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CHRONIC 
LYMPHOPROLIFERATIVE 
DISORDERS 
PRESENTER- DR. ANKITA BAGHEL 
MODERATOR- DR. MANJULA K.
CONTENTS 
 NORMAL HISTOLOGY 
 WHAT IS CLPD 
 CELL DIFFERENTIATION 
 CLASSIFICATION 
 INDIVIDUAL DISORDERS 
 APPROACH TO DIAGNOSIS 
 CYTOCHEMISTRY 
 IMMUNOPHENOTYPING 
 CYTOGENETICS 
 REFERENCES
NORMAL 
HISTOLOGY OF 
LYMPH NODE 
CORTEX 
- Outer most portion 
- B-cell lymphoid follicles 
- Primary follicles(small 
lymphocytes) 
- Secondary follicle-Germinal 
center(centroblasts,centrocytes) 
PARACORTEX 
- Below and between the 
follicle 
- T-cells, histiocytes, 
interdigitating Dendritic 
Cells And Langerhans 
Cells 
MEDULLA 
- Deep portion 
- Plasma cell-rich 
medullary cords
Chronic lymphoproliferative disorders
B CELL DIFFERENTIATION
Chronic lymphoproliferative disorders
T CELL DIFFERENTIATION
Chronic lymphoproliferative disorders
 CHRONIC LYMPHOPROLIFERATIVE 
DISORDERS(CLPDS) are a heterogeneous group of 
malignancies characterised by the proliferation of mature 
B and rarely T lymphoid cells in the peripheral blood, 
bone marrow and/or lymph nodes/spleen and other 
lymphoid tissues. 
 Classification- 
1. FAB-MORPHOLOGY+ 
CYTOCHEMISTRY+IMMUNOHISTOCHEMIST 
RY 
2. WHO- 
• Morphology 
• Cytochemistry
WHO 
CLASSIFICATION 
PRECURSOR 
LYMPHOID 
NEOPLASM 
MATURE 
LYMPHOID 
NEOPLASM 
HODGKIN’S 
LYMPHOMA
PRECURSOR LYMPHOID NEOPLASMS 
 Precursor-B 
lymphoblastic 
leukemia/lymphom 
a 
 Precursor-T 
lymphoblastic 
leukemia/lymphom 
a
MATURE B-CELL NEOPLASMS 
1. CHRONIC LYMPHOCYTIC LEUKEMIA/ SMALL LYMPHOCYTIC 
LYMPHOMA 
2. B- CELL PROLYMPHOCYTIC LEUKEMIA 
3. LYMPHOPLASMACYTIC LYMPHOMA 
4. SPLENIC MARGINAL ZONE LYMPHOMAS 
5. EXTRANODAL MARGINAL ZONE LYMPHOMA 
6. MANTLE CELL LYMPHOMA 
7. FOLLICULAR LYMPHOMA 
8. NODAL MARGINAL ZONE LYMPHOMA 
9. HAIRY CELL LEUKEMIA 
10. PLASMACYTOMA/PLASMA CELL MYELOMA 
11. DIFFUSE LARGE B-CELL LYMPHOMA 
12. BURKITT’S LYMPHOMA 
13. PLASMABLASTIC LYMPHOMA
MATURE T-CELL & NK-CELL NEOPLASMS 
1. T-CELL PROLYMPHOCYTIC LEUKEMIA 
2. LARGE GRANULAR LYMPHOCYTIC LEUKEMIA 
3. PERIPHERAL T-CELL LYMPHOMA 
4. UNSPECIFIED ANAPLASTIC LARGE CELL LYMPHOMA 
5. ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA 
6. ENTEROPATHY-ASSOCIATED T-CELL LYMPHOMA 
7. PANNICULITIS-LIKE-T-CELL LYMPHOMA 
8. HEPATOSPLENIC T-CELL LYMPHOMA 
9. ADULT T-CELL LEUKEMIA/LYMPHOMA 
10. AGGRESSIVE NK/T-CELL LYMPHOMA 
11. NK-CELL LEUKEMIA 
12. SEZARY SYNDROME 
13. MYCOSIS FUNGOIDES
HODGKIN’S LYMPHOMA 
1. CLASSICAL SUBTYPES-a. 
NODULAR SCLEOSIS 
b. MIXED CELLULARITY 
c. LYMPHOCYTE-RICH 
d. LYMPHOCYTE DEPLETION 
2. NODULAR LYMPHOCYTE PREDOMINANT
CHRONIC LYMPHOID LEUKEMIA-SUBTYPES 
B- CELL TYPE 
1. B-CELL CLL 
• CLL(PROLYMPHOCYTES <10%) 
• CLL/PLL(PROLYMPHOCYTES 11-55%) 
• RICHTER SYNDROME 
2. PROLYMPHOCYTIC LEUKEMIA(PROLYMPHOCYTES >55%) 
3. HAIRY CELL LEUKEMIA 
4. PLASMA CELL LEUKEMIA, WALDENSTROM 
MACROGLOBULINEMIA 
5. LYMPHOMA SPILL OVER- 
• SPLENIC LYMPHOMA WITH VILLOUS 
LYMPHOCYTES(SLVL) 
• MANTLE CELL LYMPHOMA
T-CELL TYPE 
1. T-CELL PROLYMPHOCYTIC LEUKEMIA 
2. LARGE GRANULAR LYMPHOCYTIC 
LEUKEMIA 
3. AGGRESSIVE NK-CELL LEUKEMIA 
4. ADULT T-CELL LEUKEMIA/LYMPHOMA 
5. MYCOSIS FUNGOIDES/SEZARY SYNDROME 
6. PERIPHERAL T-CELL LYMPHOMA 
7. ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA 
8. ANAPLASTIC LARGE CELL LYMPHOMA ALK 
+ve
B CELL CHRONIC LYMPHOCYTIC LEUKEMIA 
 Median age at diagnosis- 70 years 
 Incidence- Males= 2x Women 
 Symptoms related to- Anemia 
Thrombocytopenia 
Neutropenia 
 Neoplastic cells- 
1. Small and mature appearing 
2. Scant cytoplasm 
3. Nuclei usually round 
4. Chromatin regularly clumped(block-type chromatin) 
5. Nucleoli inconspicuous
 Diagnosis- Lymphocytosis >5 x 109 /L 
Prolymphocytes <10% 
Smudge cells 
 Cytogenetic abnormalities- 
1. Trisomy 12 
2. Del 11q22.3-23.1 
3. Del 6q21-23 
4. Deletions at 17p13.1(p53 aberrations) 
5. 14q abnormalities and complex chromosomal 
abnormalities
Chronic lymphoproliferative disorders
PROLYMPHOCYTIC LEUKEMIA 
Aggressive leukemic disorder . 
