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Lymphoma Classification

• Lymphoma first used in 1858


• Old terminology
– Hodgkin’s Disease
– Lymphosarcoma
– Reticulum cell sarcoma
– Giant follicle lymphoma
Rye Classification

• Classification for Hodgkin’s Disease


• Conference in Rye NY 1965
• Modification of Lukes-Butler classification
• Divided HD into four histologic types
Rye Classification

• Lymphocyte predominance (LP)


• Nodular sclerosis (NS)
• Mixed cellularity (MC)
• Lymphocyte depletion (LD)
Rappaport Classification

• Rappaport proposed classification in 1966


• Nodular or Diffuse
– Lymphocytic, well differentiated
– Lymphocytic, poorly differentiated
– Mixed lymphocytic-histiocytic
– Histiocytic
– Undifferentiated
Modified Rappaport Classification

• Nodular
– Lymphocytic, poorly differentiated
– Mixed lymphocytic-histiocytic
– Histiocytic
Modified Rappaport Classification

• Diffuse
– Lymphocytic, well differentiated
– Lymphocytic, intermediate differentiation
– Lymphocytic, poorly differentiated
– Mixed lymphocytic-histiocytic
– Undifferentiated, Burkitt’s type
– Undifferentiated, non-Burkitt’s type
– Histiocytic
– Lymphocytic
New Classification Schemes

• British National Lymphoma Investigation (1974)


• Lukes and Collins (1974)
• Dorfman (1974)
• Kiel (1974)
• World Health Organization (1976)
Lukes and Collins Classification

• Attempt to correlate lymphoma to current


understanding of normal immune system
• proposed immunologic subtypes could be
recognized by morphology
Lukes and Collins Classification

• Undefined cell type


• T cell types
– Small lymphocytic
– Mycosis fungoides / Sezary syndrome (cerebriform)
– Convoluted lymphocytic
– Immunoblastic sarcoma (T cell)
• Histiocytic
• Unclassifiable
Lukes and Collins Classification

• B cell types
– Small lymphocytic
– Plasmacytoid lymphocytic
– Follicular center cell
• small cleaved
• large cleaved
• small noncleaved
• large noncleaved
– Immunoblastic sarcoma (B cell)
Kiel Classification

• Proposed by Lennert and a European consortium


• Updated in 1988
Kiel Classification

• Low Grade Malignancy


– Lymphocytic
– Lymphoplasmacytoid
– Centrocytic
– Centroblastic-centrocytic
• Follicular
• Follicular and Diffuse
• Diffuse
Kiel Classification

• High Grade Malignancy


– Centroblastic
– Lymphoblastic
• Burkitt’s type
• Convoluted cell type
– Immunoblastic
Updated Kiel Classification (B Cell)

• Low Grade
– Lymphocytic: CLL, PLL and hairy cell leukemia
– Lymphoplasmacytic/cytoid (LP immunocytoma)
• Plasmacytic
• Centroblastic/centrocytic
– follicular
– diffuse
• Centrocytic
Updated Kiel Classification (B Cell)

• High Grade
– Centroblastic
– Immunoblastic
– Large Cell Anaplastic (Ki-1)
– Burkitt’s lymphoma
– Lymphoblastic
• Rare Types
Updated Kiel Classification (T Cell)

• Low Grade
– lymphocytic: CLL and PLL
– Small cerebriform cell: MF and SS
– Lymphoepithelioid (Lennert’s lymphoma)
– Angioimmunoblastic (AILD)
– T zone
– Pleomorphic, small cell (HTLV 1+/-)
Updated Kiel Classification (T Cell)

• High Grade
– Pleomorphic, medium and large cell ( HTLV 1 +/-)
– Immunoblastic (HTLV 1 +/-)
– Large cell anaplastic (Ki 1 )
– Lymphoblastic
• Rare Types
Working Formulation

