Hochberg|first19=E. P.|last20=Pileri|first20=S.|last21=Federico|first21=M.|last22=Nathwani|first22=B.|last23=Armitage|first23=J. O.|last24=Weisenburger|first24=D. D.|title=Enteropathy-associated T-cell lymphoma: clinical and histological findings from the International Peripheral T-Cell Lymphoma Project|journal=Blood|volume=118|issue=1|year=2011|pages=148–155|issn=0006-4971|doi=10.1182/blood-2011-02-335216}}</ref><ref name="pmid22943012">{{cite journal |vauthors=Bautista-Quach MA, Ake CD, Chen M, Wang J |title=Gastrointestinal lymphomas: Morphology, immunophenotype and molecular features |journal=J Gastrointest Oncol |volume=3 |issue=3 |pages=209–25 |date=September 2012 |pmid=22943012 |pmc=3418529 |doi=10.3978/j.issn.2078-6891.2012.024 |url=}}</ref><ref name="cancer.gov">Enteropathy-associated T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd5315/. Accessed on January 26, 2016</ref>
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
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** [[Fever]]
** [[Weight loss]]
** [[Night sweats]]
** [[Diarrhea]]
** [[Skin rash]]
** [[Chest pain]]
** [[Abdominal pain]]
** [[Bone pain]]
** Painless swelling in the neck, [[axilla]], [[groin]], [[thorax]], and [[abdomen]]
| align="center" style="background:#F5F5F5;" + | +
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| align="center" style="background:#F5F5F5;" + |[[CD3]]+, [[CD4]]-, [[CD5]]-, [[CD7]]+, [[CD30]]+, [[CD56]]+, [[CD103]]+, [[CD8]]+/-, and TCR beta+/-
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** lymphomatous infiltrate with neoplastic large cells
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** May have pleomorphic, multinucleated cells
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** Adjacent mucosa shows villous atrophy, crypt hyperplasia, increased inflammatory cells 
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** lymphocytosis
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|-
|-
! align="center" style="background:#DCDCDC;" + |Extranodal T-cell lymphoma, nasal type
! align="center" style="background:#DCDCDC;" + |Extranodal T-cell lymphoma, nasal type<ref name="Hindawi">Extranodal Natural-Killer/T-Cell Lymphoma, Nasal Type. Hindawi Publishing Corporation. http://www.hindawi.com/journals/ah/2010/627401/. Accessed on February 19, 2016</ref><ref name="cancer.gov2">Extranodal NK-/T-cell lymphoma, nasal type. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd530f/. Accessed on February 02, 2016</ref><ref name="Hindawi2">Extranodal Natural-Killer/T-Cell Lymphoma, Nasal Type. Hindawi Publishing Corporation. http://www.hindawi.com/journals/ah/2010/627401/. Accessed on February 18, 2016</ref>
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
| align="center" style="background:#F5F5F5;" + |
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** [[Fever]]
** [[Weight loss]]
** [[Night sweats]]
** Protrusion of eye
** Swelling of the face
** Discharge from the nose
** Nose bleeds
** Blockage of the nasal passages
** Skin rash
** Chest pain
** [[Abdominal pain]]
** [[Bone pain]]
** Painless swelling in the neck, axilla, groin, thorax, and abdomen
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* Cytoplasmic [[CD3]] epsilon, Granzyme B, perforin, [[CD2]], [[CD56]]
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| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
* medium sized tumor cells and polymorphic infiltrate of non-neoplastic inflammatory cells
| align="center" style="background:#F5F5F5;" + |
* lymphoma cells may be admixed with a polymorphic infiltrate of non-neoplastic inflammatory cells
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|-
|-
! align="center" style="background:#DCDCDC;" + |Angioimmunoblastic T-cell lymphoma
