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non-Hodgkinlymphoma(NHL)SongwenjingThedepartmentofpathologyIntroductionTheyaremalignanttumorsoriginatingfromlymphoidtissue(B-cellsandT-cellsindifferentdevelopedstage).Incidence:>HL,accountfor80~90%alllymphomas.Site:lymphnodes(2/3)↑;
extranodallymphoidtissue(1/3)↓.ThedifferencebetweenHLandNHLaboutclinic-pathologicalcharacteristicsHLNHLSiteintranode↑IntranodeandextranodeMorphologymultiplicity*R-ScellunitaryMetastasisAnatomiccontinuouslyskippingPrognosis
wellpoorIntroductionClassification:complex;relatedtotheLCdifferentation.Thecommontype:Intranode:Adult:diffuselargeBcelllymphomaChildren:acutelymphoblasticleukemia/lymphoma+BurkittlymphomaExtranode:MALT-omaExtranadalNK/T-celllymphomaTheprocessofLCdifferentiationMorphologyG:LNenlargement,softorhard,homogeneous,greyorgrey-yellow,maycoalesce.ExtranodalNHLpresentsdiffuseornodularpattern.MultiplelymphomasofstomachMorphologyThegeneralcharacteristicsonLM:LNstructureisdestroyedpartlyorcompletely;LNisreplacedbytheunitaryneoplasticcells,presents“cellularsea”;TheneoplastictissuesinvadethecapsuleandfattytissuearoundLN.Thenodulesmaybeformed.PrecursorB-cellandT-cellneoplasm(AcuteLymphoblasticLeukemia/Lymphoma)IntroductionComposedbyimmaturelymphoblasticcellsPrecursorB-cellneoplasms:involvedbonemarrowandbloodextensively.PrecursorT-cellneoplasms:involvedthymusmainly,formingmass.Incidence:PrecursorB-cell(80%)>PrecursorT-cell(15%)MorphologyLNchanges:LymphoblasticcellsdistributeddiffuselyMarrowchanges:lymphoblasticcellsaccumulatedinthemarrow.Immunephenotype:TdT(+).前體B淋巴母細(xì)胞淋巴瘤:胞漿稀少;核較小、近圓形,染色質(zhì)細(xì)致、細(xì)顆粒狀。前體T淋巴母細(xì)胞白血病(骨髓活檢切片):淋巴母細(xì)胞大小不等,核迂曲。ClinicFallillsuddenly,developquickly;Marrowfunction↓→anemia;→easytoinfection:matureWBC↓;→secondaryPt↓→hemorrhage;Bonepain;LN,liver,spleenenlargement,mediastinummass;CNSsymptoms:headache,omit,nervousparalysis.Prognosis:well.PeripheralmatureBcellneoplasmaSmalllymphocytelymphoma(Chroniclymphocyteleukemia)IntroductionAge:>50ySexuality:male>femaleOriginatefrom:matureBcellUsuallyinvademarrow,liver,spleenMorphologyLNstructureisdestroyedSmallneoplasmcellsdistributediffuselylymphoblasticfocus—havingdiagnosissignificanceImmunephenotype:expressionforBcell.B-CLL/SLLSmalllymphocytelymphomaB-cellchroniclymphocyticleukemia/smalllymphocyticlymphomaClinicDevelopslowly,asymptomaticgenerally.Non-specialsymptom:easyfatigue,weightloss,anorexia,infectioneasily;Mayoccurautoimmunediseases;LN,liverspleenenlargement;Chroniclymphocyteleukemia:WBC↑;Smalllymphocytelymphoma,theamountofWBCmaybenormal.Prognosis:different.FollicularLymphomaIntroductionOriginatefrom:germinalcenterB-cell,inertialneoplasm.Characteristic:neoplasticnoduleformation.Incidence:10%~13%Age:middle-agedperson↑,male≈femalePrognosis:survivalrate7~9years,40%maytransformtothediffuselargeB-celllymphoma.Morphology*NeoplasticnoduleformationThenoduleiscomposedofcentercellsandcentroblasticcellsMaytransformtothediffusepattern.Immunephenotype:expressionforcentrocyteBcl-2andBcl-6FollicularlymphomaofileumClinicPainlessLNenlargement;Site:inguinalLN↑;Marrowisaffectedbyneoplasm:accountforabout30-50%.Prognosis:wellDiffuselargeB-celllymphomaMorphologyNeoplasticcell:invadeddiffusely.Characteristics:
