Non Hodgkin Lymphoma Lecture Notes PDF

Dr. Shahzada Khalid Sohail Assistant professor Pathology department Last updated: Sep 2024 1 3  Lymphadenopathy (enlargement of lymph nodes) Localized:  Infections: Streptococcus, Mycobacterium  Primary malignancy:...

Dr. Shahzada Khalid Sohail Assistant professor Pathology department Last updated: Sep 2024 1 3  Lymphadenopathy (enlargement of lymph nodes) Localized:  Infections: Streptococcus, Mycobacterium  Primary malignancy: Hodgkin lymphoma  Metastatic malignancy: Axillary LN (breast cancer) P Generalized:  Infections: HIV, EBV, syphilis, Mycobacterium  Lympho/ myelo proliferative disorders: NHL  Autoimmune: SLE, Rheumatoid arthritis  Drugs: Allopurinol, Pencillins, Captopril 4 Lymphoma Large group of clonal lymphoid tumors TYPES  Hodgkin Lymphoma  Non Hodgkin Lymphoma NHL I  85% B cell (CD19, CD20)  15% T cell or NK cell (CD3, CD5, CD 4, CD8) 5  WHO classification 6 NHL Pathogenesis Ch zl it Genetic: Mutations, translocations Virus: EBV, HTLV-1, HHV-8 61 us Chronic inflammation: H. pylori associated Autoimmune: Hashimoto thyroiditis 8  1 61 Grading on NHL Degree of differentiation of tumor cells Low grade lymphomas:  Indolent  Slow growing  Example: Follicular lymphoma High grade lymphomas:  Aggressive it  Fast growing  Example: DLBCL, Burkitt lymphoma Intermediate grade:  Moderately aggressive  Example: Mantle cell lymphoma 9  Him in Staging of NHL 6 Spread of the tumor two area ghea 2 10 Diagnostic work up iii Physical examination CBC LDH (prognostic marker in NHL) EBV (Burkitt,It Hodgkin lymphoma) Chest Xray CT scan ( for diagnosis and staging) PET scan Bone marrow biopsy Excisional lymph node biopsy 11  Diffuse large B cell lymphoma Most common lymphoma of adults Heterogeneous group  Mature B-cell mi tumors  Large cell morphology  Aggressive clinical behavior Rearrangements or mutations of BCL6 gene 13  Follicular lymphoma as Most common indolent lymphoma of adults Histopathology: i 2  Nodular growth  Centrocytes : small lymphoid cells with condensed chromatin2 and irregular or cleaved nuclear outlines  Centroblasts: larger cells with nucleoli t (14;18) translocation overexpression of BCL2 In reactive follicles BCL2 is present in mantle zone cells only 14 In follicular lymphoma cells GC show strong BCL2 staining  Burkitt lymphoma Very aggressive tumor of mature B cells Childhood and adolescent Three categories 116 (1) African (endemic)J (2) sporadic (nonendemic) iii (3) occurring in individuals with HIV Is it was High mitotic rate and apoptosis Starry sky appearance Translocations involving the MYC proto-oncogene t(8:14) Infected by EBV 15  Mantle cell lymphoma Moderately aggressive Arise from mantle cells around lymphoid follicles Small lymphocytes, occasionally cleaved Iciness Cyclin D1 gene I t(11:14) 16  Oncogenes wi e r 1461m Proto-oncogenes (normal genes) Role in regulation of proliferation, cell cycle progression, and apoptosis S Potential for becoming oncogenes by amplification, point mutations, and chromosomal translocations etc 17 Oncogene in lymphoma  Clinical significance: o Diagnosis o Targeted therapies  Oncogenes in lymphoma o Bcl-2 T819,18 o Follicular lymphoma, diffuse large B-cell lymphoma o Cyclin D1 11,14 o Mantle cell lymphoma o c-Myc 811 o Burkitt lymphoma o Bcl-6 o Diffuse large B-cell lymphoma, follicular lymphoma 18