19 Nonhodgkin Lymphoma

  • classified in many ways

  • last 2: T cells

  • different in different places of lymph nodes
  • follicles: follicular lymphoma
  • region surround follicle: mantle, mantle cell lymphoma
  • marginal zone: outside mantle, marginal zone lymphoma

Diffuse Large B

  • really difficult to recognize by cell
  • lymphoid follicle structure obliterated

  • large crab marching up to archers in stronghold (B cells in lymphoma): AIDS can cause Diffused Large B Cell Lymphoma

  • testicular lymphoma

Follicular

  • B cell make antibodies: heavily use IgG H chain, over express BCL 2 next to it
  • Germinal center B cell frequent apoptosis with lack of BCL2
  • Now: does not die

  • feared outcome: convert to diffuse large B

  • abundance of follicles
  • histology shows centrocytes

  • presence of macrophages seen in reactive lymphadenopathy

  • reactive: some develop more than others

Mantle Cell

  • different in different places of lymph nodes
  • follicles: follicular lymphoma
  • region surround follicle: mantle, mantle cell lymphoma
  • marginal zone: outside mantle, marginal zone lymphoma

  • cells grow rapidly, unregulated growth

Marginal Zone

  • different in different places of lymph nodes
  • follicles: follicular lymphoma
  • region surround follicle: mantle, mantle cell lymphoma
  • marginal zone: outside mantle, marginal zone lymphoma

  • marginal zones form and expands in settings of chronic inflammation
  • found in portions of bodies where chronic inflammation occurs

Small

  • can present with swollen lymph nodes and very high WBC count, like leukemia

Burkitt

  • rapidly dividing cells, create lots of debrid cleaned up by macrophages, clearing spaces
  • cancer cells with white areas

  • Africa/New Guinea: high prevalence of EBV
  • sporadic: any country

  • B tumors association with latent EBV

  • AA bar kid with swelling jaw: Endemic or African Burkitt lymphoma = large jaw lesion and swelling

T Cell leukemia/lymphoma

  • lymphocytosis: leukemia
  • lymphadenopathy: lymphoma
  • rule of thumb: T cells involve skin
  • MM: no LAD, skin lesions, lymphocytosis, endemic location

Cutaneous T

  • mycosis: nothing to do with fungal infection

  • malignant cells enter blood stream