Often does not respond to treatment. 
Incidence- 10% that of CLL. 
Phenotypes- 
1.Mature B cell 
2.Mature T cell
B CELL PLL 
 70% cases of PLL. 
 Disease of adults 
 Male:Female-4:1 
 Lymphocytes- 
1. Large cell 
2. Moderate amount of pale basophilic cytoplasm 
3. Moderately condensed chromatin 
4. Single prominent nucleolus
Chronic lymphoproliferative disorders
T CELL PLL 
 Rare disorder of adults 
 Lymphocyte- 
1. Medium size 
2. Convoluted nuclear outlines 
3. Prominent nucleolus
Chronic lymphoproliferative disorders
HAIRY CELL LEUKEMIA 
 Uncommon malignancy of middle age. 
 Male:female-7:1 
 Presentation- 
1. Massive Splenomegaly 
2. Extensive bone marrow involvement 
3. Pancytopenia 
4. WBC count low- Neutropenia And Monocytopenia
 Neoplastic cell- 
1. Abundant pale staining cytoplasm 
2. Circumferential cytoplasmic projections(hairs) 
3. Oval or reniform nuclei 
4. Fine chromatin 
 Markers- 
1. CD19 
2. CD20(strong intensity) 
3. CD22 
4. CD25 
5. CD103 
6. CD11c 
7. TRAP
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
 Bone marrow aspiration- DRY TAP 
 Bone marrow biopsy- monotonous infiltrate of abnormal 
lymphocytes with small nuclei and abundant pale-staining 
cytoplasm- FRIED EGG APPEARANCE
LARGE GRANULAR LYMPHOCYTIC LEUKEMIA 
 LYMPHOCYTOSIS- 
1. Abundant pale staining cytoplasm 
2. Azurophilic cytoplasmic granules 
3. Nuclei with mature clumped chromatin 
 Phenotypes- 
1. T LYMPHOCYTE TYPE 
2. NK CELL TYPE
T-LGL LEUKEMIA 
 80% of LGLL 
 Age- 55years 
 PRESENTATION- Anemia 
Neutropenia 
Thrombocytopenia 
Splenomegaly
NK CELL TYPE 
 Median age-39 years 
 Acute presentation and aggressive course with 
death within 2 months
Chronic lymphoproliferative disorders
CUTANEOUS T CELL LYMPHOMA 
 Primary to skin 
 MYCOSIS FUNGOIDES-most common variant of CTCL 
 SEZARY SYNDROME- Erythroderma + Sezary cells 
 Sezary cell- 
1. Mature memory helper T cell 
2. Irregular, convoluted(cerebriform) nuclear outline 
3. Finely distributed chromatin 
4. CD3+, CD4+, CD7-
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
SUBGROUP OF 
CHRONIC LEUKEMIC 
LYMPHOID 
MALIGNANCIES 
KEY FEATURES MARKERS 
1. B CELL CLL Lymphocytosis 
Smudge cells 
Prolymphocytes <10% 
CD19+,CD5+,CD20+ 
weak intensity, 
CD23+, FMC-Surface 
Ig weak 
intensity 
2. B CELL PLL Splenomegaly 
Marked lymphocytosis 
Prolymphocytes >55% 
CD19+,CD20+,CD22 
+,CD5-/+,FMC-7+ 
Surface Ig strong 
intensity 
3.T CELL PLL Splenomegaly 
Skin lesions 
Marked lymphocytosis 
Varied morphologic appearance 
4. HAIRY CELL 
LEUKEMIA 
Pancytopenia 
Circulating hairy cells 
Bone marrow dry tap 
TRAP+ 
CD19+,CD5-,CD20+ 
strong
5. T CELL 
LGLL 
Lymphocytosis 
Anemia 
Neutopenia 
Thrombocytopenia 
Rheumatoid factor often present 
Indolent course 
CD2+,CD3+,CD4- 
,CD5+,CD7+,CD8+,CD16+, 
CD56-/+,CD57+/- 
T Cell receptor clonally 
rearranged 
6. SEZARY 
SYNDROME 
Erythroderma(red skin) 
Cutaneous T cell lymphoma 
Circulating malignant cells 
CD2+,CD3+,CD4+,CD5+,C 
D7-,CD8-
MALIGNANT 
LYMPHOMA 
HODGKIN 
NON-HODGKIN
PARAMETER HODGKIN LYMPHOMA NON-HODGKIN 
LYMPHOMA 
STAGE Usually localized Usually widespread 
DISTRIBUTION Usually central nodes Usually involves 
peripheral nodes 
MODE OF SPREAD Contiguous Non-contiguous 
EXTRANODAL DISEASE Uncommon Common 
PERIPHERAL BLOOD Never involved Can be involved 
CELL TYPE Abnormal bizarre cells Resembles normal 
lymphoid cells 
TREATMENT REGIMEN Often ABVD Often CHOP
SMALL LYMPHOCYTIC LYMPHOMA 
 Tissue equivalent of CLL.
Chronic lymphoproliferative disorders
FOLLICULAR LYMPHOMA 
 Neoplasm composed of cell originating from the germinal 
center. 
 Median age-50-60years 
 Presentation-generalized painless lymphadenopathy 
peripheral blood involvement 
bone marrow involvement 
 Lymph node-infiltrate of lymphoid cells forming poorly 
circumscribed nodules 
 Neoplastic follicles diifer from reactive follicle in lacking 
apoptosis of lymphocytes 
 Tingible body macrophages 
 Small cleaved cells(CENTROCYTES) and large 
cells(CENTROBLASTS)
GRADING OF FOLLICULAR LYMPHOMA 
GRADE DEFINITION 
1 0-5 centroblasts per defined 
HPF 
2 6-15 centroblasts per defined 
HPF 
3 >15 centroblasts per defined 
HPF
Chronic lymphoproliferative disorders
MANTLE CELL LYMPHOMA 
 Median age 60 years 
 Male predominance 
 Neoplastic cells-small to intermediate in size with round 
to slightly irregular nuclear outlines. 
