Sandbox:Preeti: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 9: Line 9:
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Mechanism
! colspan="2" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Mechanism
! colspan="12" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="12" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestations
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" + |Paraclinical findings
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Paraclinical findings
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated findings
|-
|-
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
! colspan="9" align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab findings
!
! rowspan="3" |Imaging
|-
|-
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Demography
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Demography
Line 25: Line 25:
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |PT/PTT
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |PT/PTT
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Immunochemistry
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Blood work
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Imaging
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Inherited
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Inherited
Line 46: Line 44:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Plt
|-
|-
! colspan="30" align="left" style="background:#4479BA; color: #FFFFFF;" + |HL
! colspan="29" align="left" style="background:#4479BA; color: #FFFFFF;" + |HL
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
! align="center" style="background:#4479BA; color: #FFFFFF;" + |
! align="center" style="background:#DCDCDC;" + |Hodgkin's Lymphoma
! align="center" style="background:#DCDCDC;" + |Hodgkin's Lymphoma
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
Line 79: Line 76:
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
|-
|-
! colspan="30" align="left" style="background:#4479BA; color: #FFFFFF;" + |NHL
! colspan="29" align="left" style="background:#4479BA; color: #FFFFFF;" + |NHL
|-
|-
! rowspan="9" align="center" style="background:#4479BA; color: #FFFFFF;" + |B Cell Lymphoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |B Cell Lymphoma
! align="center" style="background:#DCDCDC;" + |Precursor B-cell lymphoblastic leukemia/lymphoma
! align="center" style="background:#DCDCDC;" + |Precursor B-cell lymphoblastic leukemia/lymphoma
|
|
* Precursor B-cell Lymphoma
* Precursor B-cell Lymphoma


