Lymphoproliferative Disorders--Lymphomas

B‑lymphoblastic leukemia/lymphoma features

Abrupt onset, marrow failure, CNS involvement, TdT+, CD34+, CD19+, CD10+, high Ki‑67

B‑Cell Lymphoblastic Leukemia/Lymphoma cytogenetics

t(9;22) Philadephia BRC ABL

T‑lymphoblastic leukemia/lymphoma features

Adolescents, mediastinal mass, CNS, lymph nodes, TdT+, CD34+, CD3+, CD7+, CD4/CD8 co‑expression

CLL/SLL clinical features

Older adults, usually asymptomatic, lymphocytosis, smudge cells(Crushed Little Lymphocytes), lymphadenopathy, indolent course, risk of Richter transformation(aggressive tumor progression)

CLL/SLL phenotype

CD19+, CD20(dim), CD5+, surface Ig light chain restricted (Get crushed in 1920-5»depression esk)

Follicular lymphoma clinical features

Indolent, often asymptomatic, waxing/waning lymphadenopathy, bone marrow involvement, adults

Follicular lymphoma morphology

Nodular “back‑to‑back” follicles, centrocytes + centroblasts, loss of mantle zone

Follicular lymphoma phenotype

CD19+, CD20+, CD10+, BCL2+, light chain restricted

Follicular lymphoma genetics

t(14;18) (You get follicles at 14 and 18 pimples)

Diffuse large B‑cell lymphoma clinical features

Rapidly enlarging mass, nodal or extranodal, aggressive but curable

DLBCL morphology

Diffuse sheets of large pleomorphic cells, prominent nucleoli, high mitotic rate, necrosis

Diffuse Large B Cell Lymphoma phenotype

CD19+, CD20+, variable CD10/BCL6/MUM1, Ki‑67 50–100%

Anaplastic large cell lymphoma clinical features

T cell lymphoma, Children/young adults, rapidly enlarging nodal/extranodal masses, B‑symptoms(fever, weight loss, night sweats), aggressive but curable

Anaplastic Large (T) Cell Lymphoma morphology

Large pleomorphic cells, “hallmark” horseshoe nuclei, wreath cells, sinusoidal pattern

Anaplastic Large (T) Cell Lymphoma (ALCL) phenotype

CD30+, ALK+ or ALK–, variable CD3/CD4 bc T cell origin

Anaplastic Large (T) Cell Lymphoma (ALCL) genetics

t(2,5)

Classic Hodgkin lymphoma clinical features

Bimodal age distribution, mediastinal/cervical nodes, B Cell lymphoma, contiguous spread, B‑symptoms possible, may be EBV associated

HODGKIN=CHEST»munchkin in my chest

Classic Hodgkin lymphoma (CHL) morphology

Reed‑Sternberg cells in inflammatory background, fibrosis, lacunar/mummified variants

Classic Hodgkin lymphoma (CHL) phenotype

CD30+, CD15+, EBV variable, negative for CD19/CD20/surface Ig

Burkitt lymphoma clinical variants

Endemic (jaw), sporadic (abdomen), immunodeficiency‑associated

Burkitt lymphoma morphology

Diffuse sheets of medium cells, basophilic cytoplasm, lipid vacuoles, “starry sky” macrophages

Burkitt lymphoma phenotype

CD19+, CD20+, CD10+, Ki‑67 ≈100%, EBV variable

Burkitt lymphoma genetics!!

MYC rearrangements w/8: t(8;14)

Burkitt lymphoma treatment considerations

Requires urgent therapy, CNS prophylaxis, high tumor lysis risk

Plasma cell myeloma clinical features

Bone pain, lytic lesions, anemia, renal failure, hypercalcemia, monoclonal gammopathy (CRAB=hyperCalcemia, Renal failure, Anemia, Bone pain)

Myeloma peripheral smear

Rouleaux formation due to high serum proteins

Multiple Myeloma bone marrow

Sheets of plasma cells, atypia, multinucleation, cytoplasmic inclusions

Myeloma phenotype

CD38+, CD138+, cytoplasmic Ig+, CD56+, negative CD19/CD20

Hairy cell leukemia clinical features

Pancytopenia, massive splenomegaly, infections, no lymphadenopathy(leukemic process)

Hairy cell leukemia morphology

“Hairy” cytoplasmic projections, fried‑egg cells in spleen, dry tap marrow

Hairy cell leukemia phenotype

CD19+, CD20+, CD11c+, CD25+, CD103+, annexin A1+

Hairy cell leukemia genetics

BRAF V600E mutation (Hairy BRAF)

Hodgkin Vs Non-Hodgkin

Hodgkin has Reed Sternberg cells, spreads from lymph node to lymph node

Non-hodgkin-skin, GI, bone marrow

Mycosis Fungoides (cutaneous T cell Lymphoma)»Sezary Syndrome(Leukemic MF)

Cutaneous rash, Pautrier microabscesses, exfoliative erythroderma,

Sezary Syndrome cells

Flower like cells