 Markers- 
1. CD19+ 
2. CD5+ 
3. CD23- 
4. FMC7+ 
5. sIg+(strong intensity) 
6. Cyclin D1
Chronic lymphoproliferative disorders
MALT LYMPHOMA 
 Prsentation-localized extranodal disease 
 A preceding chronic inflammatory disorder(chronic 
gastritis,sjogrens,hashimotos) 
 Neoplastic cells- 
1. Small lymphocytes 
2. Round to slightly cleaved nuclei
Chronic lymphoproliferative disorders
BURKITT LYMPHOMA 
 High grade Non-hodgkin lymphoma 
 High incidence in Africa(ENDEMIC SUBTYPE) 
 1/3rd of pediatric lymphomas outside 
africa(SPORADIC SUBTYPE) 
 Extranodal involvement 
 Endemic-involves facial bones and jaw 
 Sporadic- intestine,ovaries or kidney 
 EBV associated
 Biopsy- STARRY SKY APPEARANCE- 
• The SKY represents the blue nuclei of the neoplastic 
lymphocytes 
• The STARS formed by scattered pale staining tingible body 
macrophages. 
 Infiltrating lymphoid cells are intermediate in size with 
nuclei approximately the same size as the nuclei of the 
tingible body macrophages. 
 Multiple small nucleoli,mitotic figures and apoptotic bodies. 
 Markers- 
1. CD19+ 
2. sIg+ 
3. CD10+ 
4. CD5-
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
HODGKINS LYMPHOMA-CLASSIFICATION 
SUBTYPE SCLEROSIS LYMPHOCYT 
ES 
TUMOUR 
CELLS 
VARIANTS 
VARIANTS CELL TYPE 
LYMPHOCYTI 
C 
PREDOMINA 
NCE 
- ++++ + L AND H B-CELL 
NODULAR 
SCLEROSIS 
PRESENT ++ ++ LACUNAR UNCERTAIN 
CELL OF 
ORIGIN 
MIXED 
CELLULARIT 
Y 
- ++ ++ - UNCERTAIN 
CELL OF 
ORIGIN 
LYMPHOCYTI 
C RICH 
- ++++ + - UNCERTAIN 
CELL OF 
ORIGIN
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
ANN ARBOR STAGING OF HODGKIN’S 
STAGE FEATURE 
STAGE I Involvement of single lymph node region(I) or a single extra lymphatic 
organ/site(IE) 
STAGE 
II 
Involvement of two more lymph node regions on the same side of 
diaphragm(II) or 
Localized involvement of an extra lymphatic organ and one more more 
lymph node regions on the same side of the diaphragm(IIE) 
STAGE 
III 
Involvement of lymph node regions on both sides of diaphragm(III), which 
may also be accompanied by localized involvement of an extra lymphatic 
organ(IIIE) or involvement of the spleen(IIIS) or both(IIIES) 
STAGE 
IV 
Diffuse or disseminated involvement of one or more extra lymphatic 
organs or tissues with or without associated lymph node enlargement.
SUBCLASSIFICATION 
 A- without symptoms 
 B- Systemic symptoms: 
1. Unexplained fever 38 degree Celsius. 
2. Unexplained weight loss 10% body weight in 
preceding 6 months. 
3. Night sweats.
MALIGNANT LYMPHOMA KEY FEATURE 
1. FOLLICULAR LYMPHOMA Nodular growth pattern 
Lack of tangible body macrophages 
CD19+,CD20+,CD5-,CD10+ 
Surface Ig strong intensity 
t(14;18) 
BCL-2 protein overexpression 
BCL-2 gene rearrangement 
2. MANTLE CELL LYMPHOMA Lack of large cells 
CD19+,CD20+,CD5+,CD23-,FMC-7+ 
Surface Ig+ strong intensity 
Cyclin-D1 overexpression 
t(11;14) 
BCL-1 rearrangement 
3. MALT LYMPHOMA Accompanied by infectious or autoimmune disease 
Often localized 
Extranodal 
Lymphoepithelial lesions 
Benign follicles 
Heterogeneous neoplastic infiltrate 
Phenotype and genotype not specific
4. WALDENSTROM MACROGLOBULINEMIA Lymphoid malignancy with plasmacytic differentiation 
IgM 
Hypervicosity syndrome 
5. BURKITT LYMPHOMA Can be associated with EBV 
Starry sky growth pattern 
CD19+,CD20+,CD5-,CD10+ 
Strong surface Ig 
t(8;14) 
C-MYC gene rearrangement 
6. ANAPLASTIC LARGE CELL LYMPHOMA Bizarre,anaplastic cells can resemble HD 
T cell or Null phenotype 
LCA+/-,CD30+,CD15-,EMA+/-,EBV-,ALK-1+/- 
t(2;5) 
7. CLASSIC HODGKIN LYMPHOMA Reed-Sternberg cells 
LCA-,CD15+,CD30+,ALK-1- 
Often EBV + 
8. LYMPHOCYTIC PREDOMINANT HL Growth pattern frequently nodular 
L and H cells 
LCA+,CD20+,CD15-,CD30-,EBV-
PLASMA CELL DISORDERS 
1. PLASMA CELL MYELOMA (MULTIPLE 
MYELOMA) 
2. PLASMACYTOMA 
3. PRIMARY AMYLOIDOSIS 
4. HEAVY CHAIN DISEASE 
5. MONOCLONAL GAMMOPATHY OF 
UNDETERMINED SIGNIFICANCE (MGUS)
KEY FEATURES OF PLASMA CELL DISORDERS 
NEOPLASM FEATURES 
1. MULTIPLE (PLASMA CELL) MYELOMA • LYTIC BONE LESIONS 
• “M” SPIKE ON SERUM/URINE 
ELECTROPHORESIS 
• ROULEAUX ON BLOOD SMEAR 
• >30% PLASMA CELLS IN BONE MARROW 
2. PLAMACYTOMA • LOCALIZED MASS 
• MONOCLONAL PLASMA CELLS 
3. MONOCLONAL GAMMOPATHY OF 
UNDETERMINED SIGNIFICANCE 
• MONOCLONAL SERUM PROTEIN 
• MONOCLONAL PROTEIN <3gm/dl 
• LYTIC BONE LESIONS ABSENT 
• BONE MARROW PLASMA CELLS <10%
CRITERIA FOR DIAGNOSIS OF MULTIPLE 
MYELOMA(SALMON AND DURIE) 
MAJOR CRITERIA- 
1. Plasmacytoma on biopsy 
2. Bone marrow plasmacytosis >30% plasma cells 
3. M band in serum 
• IgG >3.5 g/dl OR IgA >2 g/dl 
• Light chain excretion in urine >/= 1 g/24 HOURS 
MINOR CRITERIA- 
1. Bone marrow plasmacytosis 10-30% plasma cells 
2. Monoclonal globulin spike IgG <3.5 g/DL, or IgA <2g/DL 
3. Lytic bone lesions 
4. Normal IgM <50 mg/dl, IgA <0.1 g/dl OR IgG <0.6 g/dl 
CRITERIA FOR MM 
Diagnossi of myeloma is confirmed when at least- 
• One major + one minor criteria OR 
• 3 minor criteria, that must include 1 and 2 of minor criteria.
