Lymphoma

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Lymphoma

• Dr. Raid Jastania
• Dec 2006

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• By the end of this session you should be able to
• Discuss the basis of the classification of
  lymphomas
• Know the different stages of B lymphocyte
• List common genetic abnormalities in lymphomas
• Classify Hodgkin lymphoma and the difference
  between the subtypes

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Lymphoma

• Classification WHO
• Lymphoid, Myeloid, Histiocytic
• Definitions
• Precursor, mature, stage of differentiation,
  naïve, peripheral, small cell, large cell
• CDs
• Common types Follicular lymphoma, Diffuse large
  B cell lymphoma
• Age
• Non Hodgkin 6th- 7th decade
• Hodgkin 3rd decade

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• Risk factors
• Abnormalities in the immune system.
• EBV
• HHV8
• Hepatitis C virus
• H. pylori

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The Journey of the B cells
Bone marrow
Peripheral blood
Lymph node
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The Journey of the B cells

• Bone marrow- Blast- VDJ gene rearrangement-
  mature naïve Ig positive cells- IgM, IgD, CD5
• Antigen- transformation- proliferation- mature B
  cell IgM
• Germinal center maturation, Somatic mutation.
• IgG, IgA plasma cells and memory cells.
• Plasma cells- bone marrow

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The Journey of the B cells

• Bone marrow- Blast- VDJ gene rearrangement-
  mature naïve Ig positive cells- IgM, IgD
• CD20, CD19,CD10, TdT, CD5/-
• Antigen- transformation- proliferation- mature B
  cell IgM
• CD20, CD10, Bcl-2
• Germinal center maturation, Somatic mutation.
• CD20
• IgG, IgA plasma cells and memory cells.
• Loose all the B cell markers CD138
• Plasma cells- bone marrow

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The Journey of the B cells
Bone marrow
Peripheral blood
Lymph node
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Genetics

• Follicular lymphoma t(1418)
• Bcl-2 over expression
• Mantle cell lymphoma t(1114)
• CyclinD1 over expression
• Burkitt lymphoma t(814)
• C-myc over expression

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Classification

• Based on
• Morphology
• Immunophenotyping
• Clinical presentation
• Molecular/cytogenetic findings

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Classification

• Predominantly disseminated lymphoma/Leukemia
• Primary extranodal
• Primary nodal

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Classification

• Predominantly disseminated lymphoma/Leukemia
• CLL, lymphoplasmacytic lymphoma, Myeloma
• Primary extranodal
• Marginal zone lymphoma
• Primary nodal
• Follicular lymphoma, mantle cell lymphoma
• Aggressive types
• Diffuse large B cell lymphoma, Burkitt lymphoma