! align="center" style="background:#DCDCDC;" + |Angioimmunoblastic T-cell lymphoma<ref name="who1">{{cite book |last=Swerdlow |first=S.H. |last2=Campo |first2=E. |last3=Harris |first3=N.L. |last4=Jaffe |first4=E.S. |last5=Pileri |first5=S.A. |last6=Stein |first6=H. |last7=Thiele |first7=J. |last8=Vardiman |first8=J.W |chapter=11 Mature T- and NK-cell neoplasms: Angioimmunoblastic T-cell lymphoma |title=WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues |edition=4th |series=IARC WHO Classification of Tumours |volume=2 |publisher=IARC |year=2008 |isbn=9283224310 |url=http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=70&codcch=4002&content=1}}</ref><ref name="quin1">[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=10524524&query_hl=30&itool=pubmed_ExternalLink] Quintanilla-Martinez L, Fend F, Moguel LR, Spilove L, Beaty MW, Kingma DW, Raffeld M, Jaffe ES. "Peripheral T-cell lymphoma with Reed-Sternberg-like cells of B-cell phenotype and genotype associated with Epstein-Barr virus infection." '''Am J Surg Pathol'''. 1999 Oct;23(10):1233-40. PMID: 10524524</ref><ref name="seer">Angioimmunoblastic T-cell lymphoma. Surveillance, Epidemiology, and End Results Program. http://seer.cancer.gov/seertools/hemelymph/51f6cf56e3e27c3994bd52dc/ Accessed on November 27, 2015</ref>
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
| align="center" style="background:#F5F5F5;" + |
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* [[fever]], [[weight loss]], skin rash, [[night sweats]], [[edema]], chest pain, [[abdominal pain]], [[bone pain]], [[fatigue]], [[dark urine]], [[shortness of breath]], [[chronic pain]], swelling of joints and painless swelling in the neck, axilla, groin, thorax, and abdomen
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* [[CD2]], [[CD3]], [[CD4]], [[CD5]], [[CD10]], [[CD20]], and focal positivity for [[CXCL13]]
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* leukocytic infiltrate, represented mostly by elongated cells with marked artifactual changes
| align="center" style="background:#F5F5F5;" + |
* Hyperplastic [[germinal centers]] and [[Reed-Sternberg cells]]
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|-
|-
! align="center" style="background:#DCDCDC;" + |Peripheral T-cell lymphoma, unspecified
! align="center" style="background:#DCDCDC;" + |Peripheral T-cell lymphoma, unspecified<ref name="pmid22760778">{{cite journal |vauthors=Lemonnier F, Couronné L, Parrens M, Jaïs JP, Travert M, Lamant L, Tournillac O, Rousset T, Fabiani B, Cairns RA, Mak T, Bastard C, Bernard OA, de Leval L, Gaulard P |title=Recurrent TET2 mutations in peripheral T-cell lymphomas correlate with TFH-like features and adverse clinical parameters |journal=Blood |volume=120 |issue=7 |pages=1466–9 |date=August 2012 |pmid=22760778 |doi=10.1182/blood-2012-02-408542 |url=}}</ref><ref name="JhaGupta2017">{{cite journal|last1=Jha|first1=KunalKishor|last2=Gupta|first2=SureshK|last3=Saluja|first3=Harpreet|last4=Subedi|first4=Nuwadatta|title=Peripheral T-cell lymphoma, not otherwise specified|journal=Journal of Family Medicine and Primary Care|volume=6|issue=2|year=2017|pages=427|issn=2249-4863|doi=10.4103/jfmpc.jfmpc_323_16}}</ref>
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* Mature T-cell Lymphoma
* Mature T-cell Lymphoma
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
** Fatigue
** Lymphadenopathy (swollen )
** Thirst
** Nausea and vomiting
** Fever
** Skin and bone abnormalities
** Enlarged liver and/or spleen
** Frequent infections
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** CD2, CD3, TCR '''β F1;''' variable CD4, CD5 and CD7
*** Occasional CD56 and cytotoxic granule expression
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| align="center" style="background:#F5F5F5;" + |