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
APPROACH TO DIAGNOSIS OF 
LYMPHOMA??
CELL SIZE DETERMINATION 
 Neoplastic cells are compared with the Reactive 
Histiocytes interspersed among the lymphoma cells. 
 SMALL- Nuclei smaller than that of reactive histiocytes. 
 MEDIUM- Nuclei approx. same as that of histiocytes. 
 LARGE- Nuclei larger than those of histiocytes.
MEDIUM SIZED FOLLICLES-APPROACH 
TO DIAGNOSIS 
 MAJOR DIFFERENTIAL DIAGNOSIS 
1. Reactive follicular hyperplasia 
2. Follicular lymphoma 
3. Nodular mantle cell lymphoma
How to distinguish between reactive follicular hyperplasia and 
follicular lymphoma? 
FEATURE REACTIVE FOLLICULAR 
HYPERPLASIA 
FOLLICULAR 
LYMPHOMA 
FOLLICLES Discrete and separeated 
by interfollicular lymphoid 
tissue 
A pattern of back to back 
follicles with little 
interfollicular tissue 
TINGIBLE BODY 
MACROPHAGES 
Present Lack 
CELLULAR POLARIZATION Into light and dark zones 
present 
Absent 
POPULATION Heterogeneous population 
of follicular cells 
Predominance of 
centrocytes in the 
follicles
LARGE LYMPHOID NODULES: 
APPROACH TO DIAGNOSIS 
 MAJOR DIFFERENTIAL DIAGNOSIS 
1. NLPHL 
2. N-LRCHL 
3. NSHL 
4. PTGC
Chronic lymphoproliferative disorders
DIFFUSE SMALL B-CELL LYMPHOMAS-APPROACH 
TO CLASSIFICATION 
 MAJOR DIFFERENTIAL DIAGNOSIS 
1. CLL/SLL 
2. Lymphoplasmacytic lymphoma 
3. Mantle cell lymphoma 
4. Extranodal marginal cell lymphoma
LARGE CELL SCATTERED IN A BACKGROUND OF 
SMALL LYMPHOCYTES 
 MAJOR DIFFERENTIAL DIAGNOSIS 
1. Reactive lymphoid hyperplasia 
2. T-cell/histiocytic rich large B-cell lymphoma 
3. Hodgkin lymphoma
Possible diagnosis All large cells show 
morphologic 
features acceptable 
for immunoblasts or 
centroblasts( 
nuclear size <x2.5 
small lymphocyte 
nucleus: nuclear 
contour round to 
oval) 
Large cells are 
atypical(with 
irregular nuclear 
folding or granular 
chromatin),but 
most nuclei are 
<x2.5 small 
lymphocyte nucleus 
Most large cells 
have nuclei >x3 
small lymphocyte 
nucleus 
Reactive lymphoid 
hyperplasia 
+ - - 
TCRBCL + + + 
Hodgkin’s 
lymphoma 
- - +
CELL IDENTIFICATION BY 
CCYTYOTCHOEMCICHAL EREMACTIIOSNTRY CELL TYPES 
1. NON SPECIFIC ESTERASE • MYELOID CELLS 
• MONOCYTES 
• MEGAKARYOCYTES 
• T LYMPHOCYTES(dot like staining) 
2. CHLOROACETATE ESTERASE • MYELOID CELLS 
• MAST CELLS 
3. PEROXIDASE • MYELOID CELLS 
• EOSINOPHILS 
• MONOCYTES 
4. SUDAN BLACK B • MYELOID CELLS 
• MONOCYTES 
5. METHYL GREEN PYRONINE • PLASMA CELLS 
• IMMUNOBLASTS 
6.PERIODIC ACID-SCHIFF WITH DIASTASE • PLASMA CELLS 
7. TARTRATE-RESISTANT ACID PHOSPHATASE • HAIRY CELL LEUKEMIA
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
MOST USEFUL ANTIBODIES FOR ASSESSMENT OF LYMPHOID 
PROLIFERATIONS 
PROBLEM TO BE ASSESSED FIRST-LINE ANTIBODIES 
B LINEAGE ? CD20( or CD79a, PAX5) 
T LINEAGE ? CD3( OR CD2) 
NK LINEAGE ? CD56, SURFACE CD3, CYTOPLASMIC CD3, TCR 
FOLLICULAR CENTER CELL ? CD10( OR BCL6, HGAL) 
FOLLICULAR LYMPHOMA OR HYPERPLASIA ? BCL2, CD10(interfollicular invasion) 
CLL ? CD5, CD23 
NORMAL MANTLE ZONE CELLS ? IgD 
MANTLE CELL LYMPHOMA ? CYCLIN D1, CD5 
BURKITT LYMPHOMA ? Ki67, CD10(+/-BCL6), BCL2, MYC 
IMMATURE(PRECURSOR LYMPHOBLASTIC)CELL ? TdT 
ANAPLASTIC LARGE CELL LYMPHOMA ? CD30, ALK 
PLASMA CELL ? CD20- , CD138+ 
HISTIOCYTE ? CD163( or CD68) 
INTERDIGITATIONG DENDRITIC OR 
LANGERHANS CELL ? 
