NON-HODGKINS LYMPHOMA [NHL]

HODGKINS LYMPHOMA

Markers

EBV+, CD15+, CD30+

Bimodal age distribution [same in Crohns]

**REED-STERNBERG CELLS: bi-lobed nucleus prominent

nucleolus [prolif centers]

Subtypes: [1-4 = classical]

1. Lymphocyte Pre-Dom: EXCELLENT prog!
- Lymphohistiocytic cell: NO CD15, 30! Actually a Bcell
therefore has CD19,20!

2. Lymphocyte-rich: EXCELLENT prog!

Notes 3. Mixed Cellularity: Good prog
4. Lymphocyte depleted: POOR prog; Elderly!
5. NODULAR SCLEROSING: MC Hodgkins, young pt, ALL
lymphocytes; EXCELLENT prog
- Gross: Looks like cirrhosis of Liver, but w.i LN!

- Micro: broad bands of fibrosis nodules

Lacunar variant of R-S cell:

FOLLICULAR

SMALL NONCLEAVED
[BURKITTS]

MANTLE
CELL

MARGINAL
BCELL
ZONE

*MULTIPLE MYELOMA*

CD5+
CD19,20+
[CD23 -]
Normal follicle: low All tumor cells Middle-aged MALToma NO LNs, BONE!
Bcl-2
lyse at same
male w BIG MC
LAB: Total protein [Normal Albumin]
time TUMOR PAINFUL LNs Stomach d/t - SPEP [Serum]:
Follicular
LYSIS
H. pylori]
SYNDROME
NHL:Bcl-2
pre tx w IVF,
t(11;14)
Allopurinol or
11 = Bcl-1
Rasburicase
[Cyclin D1] Chronic
2nd MC
OVEREXP Inflamm
LYMPHOMA
Endemic
rapid
Malignant:
Form: Africa progress
Hashimoto,
- JAW MASS
through cell Sjogrens,
t(14;18)
- UPEP [Urine]:
cycle
etc
14 = heavy chain IN KID
in
LNs
but
like
[ISH]
to be Extra18 = Bcl-2
AKA:
OVEREXP NO nodal
Intermediat
APOPTOSIS!
American:
e
kids/adults
differentiate
- in bowel or
d
ovary
Lymphocytic
Lymphoma
- PBS: Rouleaux RBCs [d/t IgG]
AIDS pts: often
die
- in belly =
POOR prog
CD19, 20+

LYMPHOPLASMACYT
MYCOSIS
OID
FUNGOIDES:
[WALDENSTROMS
TCELL TUMOR
MACROGLOBULINEMI
OF SKIN
A]

EBV+,
CD21+

t(8;14) = MC
8 = C-MYC
OVEREXP

CD4+ T helper
cells
Lymphoma making IgM 30-60yo; MALES
BIG LNs!! NO BONES!
30-60yo MALES
C/F: Hyperviscosity
Syndrome [looks like
CVA]

Skin Bx:
Band-like prolif of
lymphocytes in
dermis move
IgM = Cold Ab Cold to epidermis
Agglut of blood
Pautriers
fingers turn blue when Microabscess
cold [Raynauds]
[bumpy Tcells
misnomer]
SPEP:
RAD, CHEMO
can CURE @
this stage

Sezary cell = 4
leaf clover
nucleus:

Ca2+: stones, nephrocalcinosis

Renal failure d/t: B-J proteins**,
Stones, Amyloid light chains [nephrotic
syndr], uric acid stones urate
nephropathy
Anemia [normocytic normochromic
w Rouleaux]

C/F = PAINLESS ENLARGING LN

- B sx [fever, night sweats, wt loss] + BIG LNs!
MIMICS MONONUCLEOSIS therefore get MONOSPOT test!

[C-MYC] See
Mick Jagger at
8:14pm under
the starry sky at
Epteins Bar, 21
to enter!

in blood 4 leaf
clover Sezary
cell SEZARY
SYBDROME:
erythroderma, BM
problems TX w
Systemic
CHEMO [[POOR
PROG]]

- BM BX: >10% are plasma cells!

Other
transloc:
t(2;8) or
t(8;22)

Micro: starry
sky; tingible
macrophages
(apoptotic
bodies engulfed
by
macrophages)

Rash
ulceration
nodules

Bone pain & fracture XRAY:

punched out lytic lesions d/t
osteoClast activating factors [IL-1, IL-6*]

MALIG Tcell
Lymphoma
charac. By
expansion of
clone of Thelper
memory cells
that freq lack
other normal Tcell
Ags (CD7)

MCC of Death: #1 INFX, #2 Renal

Failure

8urk14ts
Tx Based on stage
1 = 1 LN group = RADIATION
2 = 2 or more LN groups on SAME side of diaphragm =
RADIATION
Prog / 3 = 2 or more LN groups on OPP side of diaphragm = CHEMO
TX / 4 = METASTASIS = CHEMO
if B sx +?? CHEMO
Other
if CD20+? ADD RITUXIMAB
Complic of tx: 5-10yrs after Rad/Alk AML*

Good! 10yrs
~80% cure
Does NOT grow
rate
fast enough [LOW
grade]
If NOT cured?
Death w.i 1yr
RITUXIMAB
[before, check for
Hep] + chemo

INTERMED. LOW grade Prog factors:

GRADE!
- 2 microglobulin corresponds w
volume of tumor
Avg survival ONLY
- IL-6 = the higher the levels, the worse
= 3yrs
tumor txd prog!
w Abx!!
- Triple Tx
Palliation: Thalidomide [&
for H. pylori Lanalidomide]
- Knocks out angiogenesis
- C/I: Preg! bc causes birth defects

ALL TCELL
TUMORS ARE
INTERMED /
HIGH GRADE,
except THIS bc
on SKIN [see
skin everyday so
can catch early]