|
|
|
|
|
Line 114: Line 110:
|
|
|-
|-
!
|[[Follicular lymphoma]]
|[[Follicular lymphoma]]
|
|
Line 144: Line 141:
*[[Cough]]
*[[Cough]]
*[[Dyspnea]]
*[[Dyspnea]]
|
|
|
|
|
Line 158: Line 154:
|
|
|-
|-
!
|Mantle cell lymphoma
|Mantle cell lymphoma
|
|
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
|
|
|
|
|
Line 189: Line 185:
|
|
|-
|-
!
|Diffuse large B cell lymphoma
|Diffuse large B cell lymphoma
|
|
Line 219: Line 216:
|
|
*
*
|
|
|
|
|
Line 238: Line 234:
|
|
|-
|-
|Burkitt’s lymphoma
!Category
|
|Disease
* Mature B-cell Lymphoma
|Etiology
|
!Inherited
|
!Acquired
|
|Demography
|
|History
|
!Constitutional symptoms
|
!Rash
|
!Abdominal pain
|
!Diarrhea
|
!V/S
|
!Mass
|
!LAP
|
!Hepatosplenomegaly
|
!Arthritis
|
!Other
|
!WBC
|
!Hb
|
!Plt
|
|PBS
|
|LFT
|
|PT/PTT
|
|Immunochemistry
|
|Histopathology
|
|Other lab findings
|
|Imaging
|
|Gold standard
|
|Associated findings
|
|-
|-
!
|[[Burkitt lymphoma]]
|[[Burkitt lymphoma]]
|
|
* Translocation of chromosome 8 ''[[myc]]'' locus with 3 possible partners (accounting for 90% of translocations):
* Mature B-cell Lymphoma
** The Ig heavy chain region on chromosome 14: t(8;14)
* Translocation of chromosome 8 ''[[myc]]'' locus such as:
** The kappa light chain locus on chromosome 2: t(2;8)
** t(8;14)
** The lambda light chain locus on chromosome 22: t(8;22)
** t(2;8)
** t(8;22)
|
|
|
|
Line 283: Line 280:
* [[Night sweats]]
* [[Night sweats]]
* Unexplained [[weight loss]]
* Unexplained [[weight loss]]
* [[Swollen lymph nodes]] in the neck, axilla, or groin
|
|
|
|
Line 297: Line 293:
* [[Lymphadenopathy|Peripheral lymphadenopathy]]
* [[Lymphadenopathy|Peripheral lymphadenopathy]]
|
|
* [[Swollen lymph nodes]] in the neck, axilla, or groin
|
|
|
|
Line 313: Line 310:
* BCL6.  
* BCL6.  
* BCL2 and TdT.
* BCL2 and TdT.
|
|
|
:* Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]])
:* Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- '''key feature''' (i.e. tumor nuclei size similar to that of [[histiocytes]] or [[endothelial cells]])
Line 329: Line 325:
|
|
|-
|-
!
|B cell chronic lymphocytic leukemia/small lymphocytic lymphoma
|B cell chronic lymphocytic leukemia/small lymphocytic lymphoma
|
|
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
|
|
|
|
|
Line 360: Line 356:
|
|
|-
|-
!
|Marginal zone lymphoma
|Marginal zone lymphoma
|
|
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
|
|
|
|
|
Line 391: Line 387:
|
|
|-
|-
!
|Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
|Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
|
|
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
|
|
|
|
|
Line 455: Line 451:
|
|
|
|
|
|CBC
* Anemia and cytopenias are secondary to bone marrow infiltration
* Lymphocytosis > 4000/µL
* Elevated LDH
*
|
|
|
|
Line 468: Line 468:
** CD22  
** CD22  
* Cyclin D1 is overexpressed.  
* Cyclin D1 is overexpressed.  
|CBC
* Anemia and cytopenias are secondary to bone marrow infiltration
* Lymphocytosis > 4000/µL
* Elevated LDH
*
|
|
* Germinal centers filled by small-to-medium atypical lymphocytes.
* Germinal centers filled by small-to-medium atypical lymphocytes.
Line 520: Line 515:
* AE1/AE3  
* AE1/AE3  
* B-cell markers CD20, CD79a, CD10, CD23, and bcl-2 are expressed
* B-cell markers CD20, CD79a, CD10, CD23, and bcl-2 are expressed
|
|
|
* Follicular cells in reactive zone
* Follicular cells in reactive zone
Line 557: Line 551:
* [[CD20]]
* [[CD20]]
* [[CD79a]]
* [[CD79a]]
|
|
|
* [[B-cells]] replace the normal [[white pulp]] of the [[spleen]].
* [[B-cells]] replace the normal [[white pulp]] of the [[spleen]].
Line 607: Line 600:
|
|
|
|
* Tartrate-resistant acid phosphatase  positive
* CBC
** Decreased [[hemoglobin]] concentration
** Decreased [[platelets]] count
**
|
|
|
|
Line 620: Line 618:
* [[CD11c]]  
* [[CD11c]]  
* [[FMC7]]  
* [[FMC7]]  
|
* Tartrate-resistant acid phosphatase  positive