S100( also LANGERIN/ CD207 for the latter cell type) 
FOLLICULAR DENDRITIC CELL ? CD21 or CD35 
HODGKIN LYMPHOMA ? CD30, CD15, PAX5
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
Chronic lymphoproliferative disorders
CHARACTERISTIC CYTOGENETIC FINDINGS IN 
SPECIFIC LYMPHOMA TYPES 
LYMPHOMA TYPE SPECIFIC CHROMOSOMAL 
TRANSLOCATION 
ONCOGENE OR TUMOUR 
SUPPRESSOR GEENE 
IMPLICATED 
Follicular lymphoma t(14;18)(q32;q21) BCL2 
Mantle cell lymphoma t(11;14)(q13;q32) CCND1 
Extranodal marginal zone 
lymphoma of MALT type 
t(11;18)(q21;q21) 
t(1;14)(p22;q32) 
t(14;18)(q32;q21) 
t(3;14)(p14.1;q32) 
API2, MALT1 
BCL10 
MALT1 
FOXP1 
Burkitt lymphoma t(8;14)(q24;q32) 
t(8;22)(q24;q11) 
t(2;8)(p12;q24) 
MYC 
T-lymphoblastic 
lymphoma/leukemia 
t(1;14)
RELATIVE FREQUENCIES OF B-CELL LYMPHOMA 
SUBTYPES IN ADULTS
RELATIVE FREQUENCIES OF MATURE T-CELL 
LYMPHOMA SUBTYPES IN ADULTS
REACTIVE LYMPADENOPATHIES AND 
THEIR DISTICTION FROM LYMPHOMA 
 INFECTIOUS MONONUCLEOSIS AND OTHER VIRAL 
INFECTIONS 
 HYPERSENSITIVITY REACTIONS(PHENYTOIN) 
 KIKUCHI LYMPHADENITIS
REFERENCES 
 MCKENZIE-2ND EDITION,VOLUME 2 
 WHO CLASSIFICATION OF TUMOURS OF 
HAEMATOPOIETIC AND LYMPHOID MALIGNANCIES- 
4TH EDITION 
 WINTROBES-11TH EDITION 
 ROBBINS- 18TH EDITION 
 DIAGNOSTIC HISTOPATHOLOGY OF TUMOURS-FLETCHER 
4TH EDITION,VOLUME 2 
 IOACHIM’S LYMPH NODE PATHOLOGY 
 INTERNET
THANK YOU

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Chronic lymphoproliferative disorders

  • 1. CHRONIC LYMPHOPROLIFERATIVE DISORDERS PRESENTER- DR. ANKITA BAGHEL MODERATOR- DR. MANJULA K.
  • 2. CONTENTS  NORMAL HISTOLOGY  WHAT IS CLPD  CELL DIFFERENTIATION  CLASSIFICATION  INDIVIDUAL DISORDERS  APPROACH TO DIAGNOSIS  CYTOCHEMISTRY  IMMUNOPHENOTYPING  CYTOGENETICS  REFERENCES
  • 3. NORMAL HISTOLOGY OF LYMPH NODE CORTEX - Outer most portion - B-cell lymphoid follicles - Primary follicles(small lymphocytes) - Secondary follicle-Germinal center(centroblasts,centrocytes) PARACORTEX - Below and between the follicle - T-cells, histiocytes, interdigitating Dendritic Cells And Langerhans Cells MEDULLA - Deep portion - Plasma cell-rich medullary cords
  • 9.  CHRONIC LYMPHOPROLIFERATIVE DISORDERS(CLPDS) are a heterogeneous group of malignancies characterised by the proliferation of mature B and rarely T lymphoid cells in the peripheral blood, bone marrow and/or lymph nodes/spleen and other lymphoid tissues.  Classification- 1. FAB-MORPHOLOGY+ CYTOCHEMISTRY+IMMUNOHISTOCHEMIST RY 2. WHO- • Morphology • Cytochemistry
  • 10. WHO CLASSIFICATION PRECURSOR LYMPHOID NEOPLASM MATURE LYMPHOID NEOPLASM HODGKIN’S LYMPHOMA
  • 11. PRECURSOR LYMPHOID NEOPLASMS  Precursor-B lymphoblastic leukemia/lymphom a  Precursor-T lymphoblastic leukemia/lymphom a
  • 12. MATURE B-CELL NEOPLASMS 1. CHRONIC LYMPHOCYTIC LEUKEMIA/ SMALL LYMPHOCYTIC LYMPHOMA 2. B- CELL PROLYMPHOCYTIC LEUKEMIA 3. LYMPHOPLASMACYTIC LYMPHOMA 4. SPLENIC MARGINAL ZONE LYMPHOMAS 5. EXTRANODAL MARGINAL ZONE LYMPHOMA 6. MANTLE CELL LYMPHOMA 7. FOLLICULAR LYMPHOMA 8. NODAL MARGINAL ZONE LYMPHOMA 9. HAIRY CELL LEUKEMIA 10. PLASMACYTOMA/PLASMA CELL MYELOMA 11. DIFFUSE LARGE B-CELL LYMPHOMA 12. BURKITT’S LYMPHOMA 13. PLASMABLASTIC LYMPHOMA
  • 13. MATURE T-CELL & NK-CELL NEOPLASMS 1. T-CELL PROLYMPHOCYTIC LEUKEMIA 2. LARGE GRANULAR LYMPHOCYTIC LEUKEMIA 3. PERIPHERAL T-CELL LYMPHOMA 4. UNSPECIFIED ANAPLASTIC LARGE CELL LYMPHOMA 5. ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA 6. ENTEROPATHY-ASSOCIATED T-CELL LYMPHOMA 7. PANNICULITIS-LIKE-T-CELL LYMPHOMA 8. HEPATOSPLENIC T-CELL LYMPHOMA 9. ADULT T-CELL LEUKEMIA/LYMPHOMA 10. AGGRESSIVE NK/T-CELL LYMPHOMA 11. NK-CELL LEUKEMIA 12. SEZARY SYNDROME 13. MYCOSIS FUNGOIDES
  • 14. HODGKIN’S LYMPHOMA 1. CLASSICAL SUBTYPES-a. NODULAR SCLEOSIS b. MIXED CELLULARITY c. LYMPHOCYTE-RICH d. LYMPHOCYTE DEPLETION 2. NODULAR LYMPHOCYTE PREDOMINANT
  • 15. CHRONIC LYMPHOID LEUKEMIA-SUBTYPES B- CELL TYPE 1. B-CELL CLL • CLL(PROLYMPHOCYTES <10%) • CLL/PLL(PROLYMPHOCYTES 11-55%) • RICHTER SYNDROME 2. PROLYMPHOCYTIC LEUKEMIA(PROLYMPHOCYTES >55%) 3. HAIRY CELL LEUKEMIA 4. PLASMA CELL LEUKEMIA, WALDENSTROM MACROGLOBULINEMIA 5. LYMPHOMA SPILL OVER- • SPLENIC LYMPHOMA WITH VILLOUS LYMPHOCYTES(SLVL) • MANTLE CELL LYMPHOMA
