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Important Principles
Tissue Diagnosis is Mandatory
Traditionally All considered Malignant
(but wide range of clinical behaviours seen)
B cell in origin (80-85%)
Disrupt Normal regulatory mechanisms
(Lead to frequent Immune Abnormalities)
Monoclonal
(All derived from single transformed cell)
Neoplastic B & T cells tend to Home & Grow in areas where their Normal
Counterparts resides
Disseminated at the time of diagnosis
HL spreads in orderly fashion
(Staging important for Treatment)
Classification
NHL (Working Formulation)
Low Grade
Intermediate Grade
High Grade
Cat-Scratch Disease
Skin Lesion (7-12 days after contact)
Enlargement of Regional Lymph Nodes
History of being Scratched by Cat
Cat-Scratch Disease
Microabscesses of varying sizes
(pink areas)
Clinical Presentation
Depend on anatomical distribution of disease
2/3rd of Non-Hodgkins Lymph oma (NH L) & Hodgkins Lymphoma (H L)
Skin
Stomach
Brain
Multiple Myeloma (MM)
Cat-Scratch Disease
Gram ve
Pleomorphic
Extra-cellular Coccoba cillary
pathogen (Bartonella henselae)
Warthin-Starry Silver stain
Singly, Small Clumps, Chains
(in Necrotic Foci)
2 Syphilis
Florid Follicular Hyperplasia
Partially Fused Lymphoid Follicles assume Bizarre shapes
Toxoplasma Lymphadenitis
Painless Axillary Lymphadenopathy
Confirm by Serologic Tests
Hyperplastic Follicle with reactive germinal center (numerous Macrophages)
Clusters of Epitheloid cells (upper right of follicle)
HL
Nodular Sclerosis
Mixed Cellularity
Lymphocyte Depletion
Lymphocyte Rich /Predominance
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African (Endemic)
Burkitt Lymphoma
Starry Sky pattern
Diffuse Large B-cell Lymphoma
20% of all NHL
Constitute 60-70% of aggressive Lymphoid Neoplasms
Male slightly
Immunoblastic, Plasmacytoid
Clinical
Rapidly enlarging mass
(single nodal/ extranodal site)
(often symptomatic)
(can arise at any site)
Waldeyer ring, Oropharyngeal lymph node, Adenoids, Tonsils
Extranodal sites
Aggressive tumour & rapidly fatal if untreated
Very responsive to Chemotherapy
30-40% Cured
I
Single Lymph
Node area
Involvement
II
2 or More Lymph
Nodal Areas
(con fined to 1
side of
diaphragm)
III
Involving Lymph
nodes Above &
Below
Diaphragm
IV
Involvement
outside Lymph
Node areas
Diffuse,
Disseminated
disease of BM,
Liver, Extranodal
40-65%
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Reed-Sternberg cells
Distinctive Tumour Giant cell
Bi-Nucleated/ Bi-Lobed
owl-eyed nuclei
Nodular Sclerosis
Most common type of HL (70%)
Women more common
Mediastinal involvement present with stage II disease (80% cases)
Characteristic Feature
Lacunar (Reed -Sternberg variant)
Sclerosing bands of collagenous fibrosis forming a nodular pattern
Fibrosis Thickens the capsule & Divides proliferating processes into nodules
or islands
Numerous Lacunar variants (Classical Reed-Sternberg cells are infrequent)
Most common type in Industrialized countries
Presents in Anterior Mediastinum & Neck (Young Adult Female)
Lymph Node/ Thymu s divided into variably sized nodules
(by collagenous bands sclerosis ) extending from a thickened capsule
Nodules composed of mix of
Lymphocytes
Eosinophils
Histiocytes
Classic Reed-Sternberg cells
Lacunar variant of Reed-Sternberg cells
Lymphocyte-Rich/ Predominant
Mononuclear L&H Hodgkin cells
Popcorn shape d nuclei
Inconspi cuous n uclei
Background of Small Lymphocytes (Lymphocyte predominant)
Classic Reed-Sternberg cells (rare & difficult to find)
May be Diffuse or Nodular
Limited disease in Neck of Young Patients
Associated with
L&H (Lymphocytic & Histiocytic) cell (p opcorn cell) variant Reed-Sternberg cell
Mixed Cellularity
Men (70%) with Late Stage (III-IV) Disease & B-symptoms
Systemic Manifestations (frequently)
Numerous Reed-Sternberg cells
Mixed Inflammatory Background (obliterate normal architecture)
Plasma cells (frequent)
Eosinophils (freq uent)
Fibrosis, Necrosis (small amount present)
Mixture of Lymphocytes, Eosinop hils, Histiocytes, Reed-Sternberg cells
Mononuclear variant of Reed-Sternberg cells
Lymphocyte-Depleted
Associated with HIV Infection
Clinical
Abdominal organs
Retroperitoneal lymph nodes
Bone Marrow
Peripheral Lymph Node (involvement common)
Approximately 70% of patients present have
Advanced Stage
B symptoms (80%)
Characteristics
Reed-Sternberg cells & Variants
Extensive Fibrosis
Small Lymphocytes (virtually absent)
Subtypes
Sarcomatous
Diffuse Fibrosis
Bizarre Reed-Sternberg cells
Extensive Fibrosis
Bizarre Anaplastic
Rare Reed-Sternberg cells
Reed-Sternberg-like variants seen
Present in Retroperitoneum (without peripheral nodal disease)
Tissue contain Precollagenous Sclerosis, Pleomorphic Reed-Sternberg variants
Liver Involvement in Hodgkins Disease
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Multiple Myeloma
Definition
Plasma cell Neoplasm
Men (common)
Involvement of Skeleton at Multiple sites
Bone involvement predominates
Lymph node Spread & Skin involvement
Clinical Course
Organ Infiltration
Excess Ig
Suppression of Humoral Immunity
HyperCalcaemia
Renal Failure
Prognosis generally Poor
Presentation
Multifocal Destructive Bone Lesions
Ribs (44%)
Skull (41%)
Pelvis (28%)
Femur (24%)
Clavicle (10%)
Scapula (10%)
Punched -out lesion on Radiograph (1 -4cm in diameter)
Metastases
Breast
Lungs
Prostate
GIT
Non-H odgkins
Not as Localised
Spread often Random &
Unpredictable
Peripheral, Extranodal involvement
No Reed-Sternberg cells
Multiple Myeloma
Multiple Lytic Lesions of Vertebrae
Bone Marrow
Plasmacytosis > 30%
Malignant Plasma Cells
Lab Results
Serum Electrophoresis
Rouleaux Formation
Rouleaux Formation
Urine
Bence-Jones Protein excreted by Kidneys (can cause Renal Impairment)
Noncontiguous
Extranodal involvement Frequent