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