  • 16. T-CELL TYPE 1. T-CELL PROLYMPHOCYTIC LEUKEMIA 2. LARGE GRANULAR LYMPHOCYTIC LEUKEMIA 3. AGGRESSIVE NK-CELL LEUKEMIA 4. ADULT T-CELL LEUKEMIA/LYMPHOMA 5. MYCOSIS FUNGOIDES/SEZARY SYNDROME 6. PERIPHERAL T-CELL LYMPHOMA 7. ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA 8. ANAPLASTIC LARGE CELL LYMPHOMA ALK +ve
  • 17. B CELL CHRONIC LYMPHOCYTIC LEUKEMIA  Median age at diagnosis- 70 years  Incidence- Males= 2x Women  Symptoms related to- Anemia Thrombocytopenia Neutropenia  Neoplastic cells- 1. Small and mature appearing 2. Scant cytoplasm 3. Nuclei usually round 4. Chromatin regularly clumped(block-type chromatin) 5. Nucleoli inconspicuous
  • 18.  Diagnosis- Lymphocytosis >5 x 109 /L Prolymphocytes <10% Smudge cells  Cytogenetic abnormalities- 1. Trisomy 12 2. Del 11q22.3-23.1 3. Del 6q21-23 4. Deletions at 17p13.1(p53 aberrations) 5. 14q abnormalities and complex chromosomal abnormalities
  • 20. PROLYMPHOCYTIC LEUKEMIA Aggressive leukemic disorder . Often does not respond to treatment. Incidence- 10% that of CLL. Phenotypes- 1.Mature B cell 2.Mature T cell
  • 21. B CELL PLL  70% cases of PLL.  Disease of adults  Male:Female-4:1  Lymphocytes- 1. Large cell 2. Moderate amount of pale basophilic cytoplasm 3. Moderately condensed chromatin 4. Single prominent nucleolus
  • 23. T CELL PLL  Rare disorder of adults  Lymphocyte- 1. Medium size 2. Convoluted nuclear outlines 3. Prominent nucleolus
  • 25. HAIRY CELL LEUKEMIA  Uncommon malignancy of middle age.  Male:female-7:1  Presentation- 1. Massive Splenomegaly 2. Extensive bone marrow involvement 3. Pancytopenia 4. WBC count low- Neutropenia And Monocytopenia
  • 26.  Neoplastic cell- 1. Abundant pale staining cytoplasm 2. Circumferential cytoplasmic projections(hairs) 3. Oval or reniform nuclei 4. Fine chromatin  Markers- 1. CD19 2. CD20(strong intensity) 3. CD22 4. CD25 5. CD103 6. CD11c 7. TRAP
  • 29.  Bone marrow aspiration- DRY TAP  Bone marrow biopsy- monotonous infiltrate of abnormal lymphocytes with small nuclei and abundant pale-staining cytoplasm- FRIED EGG APPEARANCE
  • 30. LARGE GRANULAR LYMPHOCYTIC LEUKEMIA  LYMPHOCYTOSIS- 1. Abundant pale staining cytoplasm 2. Azurophilic cytoplasmic granules 3. Nuclei with mature clumped chromatin  Phenotypes- 1. T LYMPHOCYTE TYPE 2. NK CELL TYPE
  • 31. T-LGL LEUKEMIA  80% of LGLL  Age- 55years  PRESENTATION- Anemia Neutropenia Thrombocytopenia Splenomegaly
  • 32. NK CELL TYPE  Median age-39 years  Acute presentation and aggressive course with death within 2 months
  • 34. CUTANEOUS T CELL LYMPHOMA  Primary to skin  MYCOSIS FUNGOIDES-most common variant of CTCL  SEZARY SYNDROME- Erythroderma + Sezary cells  Sezary cell- 1. Mature memory helper T cell 2. Irregular, convoluted(cerebriform) nuclear outline 3. Finely distributed chromatin 4. CD3+, CD4+, CD7-
  • 37. SUBGROUP OF CHRONIC LEUKEMIC LYMPHOID MALIGNANCIES KEY FEATURES MARKERS 1. B CELL CLL Lymphocytosis Smudge cells Prolymphocytes <10% CD19+,CD5+,CD20+ weak intensity, CD23+, FMC-Surface Ig weak intensity 2. B CELL PLL Splenomegaly Marked lymphocytosis Prolymphocytes >55% CD19+,CD20+,CD22 +,CD5-/+,FMC-7+ Surface Ig strong intensity 3.T CELL PLL Splenomegaly Skin lesions Marked lymphocytosis Varied morphologic appearance 4. HAIRY CELL LEUKEMIA Pancytopenia Circulating hairy cells Bone marrow dry tap TRAP+ CD19+,CD5-,CD20+ strong
  • 38. 5. T CELL LGLL Lymphocytosis Anemia Neutopenia Thrombocytopenia Rheumatoid factor often present Indolent course CD2+,CD3+,CD4- ,CD5+,CD7+,CD8+,CD16+, CD56-/+,CD57+/- T Cell receptor clonally rearranged 6. SEZARY SYNDROME Erythroderma(red skin) Cutaneous T cell lymphoma Circulating malignant cells CD2+,CD3+,CD4+,CD5+,C D7-,CD8-
  • 40. PARAMETER HODGKIN LYMPHOMA NON-HODGKIN LYMPHOMA STAGE Usually localized Usually widespread DISTRIBUTION Usually central nodes Usually involves peripheral nodes MODE OF SPREAD Contiguous Non-contiguous EXTRANODAL DISEASE Uncommon Common PERIPHERAL BLOOD Never involved Can be involved CELL TYPE Abnormal bizarre cells Resembles normal lymphoid cells TREATMENT REGIMEN Often ABVD Often CHOP
  • 41. SMALL LYMPHOCYTIC LYMPHOMA  Tissue equivalent of CLL.