* CBC
** Decreased [[hemoglobin]] concentration
** Decreased [[platelets]] count
**
|
|
:* Small cells with "fried egg"-like appearance
:* Small cells with "fried egg"-like appearance
Line 638: Line 630:
|-
|-
|[[Multiple myeloma|Plasma cell myeloma]]
|[[Multiple myeloma|Plasma cell myeloma]]
|
|
|
|
|
Line 668: Line 659:
|-
|-
|[[Chronic lymphocytic leukemia]] / [[Chronic lymphocytic leukemia|small lymphocytic lymphoma]]
|[[Chronic lymphocytic leukemia]] / [[Chronic lymphocytic leukemia|small lymphocytic lymphoma]]
|
|
|
|
|
Line 698: Line 688:
|-
|-
|[[Monoclonal B-cell lymphocytosis]]
|[[Monoclonal B-cell lymphocytosis]]
|
|
|
|
|
Line 728: Line 717:
|-
|-
|[[B-cell prolymphocytic leukemia]]
|[[B-cell prolymphocytic leukemia]]
|
|
|
|
|
Line 758: Line 746:
|-
|-
|[[Waldenström's macroglobulinemia|Waldenström's macroglubulinemia]]
|[[Waldenström's macroglobulinemia|Waldenström's macroglubulinemia]]
|
|
|
|
|
Line 788: Line 775:
|-
|-
|[[Monoclonal gammopathy of undetermined significance]] (MGUS)
|[[Monoclonal gammopathy of undetermined significance]] (MGUS)
|
|
|
|
|
Line 818: Line 804:
|-
|-
|[[Heavy chain disease]]
|[[Heavy chain disease]]
|
|
|
|
|
Line 848: Line 833:
|-
|-
|Solitary plasmacytoma of bone
|Solitary plasmacytoma of bone
|
|
|
|
|
Line 878: Line 862:
|-
|-
|Extraosseous plasmacytoma
|Extraosseous plasmacytoma
|
|
|
|
|
Line 908: Line 891:
|-
|-
|Monoclonal immunoglobulin deposition diseases
|Monoclonal immunoglobulin deposition diseases
|
|
|
|
|
Line 938: Line 920:
|-
|-
|Extranodal marginal zone lymphoma of [[MALT lymphoma|mucosa-associated lymphoid tissue]] (MALT lymphoma)
|Extranodal marginal zone lymphoma of [[MALT lymphoma|mucosa-associated lymphoid tissue]] (MALT lymphoma)
|
|
|
|
|
Line 968: Line 949:
|-
|-
|Large B-cell lymphoma with IRF4 rearrangement
|Large B-cell lymphoma with IRF4 rearrangement
|
|
|
|
|
Line 998: Line 978:
|-
|-
|[[Primary cutaneous follicle centre lymphoma|Primary cutaneous follicle center lymphoma]]
|[[Primary cutaneous follicle centre lymphoma|Primary cutaneous follicle center lymphoma]]
|
|
|
|
|
Line 1,028: Line 1,007:
|-
|-
|T-cell/histiocyte-rich large B-cell lymphoma
|T-cell/histiocyte-rich large B-cell lymphoma
|
|
|
|
|
Line 1,058: Line 1,036:
|-
|-
|[[Lymphomatoid granulomatosis]]
|[[Lymphomatoid granulomatosis]]
|
|
|
|
|
Line 1,088: Line 1,065:
|-
|-
|[[Primary mediastinal large B-cell lymphoma|Primary mediastinal (thymic) large B-cell lymphoma]]
|[[Primary mediastinal large B-cell lymphoma|Primary mediastinal (thymic) large B-cell lymphoma]]
|
|
|
|
|
Line 1,118: Line 1,094:
|-
|-
|[[Intravascular large B-cell lymphoma]]
|[[Intravascular large B-cell lymphoma]]
|
|
|
|
|
Line 1,148: Line 1,123:
|-
|-
|ALK1 large B-cell lymphoma
|ALK1 large B-cell lymphoma
|
|
|
|
|
Line 1,178: Line 1,152:
|-
|-
|Plasmablastic lymphoma
|Plasmablastic lymphoma
|
|
|
|
|
Line 1,208: Line 1,181:
|-
|-
|[[Primary effusion lymphoma]]
|[[Primary effusion lymphoma]]
|
|
|
|
|
Line 1,238: Line 1,210:
|-
|-
|High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
|High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
|
|
|
|
|
Line 1,294: Line 1,265:
|
|
* Cutaneous manifestaions
* Cutaneous manifestaions
|
|
|
|
|
Line 1,312: Line 1,282:
|
|
|-
|-
|
|
|
|
|
Line 1,342: Line 1,311:
|
|
|-
|-
|
|
|
|
|
Line 1,372: Line 1,340:
|
|
|-
|-
|
|
|
|
|
Line 1,436: Line 1,403:
|
|
|
|
* Neutropenia
* Anemia
* Hypergammaglobulinemia
|
|
|
|
Line 1,446: Line 1,416:
* [[CD4]]-
* [[CD4]]-
* [[CD8]]+
* [[CD8]]+
|
* Neutropenia
* Anemia
* Hypergammaglobulinemia
|
|
:* Clonal rearrangements of the [[T-cell receptor]] (TCR) gene
:* Clonal rearrangements of the [[T-cell receptor]] (TCR) gene
Line 1,461: Line 1,427:
|-
|-
|[[Subcutaneous panniculitis-like T-cell lymphoma]]
|[[Subcutaneous panniculitis-like T-cell lymphoma]]
|
|
|
|
|

