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Path - Overview of Benign + Malignant Lymphoid Proliferations (ii) (Ann…
Path - Overview of Benign + Malignant Lymphoid Proliferations (ii)
Ann Arbor staging
I - 1 group of nodes
II - 2 groups of nodes on same side of diaphragm
III - 2 groups pf nodes on both sides of diaphragm
IV - mets to liver/bone/lung - worse prognosis
done by PET
gold-standard
shows avidity (strength of antigen-Ig binding)
or else x-ray, CT, MRI, FNA, BM trephine (false -ve risk), assessment of B symptoms, LDH, performance index (expected vs actual prognosis)
B cell lymphomas
low grade
small cell lymphocytic
manifests as chronic lymphocytic leukaemia
more common in the elderly
widespread adenopathy
splenomegaly
low Ig - increased infections
often presents @ late stage (3/4) as indolent, patient is not unwell (often an incidental finding)
5-10% transform (DEDIFFERENTIATE) into Richter's syndrome
diffuse + fast-growing
carries poor prognosis
rarely cured
marker = CD5+23
mantle cell
MALToma
GIT
risk factor - H pylori, causing gastritis
thyroid
salivary glands
lung
extra nodal
Dx: lymphoid aggregate in Bx
Marginal zone
follicular
v common
neoplastic follicles
usually 50+ y/o
60% present @ stage 3/4
indolent (causes little/no pain) but progressive
rarely cured
caused by t(14;18) - Bcl2 (antiapoptotic) over expression
Dx using CD20,10
70% 5 yr survival
20% transform to high grade
high grade
diffuse large cell
most common
most high grade
marker = CD20
lymphoblastic
rare
mainly in children + young adults
Burkitts
type of lymphoblastic
mass in jaws/GIT/gonads
requires v aggressive chemo
associated with EBV + c-myc translocation (8;14)
common in Africa, v rare in Europe
mainly in children + adolescents
markers = CD20+79
Molecular Markers
clonality (cells all arising from 1 single cell - dx of malignancy)
Ig gene rearrangements
TCR rearrangements