Reactive adenopathy and lymphoma

Outline
- Overview of normal ( reactive ) lymph node and B lymphocyte development
- Specific reactive adenopathies
- Characteristics of lymphoma
- Classification of lymphoma
- Specific entities

Reactive adenopathies
- Disease of lymph node; reactive lymphoid hyperplasia
- Exhibit increase in number of lymphoblast and plasma cells with variable inflammation
cells such as neutrophils, eosinophils and occasionally mast cells
- Increase in number of lymphoblasts give the appearance of many types of lymphocytes
rather than monomorophic appearance of lymphoma
- Single site ; localized infection
- Generalized :
Follicular : predominantly B cells
Paracortical : T cells, immune reaction
Sinus histiocytis : malignancy
- Syndromes :
Infectious lymphadenitis
Viral infectious mononucleosis (eg EBV)
Myocobacteria (eg TB)
Fungal
Protozoa (toxoplasma)
Sarcoidosis
Castlemans disease
Foreign bodies
- Reactive adenopathies vs lymphoma

Reactive adenopathies Lymphoma

- Exhibit increase number of lymphoblast, plasma - Monomorphic appearance of lymphoma

cells with variable inflammatory markers; consistent with the diagnosis of lymphoma
neutrophils, eosinophils, and occasionally mast - Mature lymphocytes deeply stained compared o
cells. neoplastic lymphoblasts
- Increase number of lymphoblast appearance of
many types of lymphocytes than monomorphic
appearance of lymphoma
Lymphoid neoplasm
1) Lymphocytic / lymphoblastic leukaemia
Lymphoid neoplasm presenting with widespread involvement of bone
marrow, accompanied by large number of tumour cells in peripheral blood
2) Lymphoma
Lymphoid proliferation discrete extranodal / nodal tissue masses
3) Plasma of dysciasis
Multiple myeloma

Tumours of Haematopoietic and Lymphoid Tissues WHO 2001 (update 2008, further
update 2017)
- Precursor lymphoid neoplasms
- Mature B-cell neoplasms
- Mature T-Cell and NK-cell neoplasms
- Hodgkin Lymphoma
- Post-transplant lymphoproliferative disorders; quite differen.characterized by
imuunosuppression

Lymphoma
- A heterogenous group of malignancies of B cells, T cells and rarely natural killer cells
that usually originate in lymph nodes, but may originate from any organ in body
- Relatively genetically stable - recurring molecular aberrations / chromosomal
translocations
- Macroscopically : Fish-flesh / firm-rubber
- Efface architecture of lymph node
- Relatively uniform / monomorphous cell population
- Characteristic abberant immunohistochemistry expression
- Hodgkins lymphoma

Usually arise in lymph nodes, preferentially in the cervical region; spreads first to
anatomically contiguous nodes ( veyr characteristics of HL )
Majority manifest clinically in young adults average age at diagnosis 32 years
Small numbers of scattered large mononucleated and multinucleated tumour
cells (Reed-Sternberg cells) in a heterogeneous mixture of non-neoplastic
inflammatory and accessory cells
Characterized by Reed-sternberg cells in polymorphous background.RS derived
primarily from germinal centre / post-germinal center B cells. These cells release
factors that induce the accumulation of the reactive lymphocytes, macrophages,
granulocytes that constitue > 90 % of tumour cellularity
Subtypes
Classical (95%)
1. Nodular sclerosis
2. Mixed cellularity
3. Lymphocyte rich
4. Lymphocyte depleted
Non-classical ; Nodular lymphocyte predominant (5%)
Staging Cotswold revision of Ann Arbor classification
I Single lymph node region or lymphoid structure
II Two or more lymph node regions on same side of diaphragm
III Lymph node involvement on both sides of the diaphragm
IV Involvement of extranodal sites beyond those designated E
Annotation: A Asymptomatic; B symptoms Fever, drenching sweats,
weight loss; X Bulky disease; E Single extranodal site, or contiguous to
known nodal site
Prognosis / predictor factors
Stage and presence of systemic symptoms most important predictors
With modern combined modality therapy, HL is curable in the majority of
cases; exquistable raduosensitive (radiotherapy very effective in
lymphoma esp in early stage )
The complete remission rate, the 5-year event-free survival (EFS), and
overall survival (OS) rates were 97%, 85% and 90%, respectively in a
recent study
Howver, among 1319 patients with clinical stage I-IV Hodgkin disease, 181
second malignancies (14%) and 18 third malignancies were observed.

International prognostic index; do worse

Age > 60 years
Serum LDH > twice normal
Performance status >/= 2 (eg pt going to work etc )
Ann Arbor Stage III/ IV
Extranodal involvement at >1 site

- B cells non Hodgkins lymphoma

Extranodal/ nodal
 Low grade (indolent,incerase lymph node size.but not curable by
treatment.relpase and can be high grade later )
Follicular lymphoma
Marginal zone lymphoma
Lymphoplasmacytic lymphoma
CLL/Small Lymphocytic Lymphoma
Intermediate grade (look like indolent lymphoma; but behave more aggressive)
Mantle cell lymphoma
High grade
Diffuse Large B C ell Lympoma , mantle cell variants
Aggressive (req aggressive treatment.but its curable )
Burkitts lymphoma, Lymphoblastic lymphoma
- T, NK cells lymphoma
Relatively uncommon 12% of NHL
More common in Asia mirror HTLV-1; endemic in asia population
T cell Subsets: and based on structure of T cell receptor
Most have < 30% 5 year survival, except anaplastic large cell lymphoma
Examples :
Adult T-cell leukaemia/ lymphoma
Extranodal NK/T cell lymphoma, nasal type
Enteropathy-type T-cell lymphoma
Hepatosplenic T-cell lymphoma
Mycosis fungoides
Angioimmunoblastic T cell lymphoma
Peripheral T cell lymphoma NOS
Anaplastic large cell lymphoma
Enteropathy associated T cell lymphoma
Associated with coeliac disease
Prodrome: refractory coeliac disease loss of CD8 expression
Prognosis poor