Revision as of 19:58, 28 December 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Category Disease Etiology Mechanism Clinical manifestations Paraclinical findings Gold standard Associated findings
Lab findings Imaging
Demography History Symptoms Signs CBC PBS LFT PT/PTT Immunochemistry Histopathology Other
Inherited Acquired Constitutional symptoms Rash Abdominal pain Diarrhea V/S Mass LAP Hepatosplenomegaly Arthritis Other WBC Hb Plt
HL
Hodgkin's Lymphoma
NHL
B Cell Lymphoma Precursor B-cell lymphoblastic leukemia/lymphoma
  • Precursor B-cell Lymphoma
Follicular lymphoma
  • Mature B-cell Lymphoma
  • Reciprocal translocation t(14;18)(q32;q21)
+ +
  • Painless swelling in the neck, axilla, groin, thorax and abdomen
  • Central and peripheral lymphadenopathy
+
Mantle cell lymphoma
  • Mature B-cell Lymphoma
Diffuse large B cell lymphoma
  • Mature B-cell Lymphoma
  • 8q24/MYC translocations
  • Hypermutated immunoglobulin genes
  • Mutation of BCL6, MYC, PAX5, PIM1, RhoH /TTFn, TP53 genes
  • Translocations involving c-MYC, BCL6, and IgH gene.
  • Fever
  • Night sweats
  • weight loss
Nl to ↓