largecell,obviouslyatypia.Immunephenotype:expressionforBcell.DiffuselargeB-celllymphoma(centroblasticvariation)DiffuselargeB-celllymphoma(immunoblasticvariation)ClinicLateadultmale↑;Growthquickly;Usuallydidn’taffectliver,spleen,marrow;Prognosis:invasiveability↑,death-rate↑.BurkittlymphomaIntroductionClinictype:Endemic(Africa)
SporadicHIVinfectorOriginatefrom:centerB-cell,invasiveability↑.Cause:relatedtoEBV.MorphologyNeoplasticcellsaremedium-sized,unitary,invasiondiffusely;Mitosis↑,apoptosis↑;Macrophagesengulfthenecroticnoeplasticcells,andscattered_“starrysky”.Immunephenotype:expressionforBcell.IleocecalBurkittlymphomaClinicChildren↑,youngperson↑;Site:jaw↑→mass;LNusuallywasn’tinvolved;Leukemiaisrare;Highmalignant,buttheresultofchemotherapyiswell.BurkittLymphomaMarginalzonelymphomaMucosaAssociatedLymphoidTissue,MALT-omaIntroductionIntranodeorextronodeB-celllymphoma.Thereareusuallysomebasicdiseases:eg,chronicinflammation,autoimmunediseases,specialpathogeninfection;Thelesionmayconfinetheprimaryfocusforalongtime;Ifthecausescanberemove,thetumormayrecover.PositionMorphologyM:Centrocytelikecells↑Lympho-epitheliallesions.StomachMALT-omaBreastMALTomaParotidMALT-omaEndometrialMALT-omaMultipleMyelomaPeripheralT-cellandNKcellNeoplasmsPeripheralT-celllymphoma,UnspecifiedMorphologyLNstructureisdestroyed.Thelesionstarttheparacortex,PCV↑.Neoplasticcell:pleomorphism,invasivegrowth,nucleartwist.Therearemanykindsofnon-neoplasticreactivecells.Collagenproliferation.Immunephenotype:expressionforTcell.PeripheralT-celllymphomaPeripheralT-celllymphoma(unspecified)PeripheralT-celllymphoma(unspecified)Extranodalnaturalkiller
/T-celllymphomaIntroductionOriginatefrom:NKcell.Site;2/3nose↑.Causes:EBV.Characteristics;invasion↑,highmalignant.G:themassobstructthenasalcavity,bonedestruction,intensivehemorrhageandnecrosis.M:theneoplasticcellsdistributediffusely,different-sized,pleomorphic,destroythebloodvessels.Extranodalnaturalkiller/T-celllymphomaadd:Complicationsoflymphoma
lymphomainvadeCompress,invasionmarrowspleenimmunedysfunction
marrowinhibitionautoimmunefunction↓hemolysis
anemia
infectionMyeloidneoplasmDefinition:Arisefromhematopoieticstemcells.Thenon-lymphoctictumorcellsproliferateclonely,andthenormalmarrowcellsarereplacedbytumorcells.Fourtypes:Acutemyeloblasticleukemia,AMLChronicmyeloproliferativedisorders,CMPDMyelodysplasticsyndromes,MDSMDS/MPD
HistocyticneoplasmaDefinition:Isaproliferativedisorderofhistocytesandmacrophages.Includes:Histocyticl
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