Lymphoma (malignant lymphoma, ML)Definition:
Lymphoma is a group of cancers arising primarily from lymph nodes and/or extranodal lymphoid tissues, showing features of lymphocytes.
Hodgkin’s lymphoma (HD)
non-Hodgkin’s lymphoma (NHL)
1. Age:two peaks of incidence
young adult: 15-27 years of age about 50 years of age
2. Feature → Reed-Sternberg cells (R-S c)
mixed with rich inflammatory background
(1) R-S cell
- 15-45 um in diameter
- Binucleate or multiple nuclei, acidophilic nucleoli
- Amphophilic cytoplasm
R - S cell
Mirror image cell
with symmetric binuclei
Hodgkin cell single nucleus R-S cell
i) Lacunar cell:
folded, multilobate nuclei surrounded
by pale cytoplasm
ii) Type L & H R-S cell
have twisted , multilobate nuclei
resembling popcorn kernels
iii) Undifferentiated or Pleomorphic R-S c
1) Inflammatory c infiltration
Others: plasam cells, neutrophil, eosinophil , histocyte
1.Nodular lymphocyte predominant
2. Classical Hodgkin’s lymphoma
Classical Hodgkin’s lymphoma
1-R-S c and Hodgkin c
2-Background: lymphocyte Plasma C, neutrophil, eosinophil, histocyte
(1)Nodular sclerosis HL
(2) Lymphocyte-rich classical HL
(3) Mixed cellularity
(4) Lymphocyte depletion
Nodular sclerosis HL
- The presence of a particular variant of R-S c lacunar cells
- The collagen bands that divided LN into circumscribed nodules
Nodular sclerosis HL
Nodular sclerosis HL :Lacunar cell
(2)Lymphocyte-rich classical HL
- Hodgkin c and mirror image c
- Background :LC or histocyte
Lymphocyte-rich classical HL
(3) Mixed cellularity, MC:
Most common form of HL
- Plantiful typical R-S cell
- Background: LC, PlasmaC, Eosiphil C, histocyte, fibroblast
- Small areas of necrosis and fibrosis
(4) Lymphocyte depletion, LD
Two morphologic forms
i) Diffuse fibrosis
-amorphous protein materials↑ reticular fiber ↑
-R-S cell, histocyte, LC:less
ii) Reticular variants
rich in cell:
- Highly anaplastic R-S c
- A few typical R-S cell
- Massive necrosis
- Poorly prognosis
1. Dependent on the LN biopsy
-Typical R-S cell ---→ HL
-Lacunar cell ---→ nodular sclerosis
help to diagnosis
BC: CD20 (+) ---→ nodular LC predominance
HL: CD15 , CD30 (+)
Stage of HD
The Non- Hodgkin lymphomas
The non- Hodgkin lymphoma are solid tumours arising in the peripheral lymphoid tissue particularly of lymphnodes but also of the extranodal sites such as the oro- pharynx, the gut, skin and other sites.
1. two-third ---→ primary in LN
one-third ---→ primary in
extranodal organs and tissues such as digestive , respiratory tract,lung , skin , CNS
2. Diagnosis:dependent on the biopsy of LN or related tissue pathological diagnosis
-Immune phenotype of tumor c
Model of LC transformation
- The same as Hodgkin’s diseases but the mass is more soft and a few necrosis.
- The normal architecture of lymph node have been destroyed partly or entirely.
- Very numerous monotonous neoplastic cell flood in lymph node.
- The neoplastic cell may be infiltrate to the capsule of node.
B-cell small lymphocytic
Example of Non-Hodgkin’s lymphoma
- Follicular lymphoma
- Diffuse large B-cell lymphoma
- Burkitt lymphoma
- Mycosis fungoides
Drive from germinal center BC
The most common form in the US
Less in China(10%)
Nodular growth pattern
Tumor follicle: composed of
i)Centrocyte:irregular and cleaved nuclear, scant cytoplasm
ii)Centroblast:open nuclear chromatin,several nucleoli
Diffuse large B-cell lymphoma
- Centroblast lymphoma
- B immunoblast lymphoma
- Anaplastic large BC lymphoma
- TC-rich/histocyte BC lymphoma
- Plasmablast lymphoma
- Relatively large cell:4-5 times the diameter of small LC
- A fair degree of morphologic variation: centroblast , immunoblast
- Cell morphology: round or oval nucleus,2-3 nucleoli, margination of chromatin moderate cytoplasm
- Diffuse pattern of growth
Diffuse large cell,centroblastic
- Brukitt’s lymphoma was described initially in Africa, where it is endemic in some parts, but it is also ocure sporadically in nonendemic area.
- Rare cases have been recorded in European and North America.
- This disorder is relationship of the Epstein-Barr viruses.
- Both the African and non Africa cases are found largely in children or young adults.
The disease rarely arises in lymph nodes, but usually appears in the jaw or ovaries (retroperitoneal tissues in males) this disease grows extremely rapidly and spreads extensively, leading quickly to complication.
Histological appearance is typical and striking
1. diffuse proliferation of lymphoblasts (B cell type) cell medium- sized and uniform, mitoses frequent.
2. Scattering of macrophages containing debris desired from very rapid cell turnover contributing ‘starry sky’. These benign macrophage are diffusely distributed among the tumor cell. The macrophage often sounded by a clear space.
NOTE: Leukemic transformation may occur, but is uncommon, these tumors respond well to aggressive chemotherapy and long remissions have been reported. However, in most cases a relapse occurs, and a majority of patients die with in 5 years.
Mycosis fungoides are uncommon lymphoid malignancies that are primary in the skin. It is infrequent T cell lymphomas. These disease usually affects males 40-60 years of age.
Grossly: The lesions begin as poorly defined areas of eczema, followed by formation of plaques and ultimately of multiple nodules. The nodules often rapture and become ulcer.
This disease is characterized by dermal infiltrates of atypical lymphoid cell that invade the epidermis. The neoplastic cell (mycosis cells) have deeply lobulated or cerebra-form nuclei. Immunology studies indicate the presence of T cell markers on mycosis cells.