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پاتولوژی (White Cell Disorders (Neoplastic Proliferations of White Cells…

- - - - Lymphoma: produce masses in lymph nodes or other tissues
        
        Non-Hodgkin lymphoma
        
        Extranodal marginal zone lymphoma
        
        Mantle cell lymphoma
        
        Follicular lymphoma
        
        Burkitt lymphoma
        
        Diffuse large B cell lymphomas
        
        Hodgkin lymphoma: set apart by presence of distinctive neoplastic RS giant cells, which u. greatly outnumbered by nonneoplastic infl cells
        
        MORPHOLOGY
        
        Classification
        
        classical Hodgkin lymphoma
        
        (1) nodular sclerosis:
        
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        (2) mixed cellularity: 25% of cases overall; male predominance; Classic RS cells plentiful; more likely to be disseminated
        
        (3) lymphocyte rich
        
        (4) lymphocyte depletion
        
        (5) lymphocyte predominant: set apart by expression of germinal center B cell markers by RS cells; charac by lymphohistiocytic (L&H) variant RS cells (have a delicate multilobed, puffy nucleus resembling popped corn (“popcorn cell”))
        
        Reed-Sternberg (RS) cell: very large cell, enormous multilobate nucleus, exceptionally prominent nucleoli, abundant slightly eosinophilic cytoplasm
        Partic charac: cells w/ two mirrorimage nuclei or nuclear lobes, each containing a large (inclusion-like) acidophilic nucleolus surrounded by a clear zone (an owl-eye appearance)
        Typical RS cells and variants: charac immunophenotype: express CD15 and CD30 and fail to express CD45 (leukocyte common antigen), b cell and t cell Ags
        
        charac by presence of a tumor giant cell: RS cell. Unlike most NHLs, arise in a single or chain of lymph nodes and typically spread in a stepwise fashion to anatomically contiguous nodes
        
        Pathogenesis:
        arises from germinal center B cells; frequent involvement of EBV;
        charac nonneoplastic, infl cell infiltrate generated by a number of cytokines;
        a cardinal example of a tumor that escapes from host immune response by expressing prs that inhibit T cell function
        
        Clinical Features
        
        “B symptoms” (fever, weight loss, night sweats)
      - Plasma cell neoplasms
        
        Multiple myeloma
        
        Monoclonal gammopathy of undetermined significance (MGUS)
      - Leukemia: involvement of bone marrow & peripheral blood
        
        Precursor B and T cell lymphoblastic lymphoma/ leukemia—commonly called acute lymphoblastic leukemia (ALL)
        
        Chronic lymphocytic leukemia/small lymphocytic lymphoma
      - Miscellaneous Lymphoid Neoplasms
        
        Hairy Cell Leukemia
        
        Mycosis Fungoides and Sézary Syndrome
        
        Adult T Cell Leukemia/Lymphoma
        
        Peripheral T Cell Lymphoma