5. LYMPHOMA-II (NON-HODGKIN LYMPHOMA-I)_820fe86ccb759d66db9b1d33e3b9d74a copy
Page 1: Cover Page
University: Almaarefa University
Course: Lymphoma-II
Page 2: Learning Objectives
Define Lymphoma
Classify lymphomas
Recall etiology, common types, pathomorphological features, diagnosis, prognosis, and staging of Non-Hodgkin Lymphoma (NHL)
Discuss Burkitt lymphoma: origin, etiology, common sites, types, and clinical features
Page 3: Normal Structure of Lymph Node
Image reference: SCIENCEphotoLIBRARY
Page 4: Definition of Lymphoma
Malignant neoplasm of lymphoid origin
Can cause solid tissue mass (lymphadenopathy) or extra-nodal mass (e.g., brain, intestine)
Page 5: WHO Classification of Lymphoid Neoplasms
I. Non-Hodgkin Lymphoma
A. B cell lymphoma
B. T cell/NK cell lymphoma
II. Hodgkin Lymphoma
Page 6: Non-Hodgkin Lymphoma (NHL)
Overview of NHL as a major type of lymphoma
Page 7: Epidemiology of NHL
Most common hematopoietic neoplasm
Seventh among all cancers
5 times more common than Hodgkin Lymphoma
Predominantly affects males > females
Typically occurs in individuals older than 50 years
Higher risk in white populations compared to black and Asian Americans
Page 8: Etiology of NHL
Chromosomal translocations: most common - t(14;18)
Immunodeficiency states (e.g., AIDS, immunosuppression)
Chronic inflammation (autoimmune diseases: Sjögren syndrome, Hashimoto thyroiditis)
Page 9: Infections associated with NHL
Human T-cell leukemia virus type-1 (HTLV-1)
Epstein-Barr virus
Hepatitis C virus
Kaposi sarcoma-associated herpesvirus (KSHV)
Helicobacter pylori
Page 10: Environmental Factors
Chemicals: pesticides, herbicides, solvents, organic chemicals, wood preservatives, hair dye
Previous chemotherapy treatment
Radiation exposure
Page 11: Sites for Non-Hodgkin Lymphoma
A. Nodal lymphoma
Begins in lymph nodes
B. Extra-nodal lymphoma
Common sites include:
Intestine
Central nervous system
Skin
Brain
Testis
Spleen
Ovary
Page 12: General Clinical Manifestations
Asymptomatic lymphadenopathy
Progressive, peripheral, and painless
"B symptoms":
Fever
Night sweats
Weight loss >10% in 6 months
Page 13: Features Related to Extra-Nodal Involvement
Splenomegaly
Hepatomegaly
Large abdominal mass
Testicular mass
Page 14: General Investigations
Complete blood cell (CBC) count
Chest radiography
CT scan of neck, chest, abdomen, pelvis
PET scan
Lymph node biopsy
Bone marrow aspirate and biopsy
Biopsy of extranodal sites
Page 15: General Morphological Features
Gross Features
Affected lymph nodes:
Enlarged
Soft, fleshy consistency
Grayish-white appearance
Presence of foci of hemorrhage and necrosis
Page 16: Gross Image of Lymph Nodes Involved by NHL
Page 17: Spleen Involvement in NHL
Gross image reference
Page 18: Involvement of Small Intestine by NHL
Gross image reference
Page 19: Microscopic Features (H&E Stain)
Loss of normal architecture
Diffuse infiltration by monoclonal malignant lymphoid cells
Subtyping by Immunohistochemistry
B cell lymphoma: CD20
T cell lymphoma: CD3, CD5
Page 20: Microscopy of NHL - Lymph Node (H&E Stain)
Page 21: Microscopy of NHL - Intestine (H&E Stain)
Page 22: Immuno-histochemical Image
B cell lymphoma (NHL) with CD20 stain
Page 23: Origin and Classification of NHL
Page 24: Stages of B and T Cell Generation
Origin of various types of Non-Hodgkin Lymphoma
Key cells involved: Precursor B lymphoblastic, T cell neoplasms
Page 25: B Cell Neoplasms
A. Precursor B Cell Neoplasms
Lymphoblastic leukemia/lymphoma
B. Peripheral B Cell Neoplasms
Chronic Lymphocytic leukemia/small lymphocytic lymphoma
Diffuse large B cell lymphoma
Lymphoplasmacytic lymphoma
Mantle cell lymphoma
Follicular lymphoma
Marginal zone lymphoma
Burkitt lymphoma
Page 26: B-Cell Lymphomas
Constitute about 90% of all lymphomas
Diffuse large B-cell lymphoma (DLBCL): most common, highly aggressive
Follicular lymphoma: second most common, slow-growing (indolent)
Page 27: Burkitt Lymphoma (BL)
Type of peripheral B cell neoplasm
Origin: Germinal center cells
Affects children and young adults, males 2-3 times more than females
Characterized by translocations of the c-MYC gene on chromosome 8
Very aggressive but responds well to intensive chemotherapy
Most patients can be cured
Page 28: Three Types of Burkitt Lymphoma
African (endemic) BL
Sporadic (nonendemic) BL
Associated with HIV
Page 29: Endemic BL
Most common in children aged 4-7 years in certain regions of Africa
Typically associated with EBV infection
Common sites include: Mandible, kidneys, ovaries, adrenal glands
Page 30: Sporadic Burkitt Lymphoma
Common sites include ileocecum and peritoneum
Page 31: Burkitt Lymphoma Before and After Treatment
Image reference: SOCCER STAR
Page 32: Microscopic Features of Burkitt Lymphoma
Characteristic “Starry sky” pattern
Intermediate-sized malignant lymphoid cells
Tingible body macrophages
Page 33: Microscopy of Burkitt Lymphoma (H&E Stain)
"Starry sky pattern"
Page 34: T Cell and NK Cell Neoplasms
A. Precursor T Cell Neoplasms
T cell acute lymphoblastic leukemia/lymphoma (T-ALL)
B. Peripheral T-Cell and NK Cell Neoplasms
Various subtypes including: T cell prolymphocytic leukemia, mycosis fungoides, Large granular lymphocytic leukemia
Aggressive natural killer cell lymphoma
Page 35: T Cell and NK Cell Lymphomas
Constitute 10% of all NHL
Generally more aggressive than B-cell lymphomas
Peripheral T cell lymphomas are especially common in Asia
Page 36: Staging of NHL
Utilizes the Ann Arbor Staging System
Purpose: to guide treatment and prognosis
Page 37: Treatment Options
Radiation therapy
Chemotherapy
Monoclonal antibodies
Page 38: References
Key texts: Robbins and Cotran Pathologic Basis of Disease, Robbins Basic Pathology
AMBOSS resource link
Page 39: Thank You
Closing remarks