Soebandiri

Division of Hematology & Medic Oncology

Departement of Medicine Airlangga University of
Medicine

Synoniem : Lymphatic = Lymphoid

Definition : Lymphatic system is the system
where the lymphoid cells are produced and
developed
LS

is one subsystem of the hematologic

system

1.
2.
3.
4.
5.

6.

Bone Marrow
Lymphnode
Thymus
Liver & Spleen
Lymphoid Tissue along the GI Tract (Bursa
Equivalent Organ)
Blood

Hemopoeisis Picture

The basic science of this system consists of:

I. Physiology and
II. Anatomy
Of this of sub system in normal (healthy) as well as
in abnormal (diseased) individuals
For the 1st stratum medical science this is viewed
from the organ and cell biology

I. PHYSIOLOGICAL (FUNCTIONAL)
VIEW:
Thymus
Cellular Immunitiy
Lymphoid Stem Cells
Bursa Equivalent organs
Humoral Immunitiy
HSC

Immunity is the capacity to fight and neutralize foreign evil

bodies / substances called antigen

The science is immunology

To fight / neutralize antigen our immune system makes

antibody. There are 2 types of antibody (a,b)
A.

Humoral a.b called immuno globulins (Ig) (A, M,

G,E, D); a molecule which can be dissolved in
body fluids,

B.

Cellular a.b takes the form of a cell (T-lymphoid

cell) called T cytotoxic lymphocyte

The binding of a.b to its specific antigen followed by the

destruction (killing, neutralizing) the antigen from its evil
character is called the immunological process

Immunology

Humoral immunology
(B-cell mediated)
Cellular immunology
(T-cell mediated)

Other subsets of lymphocytes are:

1.

T helper cells, which helped in the production of a.b.

a)

Th1 for humoral a.b. production

b)

Th2 for cellular a.b. production

2.

Null lymphocyte with neither T or B markers

3.

Natural killer (NK) cells

II. Anatomic / Morphologic / structural composition of

view: The science studying it is called anatomy, normal
as well as pathologic gross as well as microscopic

The specialist in this field is called (histo) pathologist

or hemato pathologist

The abnormal histo patology of the lymphatic system is

very broad, they can occur in
a)

Bone marrow : e.g multiple myeloma

b)

Lymphnodes :e.g malignant lymphoma. Dd with

lymphadenitis

c)

Blood:e.g lymphatic leukemia (acute and chronic)

There disorder are still in the domain of clinical

hematologist

Nature & definition : this is the abnormal growth of the

plasma cells (plasma cell discrasia) also called
cancer of the plasma cells
There are 3 types of abnormal growth:
1. Local:
plasmacytoma
2. Multiple:
multiple myeloma
3. Disseminated: plasmacell leukemia
Definition : Multiple Myeloma is plasma cell dyscrasia
affecting multiple sites of the bone marrow

Complaints (symptoms):
1.

Bone pain rheumatologist

2.

Spontaneous fractures orthopedic surgeon

3.

Compression fractures of the vertebral coloum

paraplegia neurologist

4.

Anemic symptoms hematologist

SIGNS
Physcal Exams: fracture
X ray of bone: Multiple osteolytic lesions (moth eaten
appearence)
Urine : Bence Jones proteinuria
Peripheral blood
: - Anemia
- few plasma cell (1-2%) is diagnostic
Clinical chemistry : Protein electrophoresis showed
M-component (peaked clonal Ig component)

Bone Marrow : many plasma cells (diagnostic)

Kidney : Myeloma protein may infiltrate kidney cells
kidney failure (myeloma kidney)
Staging : using Salmon & Durie method : 3 stages
Dx + Rx : Preferable by a specialist in chemotherapy
for the safety ; BMT etc.

MALIGNAT LYMPHOMA (ML)

Definition: malignant lymphoma is a malignant growth
of lymphoid tissue (LN.etc) and its supporting
tissue.

2 types :
1.

Hodgkin lymphoma (characteristic HPA)

2.

Non hodgkin lymphoma (only HPA)

CLINICAL MANIFESTATION

Mass originating from the lymphoid tissue occurs in 1 or

more regions (depends on the stage)

Systemic symptoms : high fever, pruritus, weight loss

>10% in 3 months, (also called B symptoms)

Stage (Ann Arbor):

Stage I : Involving 1 regio of LN

Stage II : Involving 2 or more regios on one side of the

diaphragma (above OR bellow)

Stage III : 2 or more regions on both side of the

diaphragma (above AND bellow)

Stage IV: involving extranodal organs

A when there is no systemic symptoms

B when there is systemic symptoms
E when the primary is extranodal
The extranodal organs are designated as follows
S = spleen
H = liver
P = lung
M = bone marrow
GI= GI tract ,etc
spleen is regarded as lymphnode (LN spleen)

Suffix

DIAGNOSIS & THERAPY

Dx must mention :

Tissue of origin and location of the primary tumor

2. Histopatology (including grade)
3. Stage.
option
4. Complication (if present)
1.

DD : lymphadenitis tuberculosa :
Only 1 region
After suppuration & fisteling
Histopathology
Therapy : surgery, radiotherapy, chemotherapy
(specialist)

 LEUKEMIA
(LYMPHATIC)
Definition : Leukemia is a malignant growth of blood cells
(lymphoid)

Etiology : Multiple genetical mutations of the gene

regulating proliferation and apoptosis

Clinical Manifestation:
Anemia

due to bone marrow failure

Bleeding duo to bone marrow failure & trombocythopenia
Severe infection due to bone marrow failure &
granulocytopenia & immunocompromized state
Abnormal (leukemia) cells in the peripheral blood & bone
marrow

2 TYPES:

1. ACUTE L.L (ALL)

2. CHRONIC L.L (CLL)

ALL:
Deffinition : abnormal growth of young lymphoid
cells (blast) which proggress in a short time

Classification :
a)

Morfologic : L 1, L2, L3

b)

Immunologic : LSC, pro B, pro T, Pre B, pre T, T,

mixed lineage

c)

MIC (not discussed)

ALL
Clinical manifestation
1.
2.
3.
4.

Anemia; may be severe

Bleeding due to trombopenia
Abnormal proportion of lymphoid cells
Lymphoblast predominant

CLL
Definition : Similar to ALL but takes a longer time (years)

There are also many clasification of CLL & variants

Clinical manifestation
Blood: slight anemia, almost normal trombocyte counts. The
proliferative cells are more mature lymphocyte, blast < 5%
(peripheral blood)

Dx + Rx : of ALL & CLL

Preferable by a competent hematologist oncologist (KHOM)