• Collaborative international study sponsored by


NCI
• Published new terminology in 1982
• A Working Formulation of Non-Hodgkin’s
Lymphoma for Clinical Usage
• Not a new classification but a means o translation
from one classification to another
Working Formulation - Low Grade
A. Malignant lymphoma (small lymphocytic)
Consistent with CLL
Plasmacytoid
B. Malignant lymphoma, follicular (predominantly small cleaved cell)
Diffuse areas
Sclerosis
C. Malignant lymphoma, follicular (mixed, small cleaved and large
cell)
Diffuse areas
Sclerosis
Working Formulation - Intermediate
Grade
D. Malignant lymphoma, follicular (predominantly large cell)
Diffuse areas
Sclerosis
E. Malignant lymphoma, diffuse (small cleaved cell)
Sclerosis
F. Malignant lymphoma, diffuse (mixed, small and large cell)
Sclerosis
Epithelioid cell component
G. Malignant lymphoma, diffuse (large cell)
Cleaved cell
Noncleaved cell
Sclerosis
Working Formulation - High Grade
H. Malignant lymphoma (large cell, immunoblastic)
Plasmacytoid
Clear cell
Polymorphous
Epithelioid cell component
I. Malignant lymphoma (lymphoblastic)
Convoluted cell
Nonconvoluted cell
J. Malignant lymphoma (small noncleaved cell)
Burkitt’s
Follicular areas
Working Formulation -
Miscellaneous

• Composite
• Mycosis fungoides
• Histiocytic
• Extramedullary plasmacytoma
• Unclassifiable
• Other
Revised European-American
Lymphoma Classification

• Consensus conference in Berlin Germany in 1993


• 19 hematopathologists - The International
Lymphoma Study Group
• Define diseases which can be reliably recognized
with currently available morphologic,
immunologic, and genetic techniques
Revised European-American
Lymphoma Classification

• B-Cell Neoplasms
I. Precursor B-cell neoplasm: B-precursor lymphoblastic
leukemia/lymphoma
II. Peripheral B-cell neoplasms
• T-Cell and Putative NK-Cell Neoplasms
I. Precursor T-cell neoplasms: T-precursor
lymphoblastic leukemia/lymphoma
II. Peripheral T-cell and NK-cell neoplasms
• Hodgkin’s Disease
Revised European-American
Lymphoma Classification

• Peripheral B-cell Neoplasms


B-cell chronic lymphocytic leukemia/prolymphocytic
leukemia/small lymphocytic lymphoma
Lymphoplasmacytoid lymphoma/immunocytoma
Mantle cell lymphoma
Revised European-American
Lymphoma Classification

• Peripheral B-cell Neoplasms


Follicle center lymphoma
Provisional cytologic grades: I (small cell), II (mixed small
and large cell), III (large cell)
Provisional subtype: diffuse, predominantly small cell type
Revised European-American
Lymphoma Classification

• Peripheral B-cell Neoplasms


Marginal zone B-cell lymphoma
Extranodal (MALT type +/- monocytoid B cells)
Provisional category: nodal (+/- monocytoid B cells)
Provisional entity: splenic marginal zone lymphoma (+/-
villous lymphocytes)
Hairy cell leukemia
Plasmacytoma/myeloma
Revised European-American
Lymphoma Classification

• Peripheral B-cell Neoplasms


Diffuse large B-cell lymphoma
Subtype: primary mediastinal (thymic) B-cell lymphoma
Burkitt’s lymphoma
Provisional category: high-grade B-cell lymphoma,
Burkitt’s-like
Revised European-American
Lymphoma Classification

• T-Cell and Putative NK-Cell Neoplasms


T-cell chronic lymphocytic leukemia/prolymphocytic
leukemia
Large granular lymphocytic leukemia (LGL)
T-cell type
NK-cell type
Mycosis fungoides/Sezary syndrome
Revised European-American
Lymphoma Classification

• T-Cell and Putative NK-Cell Neoplasms


Peripheral T-cell lymphomas, unspecified
Provisional cytologic categories: medium sized cell, mixed
medium and large cell, large cell, lymphoepithelioid cell
Provisional subtype: Hepatosplenic gd T-cell lymphoma
Provisional subtype: Subcutaneous panniculitic T-cell
lymphoma
Revised European-American
Lymphoma Classification

• T-Cell and Putative NK-Cell Neoplasms


Angioimmunoblastic T-cell lymphoma
Angiocentric lymphoma
Intestinal T-cell lymphoma (+/- enteropathy associated)
Adult T-cell leukemia/lymphoma
Revised European-American
Lymphoma Classification

• T-Cell and Putative NK-Cell Neoplasms


Anaplastic large cell lymphoma (ALCL), CD30+ T- and
null cell types
Provisional entity: Anaplastic large cell lymphoma,
Hodgkin’s-like
Revised European-American
Lymphoma Classification

• Hodgkin’s Disease
Lymphocyte predominance
Nodular sclerosis
Mixed cellularity
Lymphocyte depletion
Provisional entity: Lymphocyte-rich classical Hodgkin’s
Disease