  • 43. FOLLICULAR LYMPHOMA  Neoplasm composed of cell originating from the germinal center.  Median age-50-60years  Presentation-generalized painless lymphadenopathy peripheral blood involvement bone marrow involvement  Lymph node-infiltrate of lymphoid cells forming poorly circumscribed nodules  Neoplastic follicles diifer from reactive follicle in lacking apoptosis of lymphocytes  Tingible body macrophages  Small cleaved cells(CENTROCYTES) and large cells(CENTROBLASTS)
  • 44. GRADING OF FOLLICULAR LYMPHOMA GRADE DEFINITION 1 0-5 centroblasts per defined HPF 2 6-15 centroblasts per defined HPF 3 >15 centroblasts per defined HPF
  • 46. MANTLE CELL LYMPHOMA  Median age 60 years  Male predominance  Neoplastic cells-small to intermediate in size with round to slightly irregular nuclear outlines.  Markers- 1. CD19+ 2. CD5+ 3. CD23- 4. FMC7+ 5. sIg+(strong intensity) 6. Cyclin D1
  • 48. MALT LYMPHOMA  Prsentation-localized extranodal disease  A preceding chronic inflammatory disorder(chronic gastritis,sjogrens,hashimotos)  Neoplastic cells- 1. Small lymphocytes 2. Round to slightly cleaved nuclei
  • 50. BURKITT LYMPHOMA  High grade Non-hodgkin lymphoma  High incidence in Africa(ENDEMIC SUBTYPE)  1/3rd of pediatric lymphomas outside africa(SPORADIC SUBTYPE)  Extranodal involvement  Endemic-involves facial bones and jaw  Sporadic- intestine,ovaries or kidney  EBV associated
  • 51.  Biopsy- STARRY SKY APPEARANCE- • The SKY represents the blue nuclei of the neoplastic lymphocytes • The STARS formed by scattered pale staining tingible body macrophages.  Infiltrating lymphoid cells are intermediate in size with nuclei approximately the same size as the nuclei of the tingible body macrophages.  Multiple small nucleoli,mitotic figures and apoptotic bodies.  Markers- 1. CD19+ 2. sIg+ 3. CD10+ 4. CD5-
  • 54. HODGKINS LYMPHOMA-CLASSIFICATION SUBTYPE SCLEROSIS LYMPHOCYT ES TUMOUR CELLS VARIANTS VARIANTS CELL TYPE LYMPHOCYTI C PREDOMINA NCE - ++++ + L AND H B-CELL NODULAR SCLEROSIS PRESENT ++ ++ LACUNAR UNCERTAIN CELL OF ORIGIN MIXED CELLULARIT Y - ++ ++ - UNCERTAIN CELL OF ORIGIN LYMPHOCYTI C RICH - ++++ + - UNCERTAIN CELL OF ORIGIN
  • 58. ANN ARBOR STAGING OF HODGKIN’S STAGE FEATURE STAGE I Involvement of single lymph node region(I) or a single extra lymphatic organ/site(IE) STAGE II Involvement of two more lymph node regions on the same side of diaphragm(II) or Localized involvement of an extra lymphatic organ and one more more lymph node regions on the same side of the diaphragm(IIE) STAGE III Involvement of lymph node regions on both sides of diaphragm(III), which may also be accompanied by localized involvement of an extra lymphatic organ(IIIE) or involvement of the spleen(IIIS) or both(IIIES) STAGE IV Diffuse or disseminated involvement of one or more extra lymphatic organs or tissues with or without associated lymph node enlargement.
  • 59. SUBCLASSIFICATION  A- without symptoms  B- Systemic symptoms: 1. Unexplained fever 38 degree Celsius. 2. Unexplained weight loss 10% body weight in preceding 6 months. 3. Night sweats.
  • 60. MALIGNANT LYMPHOMA KEY FEATURE 1. FOLLICULAR LYMPHOMA Nodular growth pattern Lack of tangible body macrophages CD19+,CD20+,CD5-,CD10+ Surface Ig strong intensity t(14;18) BCL-2 protein overexpression BCL-2 gene rearrangement 2. MANTLE CELL LYMPHOMA Lack of large cells CD19+,CD20+,CD5+,CD23-,FMC-7+ Surface Ig+ strong intensity Cyclin-D1 overexpression t(11;14) BCL-1 rearrangement 3. MALT LYMPHOMA Accompanied by infectious or autoimmune disease Often localized Extranodal Lymphoepithelial lesions Benign follicles Heterogeneous neoplastic infiltrate Phenotype and genotype not specific
  • 61. 4. WALDENSTROM MACROGLOBULINEMIA Lymphoid malignancy with plasmacytic differentiation IgM Hypervicosity syndrome 5. BURKITT LYMPHOMA Can be associated with EBV Starry sky growth pattern CD19+,CD20+,CD5-,CD10+ Strong surface Ig t(8;14) C-MYC gene rearrangement 6. ANAPLASTIC LARGE CELL LYMPHOMA Bizarre,anaplastic cells can resemble HD T cell or Null phenotype LCA+/-,CD30+,CD15-,EMA+/-,EBV-,ALK-1+/- t(2;5) 7. CLASSIC HODGKIN LYMPHOMA Reed-Sternberg cells LCA-,CD15+,CD30+,ALK-1- Often EBV + 8. LYMPHOCYTIC PREDOMINANT HL Growth pattern frequently nodular L and H cells LCA+,CD20+,CD15-,CD30-,EBV-
  • 62. PLASMA CELL DISORDERS 1. PLASMA CELL MYELOMA (MULTIPLE MYELOMA) 2. PLASMACYTOMA 3. PRIMARY AMYLOIDOSIS 4. HEAVY CHAIN DISEASE 5. MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE (MGUS)
  • 63. KEY FEATURES OF PLASMA CELL DISORDERS NEOPLASM FEATURES 1. MULTIPLE (PLASMA CELL) MYELOMA • LYTIC BONE LESIONS • “M” SPIKE ON SERUM/URINE ELECTROPHORESIS • ROULEAUX ON BLOOD SMEAR • >30% PLASMA CELLS IN BONE MARROW 2. PLAMACYTOMA • LOCALIZED MASS • MONOCLONAL PLASMA CELLS 3. MONOCLONAL GAMMOPATHY OF UNDETERMINED SIGNIFICANCE • MONOCLONAL SERUM PROTEIN • MONOCLONAL PROTEIN <3gm/dl • LYTIC BONE LESIONS ABSENT • BONE MARROW PLASMA CELLS <10%
  • 64. CRITERIA FOR DIAGNOSIS OF MULTIPLE MYELOMA(SALMON AND DURIE) MAJOR CRITERIA- 1. Plasmacytoma on biopsy 2. Bone marrow plasmacytosis >30% plasma cells 3. M band in serum • IgG >3.5 g/dl OR IgA >2 g/dl • Light chain excretion in urine >/= 1 g/24 HOURS MINOR CRITERIA- 1. Bone marrow plasmacytosis 10-30% plasma cells 2. Monoclonal globulin spike IgG <3.5 g/DL, or IgA <2g/DL 3. Lytic bone lesions 4. Normal IgM <50 mg/dl, IgA <0.1 g/dl OR IgG <0.6 g/dl CRITERIA FOR MM Diagnossi of myeloma is confirmed when at least- • One major + one minor criteria OR • 3 minor criteria, that must include 1 and 2 of minor criteria.
  • 68. APPROACH TO DIAGNOSIS OF LYMPHOMA??
  • 69. CELL SIZE DETERMINATION  Neoplastic cells are compared with the Reactive Histiocytes interspersed among the lymphoma cells.  SMALL- Nuclei smaller than that of reactive histiocytes.  MEDIUM- Nuclei approx. same as that of histiocytes.  LARGE- Nuclei larger than those of histiocytes.