Centroblastic

Immunoblastic

  • > 90% immunoblasts
  • Trapezoid shaped large lymphoid cells with significant basophilic cytoplasm

Anaplastic:

  • Very large cells with a round, oval, or polygonal shape that may resemble Reed-Sternberg cells
  • Hypergammaglobulinemia
Category Disease Etiology Inherited Acquired Demography History Constitutional symptoms Rash Abdominal pain Diarrhea V/S Mass LAP Hepatosplenomegaly Arthritis Other WBC Hb Plt PBS LFT PT/PTT Immunochemistry Histopathology Other lab findings Imaging Gold standard Associated findings
Burkitt lymphoma
  • Mature B-cell Lymphoma
  • Translocation of chromosome 8 myc locus such as:
    • t(8;14)
    • t(2;8)
    • t(8;22)
  • Medium-sized (~1.5-2x the size of a RBC) with uniform size ("monotonous") -- key feature (i.e. tumor nuclei size similar to that of histiocytes or endothelial cells)
  • Round nucleus
  • Small nucleoli
  • basophilic cytoplasm
  • Brisk mitotic rate and apoptotic activity
  • Cellular outline usually appears squared off
  • "Starry-sky pattern":
    • The stars in the pattern are tingible-body macrophages (macrophages containing apoptotic tumor cells)
    • The tumour cells are the sky
B cell chronic lymphocytic leukemia/small lymphocytic lymphoma
  • Mature B-cell Lymphoma
Marginal zone lymphoma
  • Mature B-cell Lymphoma
Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
  • Mature B-cell Lymphoma
B cell lymphoma Mantle cell lymphoma
  • Stage IV disease
  • B symptoms,
  • Generalized lymphadenopathy
  • Abdominal distention
  • Fatigue
  • Night sweats
  • Weight Loss
  • Extranodal involvement of gastrointtestinal (GI) tract, lungs, and central nervous system (CNS)
  • Generalized lymphadenopathy
  • Hepato-splenomegaly
  • Mental Retardation
  • Less commonly
    • Palpable masses in skin, breast, and salivary glands
CBC
  • Anemia and cytopenias are secondary to bone marrow infiltration
  • Lymphocytosis > 4000/µL
  • Elevated LDH
  • CD5+
  • B-cell antigen positive
    • CD19
    • CD20
    • CD22
  • Cyclin D1 is overexpressed.
  • Germinal centers filled by small-to-medium atypical lymphocytes.
  • Nodular appearance may be evident from expansion of the mantle zone in 30-50% of patients early in the disease.
Nodal marginal zone B-cell lymphoma
  • Arise from memory B cells. Include
    • Splenic marginal zone lymphoma
    • Nodal marginal zone lymphoma
    • Extranodal marginal zone lymphoma.
  • Stimulation of antigen receptor by autoantigen and co-stimulatory molecule CD40.
  • Depends largely on its location
  • Gastric marginal zone lymphoma
    • Dyspepsia
    • Abdominal pain
    • Hemorrhage
  • Chronic infectious conditions or autoimmune processes, such as
    • H pylori gastritis
    • Hashimoto thyroiditis
    • Sjögren syndrome.
  • AE1/AE3
  • B-cell markers CD20, CD79a, CD10, CD23, and bcl-2 are expressed
  • Follicular cells in reactive zone
  • Centrocyte like cells in marginal zone lymphoma
Splenic marginal zone lymphoma
  • Clonal rearrangements of the immunoglobulin genes (heavy and light chains) .
    • Deletion 7q21-32
    • Translocations of the CDK6 gene located at 7q21.
  • B-cells replace the normal white pulp of the spleen.
  • The neoplastic cells compromise
  • Sinus invasion
  • Epithelial histocytes
  • Plasmacytic differentiation of neoplastic cells.
  • Splenic Hilar Lymph Nodes
  • Bone Marrow Biopsy
    • Splenic marginal zone lymphoma in bone marrow displays a nodular pattern with morphology similar to what is observed in the splenic hilar lymph nodes.
Hairy cell leukemia
  • Production of cytokines, such as TNF alpha and IL-2R, provide important stimuli for malignant B cells proliferation in hairy cell leukemia.
    • The p38-MAPK-JNK cascade
    • The MEK-ERK cascade
    • The Phosphatidylinositol 3 kinase (PI3K)-AKT cascade
  • Tartrate-resistant acid phosphatase positive
  • CBC
  • Small cells with "fried egg"-like appearance
  • Well-demarcated thread-like cytoplasmic extensions
  • Clear cytoplasm
  • Central round nucleus
  • Peri-nuclear clearing ("water-clear rim" appearance)
Plasma cell myeloma
Chronic lymphocytic leukemia / small lymphocytic lymphoma
Monoclonal B-cell lymphocytosis
B-cell prolymphocytic leukemia
Waldenström's macroglubulinemia
Monoclonal gammopathy of undetermined significance (MGUS)
Heavy chain disease
Solitary plasmacytoma of bone
Extraosseous plasmacytoma
Monoclonal immunoglobulin deposition diseases
Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)
Large B-cell lymphoma with IRF4 rearrangement
Primary cutaneous follicle center lymphoma
T-cell/histiocyte-rich large B-cell lymphoma
Lymphomatoid granulomatosis
Primary mediastinal (thymic) large B-cell lymphoma
Intravascular large B-cell lymphoma
ALK1 large B-cell lymphoma
Plasmablastic lymphoma
Primary effusion lymphoma
High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
T cell lymphoma Mycosis fungoides / Sézary syndrome
  • Cutaneous manifestaions
T-cell granular lymphocytic leukemia
  • Disregulation of signaling pathways:
    • FAS/FAS-L
    • Phosphatidylinositol-3 kinase (PI3K),
    • Mitogen-activated proteinkinase/extracellular signal-regulated kinase (MAPK/ERK)

Symptoms of T-cell large granular lymphocyte leukemia may include the following:

  • Neutropenia
  • Anemia
  • Hypergammaglobulinemia
  • Clonal rearrangements of the T-cell receptor (TCR) gene
  • Chronic (> 6 months) elevation in large granular lymphocytes (LGLs) in the peripheral blood
  • Large granular lymphocyte count greater than 2.0 × 109/L
  • Lymphocytosis (typically 2-20x109/L)
Subcutaneous panniculitis-like T-cell lymphoma