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** Clear cytoplasm, resemble Reed-Sternberg cells, with irregular, pleomorphic, hyperchromatic or  nuclei
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** A lot of mitotic figures; very broad cytologic spectrum
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Latest revision as of 20:00, 23 January 2019


xray showing femur fracture source:Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID: 25704


X-ray showing Humerus Fracture source:Case courtesy of Dr Benoudina Samir, Radiopaedia.org, rID: 22063


X-Ray showing Tibial Fracture source:Case courtesy of MD PhD gasssss, Radiopaedia.org, rID: 13768


==References==

Differentiating NHL

Category Disease Etiology Constitutional symptoms Rash Abdominal pain Diarrhea Mass Other Immunochemistry Histopathology Gold standard Associated findings
T cell lymphoma Precursor T-cell lymphoblastic leukemia/lymphoma[1][2]
  • Precursor T-cell Lymphomas
  • CD3
  • CD7
  • TDT
    • Blast-like cells with scant cytoplasm, convoluted nuclei, fine chromatin, indistinct nucleoli,
      • Some lymphoblasts have cytoplasmic pseudopods
  • males in their teens to early twenties
  • lymphadenopathy in cervical, supraclavicular, axillary ,and mediastinum
  • In most patients the mediastinal mass is anterior; associated with pleural effusions. Can produce such complications as superior vena cava syndrome, tracheal obstruction, and pericardial effusions
T-cell granular lymphocytic[3][4][5]
  • clonal proliferation of CD8 T cells
  • Constant immune stimulation
  • Absence of homeostatic apoptosis
  • Fatigue
  • Lymphadenopathy
  • Fever
  • Enlarged liver and/or spleen
  • Frequent infections
  • Night sweats
  • CD8
  • CD57
  • TCRαβ
  • CD3
  • CD16
  • Granzyme b
  • TIA1
Medium / large lymphocytes with abundant cytoplasm having azurophilic granules
T-cell prolymphocytic leukemia[6]
  • Abnormal proliferation of mature T cells (post thymic)
  • CD2
  • CD3
  • CD4
  • CD5
  • CD7
  • CD56
  • TCL1
    • lymphocytes with abundant basophilic, nongranular cytoplasm, atypical nucleus
    • cytoplasmic protrusions (blebs)
Adult T cell leukemia/lymphoma[7][8][9]
  • Mature T-cell Lymphoma
  • Human T-lymphotrophic virus 1 infection
  • Hepatospleanomagaly
  • Hypercalcemia
  • Skin lesions
  • Lytic bone lesions
  • Elevated LDH
  • T-cell deficiency leading immunodeficiency causing opportunistic infection
+
  • Adult T-cell leukemia cells are typically CD2, CD4, CD5, and CD8 positive
  • Charecterstic leukemia cells with sharp nuclear indentations and a prominent nucleoli
  • "Cloverleaf" or "flower" cells
Hypercalcemia
Anaplastic large cell lymphoma[10][11][12][13]
  • Mature T-cell Lymphoma
+ +
  • Strongly immunoreactive for CD30, Anaplastic lymphoma kinase (ALK), EMA, and vimentin
  • Nucleoli tend to be more prominent
  • The cytoplasm may be either basophilic or eosinophilic and the cell might have many nuclei with dispersed or clumped chromatin
Painless swelling in the neck, axilla, groin, thorax, and abdomen
Cutaneous T-cell lymphoma Mycosis fungoides / Sézary syndrome[14][15][16] + +
  • Cutaneous manifestations
Beta F1+, CD2-/+, CD3+, CD3- (CD4-positive variant), CD4+ (CD4-positive variant), CD4-, CD5-, CD7+/-, CD8+, CD8- (CD4-positive variant), Granzyme B+, and perforin+
  • polymorphous inflammatory infiltrate in the dermis that contains small numbers of frankly atypical lymphoid cells
  • These cells may line up individually along the epidermal basal layer
  • The presence of spongiosis is highly suggestive of mycosis fungoides
Peripheral T-cell lymphoma Subcutaneous panniculitis-like T-cell lymphoma[17][18][19]
  • Mature T-cell Lymphoma
Hepatosplenic T-cell lymphoma[20][21][22]
  • Mature T-cell Lymphoma
  • Inflammatory bowel disease
