Lymphoma, Chronic lymphocytic lymphoma, small lymphocytic lymphoma

Describing about lymphoma

1. Chronic lymphocytic Leukaemia (CLL)/Small lymphocytic Lymphoma (SLL) Represents the most common adult leukaemia with median age at diagnosis being 60 years, 2:1 male preponderance in Western countries comparing with Asian countries and Japan. Microscopically: diffuse infiltration with small lymphocytes with proliferation centres in the lymph nodes, bone marrow, spleen and liver. Expression of CD 19, 20, 23 and 5, surface IgM. Clinically, fatigability, anorexia, weight loss, lymphadenopathy, hepatosplenomegaly, hypogammaglobulinemia, relatively slow course , tendency to transformation to more aggressive forms (Richter syndrome). Possible use of immunotherapy, chemotherapy and transplantation.

2. Fig: Peripheral blood smear showing CLL cells

3. Follicular Lymphoma An indolent ,most common NHL in middle age with uneven frequency in the Word. Typical cell is a small lymphocyte with irregular/cleaved nuclei (centrocyte) in predominant follicular arrangement. Immunophenotype: CD 10, 19, 20, surface Ig, BCL 6.Clinically: generalized, painless lymphadenopathy, and relatively uncommon involvement of extranidal sites. Median survival: 7-9 years, with possible transformation to diffuse large B cell lymphoma (duration less than 1 year).

4. Follicular lymphoma presents as enlarged follicles without a mantle zone. The lymphoma cells are found outside of the follicles and in the villi (hematoxylin-eosin, original magnification 34).

5. Diffuse large B-cell Lymphoma The most common NHL with median age of 60 years, may affect even children. Microscopically these tumors grow diffusely and contain relatively large cells. Immunophenotype: CD 19, 20, sometimes also CD10 and BCL-6.Cytogenetic gene expression is heterogenous. Special forms: Immunodeficiency-associated large B cell Lymphoma and Primary effusion lymphoma in AIDS and elderly. If untreated, is an aggressive tumor affecting many sites and rapidly fatal. Immunotherapy improves responses and outcome/prognosis.

6. Fig:Micrograph  ( Field stain ) of a diffuse large B cell lymphoma .

7.   Marginal Zone Lymphoma Encompasses a heterogenous group of B cell tumors arising within lymph nodes, spleen or extranodally (e.g. mucous membranes, „ maltoma “). They often arise within tissues involved by chronic inflammatory disorders of autoimmune ( Sjögren , Hashimoto) or infectious etiology (H. pylori) with possible regression following successful treatment of H. pylori

8. Mantle Cell Lymphoma Mantle Cell LymphomaIs a rare, prognostically poor form of lymphoma with painless generalized lymphadenopathy in elderly with male predominance. Small cells resemble the normal mantle zone B cells surroundinggerminal centers . Immunophenotype: CD 5, 19, 20, cyclin D1.

9. Burkitt Lymphoma (BL) Microscopically: a starry-sky appearance, high mitotic index Immunophenotype: CD 10, 19, 20, BCL-6, sIgM Molecular pathogenesis: Translocations of the C MYC gene on chromosome 8 Endemic and sporadic BLs are formed mainly in children and young adults mostly in extranodal sites (mandible, kidneys, ovaries, adrenals) Tumors are aggresive but treatable

10. Hairy Cell leukaemia Hairy Cell leukemia is a rare, distinctive B cell NHL (2%) with massive splenomegaly and frequent infections. Males are affected more frequently (5:1), median age is 55 years. Overall prognosis is excellent. Immunophenotype: CD 11c, CD 19, 20, 25 and 103.

11. Treatment Which lymphoma treatments are right for you depends on the type and stage of your disease, your overall health, and your preferences. The goal of treatment is to destroy as many cancer cells as possible and bring the disease into remission. Lymphoma treatments include: Active surveillance.  Some forms of lymphoma are very slow growing. You and your doctor may decide to wait to treat your lymphoma when it causes signs and symptoms that interfere with your daily activities. Until then, you may undergo periodic tests to monitor your condition. Chemotherapy.  Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. The drugs are usually administered through a vein, but can also be taken as a pill, depending on the specific drugs you receive. Radiation therapy.  Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.

12. Treatment Bone marrow transplant.  A bone marrow transplant, also known as a stem cell transplant, involves using high doses of chemotherapy and radiation to suppress your bone marrow. Then healthy bone marrow stem cells from your body or from a donor are infused into your blood where they travel to your bones and rebuild your bone marrow. Other treatments.  Other drugs used to treat lymphoma include targeted drugs that focus on specific abnormalities in your cancer cells. Immunotherapy drugs use your immune system to kill cancer cells. A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes your body's germ-fighting T cells, engineers them to fight cancer and infuses them back into your body