Lymphoma Dr. Raid Jastania Dec 2006

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

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

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

The Journey of the B cells Bone marrowPeripheral blood Lymph node

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

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

The Journey of the B cells Bone marrowPeripheral blood Lymph node

Genetics Follicular lymphoma t(14;18) –Bcl-2 over expression Mantle cell lymphoma: t(11;14) –CyclinD1 over expression Burkitt lymphoma: t(8;14) –C-myc over expression

Classification Based on: –Morphology –Immunophenotyping –Clinical presentation –Molecular/cytogenetic findings

Classification Predominantly disseminated: lymphoma/Leukemia Primary extranodal Primary nodal

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