Sandbox:Preeti: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 80: Line 80:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |B Cell Lymphoma
! align="center" style="background:#4479BA; color: #FFFFFF;" + |B Cell Lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |Precursor B-cell lymphoblastic leukemia/lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |Precursor B-cell lymphoblastic leukemia/lymphoma
| align="center" style="background:#F5F5F5;" + |
| align="left" style="background:#F5F5F5;" + |
* Precursor B-cell Lymphoma
* Precursor B-cell Lymphoma
| align="center" style="background:#F5F5F5;" + |
| align="center" style="background:#F5F5F5;" + |
Line 111: Line 111:
!
!
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Follicular lymphoma]]
! colspan="2" align="center" style="background:#DCDCDC;" + |[[Follicular lymphoma]]
|
| align="left" style="background:#F5F5F5;" + |
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
* Reciprocal translocation t(14;18)(q32;q21)
* Reciprocal translocation t(14;18)(q32;q21)
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="left" style="background:#F5F5F5;" + |
*[[Fever]]
*[[Fever]]
*[[Weight loss]]
*[[Weight loss]]
*[[Night sweats]]
*[[Night sweats]]
| +
| align="center" style="background:#F5F5F5;" + |+
| +
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="left" style="background:#F5F5F5;" + |
* Painless swelling in the neck, axilla, groin, thorax and abdomen
* Painless swelling in the neck, axilla, groin, thorax and abdomen
|
| align="left" style="background:#F5F5F5;" + |
* Central and peripheral lymphadenopathy
* Central and peripheral lymphadenopathy
| +
| align="center" style="background:#F5F5F5;" + |+
|
| align="center" style="background:#F5F5F5;" + |
|
| align="left" style="background:#F5F5F5;" + |
* [[Seizures]]
* [[Seizures]]
*[[Chest pain]]
*[[Chest pain]]
Line 138: Line 138:
*[[Cough]]
*[[Cough]]
*[[Dyspnea]]
*[[Dyspnea]]
|
| 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;" + |
|
| 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;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|-
|-
!
!
! colspan="2" align="center" style="background:#DCDCDC;" + |Mantle cell lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |Mantle cell lymphoma
|
| align="left" style="background:#F5F5F5;" + |
* [[CD5 (protein)|CD5]] positive antigen in pregerminal center of B-cell
* [[CD5 (protein)|CD5]] positive antigen in pregerminal center of B-cell
* [[Chromosomal translocation]] at '''t(11:14)'''
* [[Chromosomal translocation]] at '''t(11:14)'''
** Over-express [[cyclin D1]]  
** Over-express [[cyclin D1]]  
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="left" style="background:#F5F5F5;" + |
* Stage IV disease
* Stage IV disease
* B symptoms,  
* B symptoms,  
Line 170: Line 170:
* Weight Loss
* Weight Loss
* Extranodal involvement of gastrointtestinal (GI) tract, lungs, and central nervous system (CNS)
* Extranodal involvement of gastrointtestinal (GI) tract, lungs, and central nervous system (CNS)
|
| 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;" + |
* Generalized lymphadenopathy
* Generalized lymphadenopathy
* Hepato-splenomegaly  
* Hepato-splenomegaly  
Line 180: Line 180:
* Less commonly
* Less commonly
** Palpable masses in skin, breast, and salivary glands
** Palpable masses in skin, breast, and salivary glands
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|CBC
| align="center" style="background:#F5F5F5;" + |CBC
* Anemia and cytopenias are secondary to bone marrow infiltration
* Anemia and cytopenias are secondary to bone marrow infiltration
* Lymphocytosis > 4000/µL  
* Lymphocytosis > 4000/µL  
* Elevated LDH
* Elevated LDH
*  
*  
|
| 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;" + |
|
| align="left" style="background:#F5F5F5;" + |
* CD5<sup>+</sup>  
* CD5<sup>+</sup>  
* B-cell antigen positive  
* B-cell antigen positive  
Line 201: Line 201:
** CD22  
** CD22  
* Cyclin D1 is overexpressed.  
* Cyclin D1 is overexpressed.  
|
| align="left" style="background:#F5F5F5;" + |
* Germinal centers filled by small-to-medium atypical lymphocytes.
* 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.
* Nodular appearance may be evident from expansion of the mantle zone in 30-50% of patients early in the disease.
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|-
|-
!
!
! colspan="2" align="center" style="background:#DCDCDC;" + |Diffuse large B cell lymphoma
! colspan="2" align="center" style="background:#DCDCDC;" + |Diffuse large B cell lymphoma
|
| align="left" style="background:#F5F5F5;" + |
* Mature B-cell Lymphoma
* Mature B-cell Lymphoma
* 8q24/''MYC'' [[translocations]]
* 8q24/''MYC'' [[translocations]]
Line 217: Line 217:
* Mutation of ''BCL6'', ''MYC'', ''[[PAX5]]'', ''[[PIM1]]'', ''[[RhoH]]'' /''TTFn'', ''[[TP53]]'' genes
* Mutation of ''BCL6'', ''MYC'', ''[[PAX5]]'', ''[[PIM1]]'', ''[[RhoH]]'' /''TTFn'', ''[[TP53]]'' genes
* Translocations involving ''c-MYC'', ''BCL6'', and ''IgH'' gene.
* Translocations involving ''c-MYC'', ''BCL6'', and ''IgH'' gene.
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="left" style="background:#F5F5F5;" + |
* Fever
* Fever
* Night sweats
* Night sweats
* weight loss
* weight loss
|
| 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;" + |
|
| align="left" style="background:#F5F5F5;" + |
* Painless rapidly enlarging [[lymph nodes]]
* Painless rapidly enlarging [[lymph nodes]]
|
| 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;" + |↓
|Nl to ↓
| align="center" style="background:#F5F5F5;" + |Nl to ↓
|
| align="center" style="background:#F5F5F5;" + |
*
*
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="left" style="background:#F5F5F5;" + |
'''Centroblastic'''
'''Centroblastic'''
*Medium-to-large-sized [[Lymphocyte|lymphocytes]]
*Medium-to-large-sized [[Lymphocyte|lymphocytes]]
Line 252: Line 252:
'''Anaplastic'''
'''Anaplastic'''
*Very large cells with a round, oval, or polygonal shape that may resemble Reed-Sternberg cells  
*Very large cells with a round, oval, or polygonal shape that may resemble Reed-Sternberg cells  
|
| align="left" style="background:#F5F5F5;" + |
* Hypergammaglobulinemia
* Hypergammaglobulinemia
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|
| align="center" style="background:#F5F5F5;" + |
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Category

Revision as of 19:03, 31 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
  • 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.
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 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type
  • Mature B-cell 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.
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
Lymphoplasmacytic lymphoma (Waldenstrom’s macroglobulinemia)
  • Mature B-cell Lymphoma
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)
Precursor T-cell lymphoblastic leukemia/lymphoma
  • Precursor T-cell Lymphomas
Adult T cell leukemia/lymphoma
T cell lymphoma Anaplastic large cell lymphoma
Cutaneous T-cell lymphoma Mycosis fungoides / Sézary syndrome
  • Cutaneous manifestations
Peripheral T-cell lymphoma Subcutaneous panniculitis-like T-cell lymphoma
Hepatosplenic gamma-delta T-cell lymphoma
Enteropathy-type intestinal T-cell lymphoma
Extranodal T-cell lymphoma, nasal type
Angioimmunoblastic T-cell lymphoma
Peripheral T-cell lymphoma, unspecified