    • Organ transplant patients (reciever)
    • Immunosuppresent medications
    • Thiopurines
    • Infliximab
    • Cyclophosphamide
    • Vincristine
    • Doxorubicin
+ +
  • CD2, CD3, CD7, CD16 , CD56 or CD57, TIA1, Granzyme m, Fas ligand,
  • Intermediate sized tumor cells with clear cytoplasm, oval nuclei, slightly dispersed condensed chromatin, inconspicuous nucleoli
Enteropathy-type intestinal T-cell lymphoma[23][24][25]
  • Mature T-cell Lymphoma
+ + CD3+, CD4-, CD5-, CD7+, CD30+, CD56+, CD103+, CD8+/-, and TCR beta+/-
    • lymphomatous infiltrate with neoplastic large cells
    • May have pleomorphic, multinucleated cells
    • Adjacent mucosa shows villous atrophy, crypt hyperplasia, increased inflammatory cells
    • lymphocytosis
Extranodal T-cell lymphoma, nasal type[26][27][28]
  • Mature T-cell Lymphoma
  • Cytoplasmic CD3 epsilon, Granzyme B, perforin, CD2, CD56
  • medium sized tumor cells and polymorphic infiltrate of non-neoplastic inflammatory cells
  • lymphoma cells may be admixed with a polymorphic infiltrate of non-neoplastic inflammatory cells
Angioimmunoblastic T-cell lymphoma[29][30][31]
  • Mature T-cell Lymphoma
Peripheral T-cell lymphoma, unspecified[32][33]
  • Mature T-cell Lymphoma
    • Fatigue
    • Lymphadenopathy (swollen )
    • Thirst
    • Nausea and vomiting
    • Fever
    • Skin and bone abnormalities
    • Enlarged liver and/or spleen
    • Frequent infections
    • CD2, CD3, TCR β F1; variable CD4, CD5 and CD7
      • Occasional CD56 and cytotoxic granule expression
    • Clear cytoplasm, resemble Reed-Sternberg cells, with irregular, pleomorphic, hyperchromatic or nuclei
    • A lot of mitotic figures; very broad cytologic spectrum
  1. Shelly D, Gujral S (2017). "Early T-Cell Precursor Acute Lymphoblastic Leukaemia/Lymphoma: Immunohistochemical Evaluation of Four Lymph Node Biopsies". J Clin Diagn Res. 11 (7): EL01–EL02. doi:10.7860/JCDR/2017/29352.10164. PMC 5583929. PMID 28892922.
  2. You MJ, Medeiros LJ, Hsi ED (2015). "T-lymphoblastic leukemia/lymphoma". Am J Clin Pathol. 144 (3): 411–22. doi:10.1309/AJCPMF03LVSBLHPJ. PMID 26276771.
  3. Rose, M. G. (2004). "T-Cell Large Granular Lymphocyte Leukemia and Related Disorders". The Oncologist. 9 (3): 247–258. doi:10.1634/theoncologist.9-3-247. ISSN 1083-7159.
  4. Liu EB, Chen HS, Zhang PH, Li ZQ, Sun Q, Yang QY; et al. (2012). "[Hematopathologic features of T-cell large granular lymphocytic leukemia]". Zhonghua Bing Li Xue Za Zhi. 41 (4): 229–33. doi:10.3760/cma.j.issn.0529-5807.2012.04.004. PMID 22800517.
  5. Osuji N, Matutes E, Catovsky D, Lampert I, Wotherspoon A (2005). "Histopathology of the spleen in T-cell large granular lymphocyte leukemia and T-cell prolymphocytic leukemia: a comparative review". Am J Surg Pathol. 29 (7): 935–41. PMID 15958859.
  6. Graham RL, Cooper B, Krause JR (2013). "T-cell prolymphocytic leukemia". Proc (Bayl Univ Med Cent). 26 (1): 19–21. PMC 3523759. PMID 23382603.
  7. Matutes E (2007). "Adult T-cell leukaemia/lymphoma". J. Clin. Pathol. 60 (12): 1373–7. doi:10.1136/jcp.2007.052456. PMC 2095573. PMID 18042693.
  8. Matutes E (2007) Adult T-cell leukaemia/lymphoma. J Clin Pathol 60 (12):1373-7. DOI:10.1136/jcp.2007.052456 PMID: 18042693
  9. Shimoyama M (1991). "Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Group (1984-87)". Br J Haematol. 79 (3): 428–37. PMID 1751370.
  10. Al-Ahmad, Selma; Maertens, Vincent; Libeer, Christophe; Schelfhout, Vera; Vanhoenacker, Filip; Boeckx, Nancy; Vandevenne, Marleen (2017). "The masquerading presentation of a systemic anaplastic large cell lymphoma, ALK positive: a case report and review of the literature". Acta Clinica Belgica. 72 (6): 454–460. doi:10.1080/17843286.2017.1312057. ISSN 1784-3286.
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