  • 70. MEDIUM SIZED FOLLICLES-APPROACH TO DIAGNOSIS  MAJOR DIFFERENTIAL DIAGNOSIS 1. Reactive follicular hyperplasia 2. Follicular lymphoma 3. Nodular mantle cell lymphoma
  • 71. How to distinguish between reactive follicular hyperplasia and follicular lymphoma? FEATURE REACTIVE FOLLICULAR HYPERPLASIA FOLLICULAR LYMPHOMA FOLLICLES Discrete and separeated by interfollicular lymphoid tissue A pattern of back to back follicles with little interfollicular tissue TINGIBLE BODY MACROPHAGES Present Lack CELLULAR POLARIZATION Into light and dark zones present Absent POPULATION Heterogeneous population of follicular cells Predominance of centrocytes in the follicles
  • 72. LARGE LYMPHOID NODULES: APPROACH TO DIAGNOSIS  MAJOR DIFFERENTIAL DIAGNOSIS 1. NLPHL 2. N-LRCHL 3. NSHL 4. PTGC
  • 74. DIFFUSE SMALL B-CELL LYMPHOMAS-APPROACH TO CLASSIFICATION  MAJOR DIFFERENTIAL DIAGNOSIS 1. CLL/SLL 2. Lymphoplasmacytic lymphoma 3. Mantle cell lymphoma 4. Extranodal marginal cell lymphoma
  • 75. LARGE CELL SCATTERED IN A BACKGROUND OF SMALL LYMPHOCYTES  MAJOR DIFFERENTIAL DIAGNOSIS 1. Reactive lymphoid hyperplasia 2. T-cell/histiocytic rich large B-cell lymphoma 3. Hodgkin lymphoma
  • 76. Possible diagnosis All large cells show morphologic features acceptable for immunoblasts or centroblasts( nuclear size <x2.5 small lymphocyte nucleus: nuclear contour round to oval) Large cells are atypical(with irregular nuclear folding or granular chromatin),but most nuclei are <x2.5 small lymphocyte nucleus Most large cells have nuclei >x3 small lymphocyte nucleus Reactive lymphoid hyperplasia + - - TCRBCL + + + Hodgkin’s lymphoma - - +
  • 77. CELL IDENTIFICATION BY CCYTYOTCHOEMCICHAL EREMACTIIOSNTRY CELL TYPES 1. NON SPECIFIC ESTERASE • MYELOID CELLS • MONOCYTES • MEGAKARYOCYTES • T LYMPHOCYTES(dot like staining) 2. CHLOROACETATE ESTERASE • MYELOID CELLS • MAST CELLS 3. PEROXIDASE • MYELOID CELLS • EOSINOPHILS • MONOCYTES 4. SUDAN BLACK B • MYELOID CELLS • MONOCYTES 5. METHYL GREEN PYRONINE • PLASMA CELLS • IMMUNOBLASTS 6.PERIODIC ACID-SCHIFF WITH DIASTASE • PLASMA CELLS 7. TARTRATE-RESISTANT ACID PHOSPHATASE • HAIRY CELL LEUKEMIA
  • 80. MOST USEFUL ANTIBODIES FOR ASSESSMENT OF LYMPHOID PROLIFERATIONS PROBLEM TO BE ASSESSED FIRST-LINE ANTIBODIES B LINEAGE ? CD20( or CD79a, PAX5) T LINEAGE ? CD3( OR CD2) NK LINEAGE ? CD56, SURFACE CD3, CYTOPLASMIC CD3, TCR FOLLICULAR CENTER CELL ? CD10( OR BCL6, HGAL) FOLLICULAR LYMPHOMA OR HYPERPLASIA ? BCL2, CD10(interfollicular invasion) CLL ? CD5, CD23 NORMAL MANTLE ZONE CELLS ? IgD MANTLE CELL LYMPHOMA ? CYCLIN D1, CD5 BURKITT LYMPHOMA ? Ki67, CD10(+/-BCL6), BCL2, MYC IMMATURE(PRECURSOR LYMPHOBLASTIC)CELL ? TdT ANAPLASTIC LARGE CELL LYMPHOMA ? CD30, ALK PLASMA CELL ? CD20- , CD138+ HISTIOCYTE ? CD163( or CD68) INTERDIGITATIONG DENDRITIC OR LANGERHANS CELL ? S100( also LANGERIN/ CD207 for the latter cell type) FOLLICULAR DENDRITIC CELL ? CD21 or CD35 HODGKIN LYMPHOMA ? CD30, CD15, PAX5
  • 84. CHARACTERISTIC CYTOGENETIC FINDINGS IN SPECIFIC LYMPHOMA TYPES LYMPHOMA TYPE SPECIFIC CHROMOSOMAL TRANSLOCATION ONCOGENE OR TUMOUR SUPPRESSOR GEENE IMPLICATED Follicular lymphoma t(14;18)(q32;q21) BCL2 Mantle cell lymphoma t(11;14)(q13;q32) CCND1 Extranodal marginal zone lymphoma of MALT type t(11;18)(q21;q21) t(1;14)(p22;q32) t(14;18)(q32;q21) t(3;14)(p14.1;q32) API2, MALT1 BCL10 MALT1 FOXP1 Burkitt lymphoma t(8;14)(q24;q32) t(8;22)(q24;q11) t(2;8)(p12;q24) MYC T-lymphoblastic lymphoma/leukemia t(1;14)
  • 85. RELATIVE FREQUENCIES OF B-CELL LYMPHOMA SUBTYPES IN ADULTS
  • 86. RELATIVE FREQUENCIES OF MATURE T-CELL LYMPHOMA SUBTYPES IN ADULTS
  • 87. REACTIVE LYMPADENOPATHIES AND THEIR DISTICTION FROM LYMPHOMA  INFECTIOUS MONONUCLEOSIS AND OTHER VIRAL INFECTIONS  HYPERSENSITIVITY REACTIONS(PHENYTOIN)  KIKUCHI LYMPHADENITIS
  • 88. REFERENCES  MCKENZIE-2ND EDITION,VOLUME 2  WHO CLASSIFICATION OF TUMOURS OF HAEMATOPOIETIC AND LYMPHOID MALIGNANCIES- 4TH EDITION  WINTROBES-11TH EDITION  ROBBINS- 18TH EDITION  DIAGNOSTIC HISTOPATHOLOGY OF TUMOURS-FLETCHER 4TH EDITION,VOLUME 2  IOACHIM’S LYMPH NODE PATHOLOGY  INTERNET