Lymphomas

Follicular Lymphoma

Diffuse Large B-Cell

Lymphoma

Burkitt's Lymphoma

African Burkitt's

American (Sporadic)
Burkitt's

Grade

Low

Int.

Demographics

Symptoms

Cell Type

60-70 yo

- Often asymptomatic
- "waxing and waning"
LNs

B-Cell
Lineage

Adults and
children

- Rapidly enlarging mass

- May be nodal or
extranodal (up to 40%)
----GI, skin, CNS, bone,
testis
- May progress from
Follicular Lymphoma
B-Cell

- A lot of extranodal
involvement...Burkitt's
until proven otherwise B-Cell

High

4-7 yo
M:F, 2:1

- Involves jaw and

other facial bones
- Kidneys, GI tract, other
extranodal sites
- Involves abdomen,
ovaries, kidneys,
omentum, Waldeyer's
ring, and other
extranodal sites

Immuno-Burkitt's

- Children and
Yound Adults
Anaplastic Large Cell
Lymphoma

Classical Hodgkin
Lymphoma

Aggress
ive
- M>>F

Nodal/Extranodal
- Advanced stage w/ BSymptoms
T-Cell

- Bimodal Age
Distribution
- B Cell Symptoms
---Young
- Lymphadenopathy
Adults; Elderly - Mediastinum

Genetics

Diagnosis

Treatment

Histology
- "Follicular lymphoma cells
consist of centrocytes, small
cleaved cells (look like raisons),
and centroblasts, larger cells that
divide more"

- Not curable
- But very treatable
(chemo)
Translocation (14;18)
*Not diagnostic (DLBCL)

*Stem cell transplant

- Mantle zone lost

- Follicles merge together
- Polarization of GC lost
- Paracortex lost

- Diffuse effacement of LN

None

- Curable (50% CR)

R-CHOP
----Rituximab
----Cyclophosphamide
----Hydroxy -doxorubicin
----Oncovin
----Prednisone

- Must have a C-myc

abnormality
(Chromosome 8) to be
considered Burkitt's

- Curable ---- Cure rate:

40%
- Complex chemo regimen
- Must receive intrathecal - Extremely high mitotic activity
CNS chemotherapy as a
----Almost 100% of cells are
prophylaxis
dividing based on Ki-67 staining

- EBV associated
(almost ALWAYS)

- EBV associated (1530%)

- Diagnose with
tissue (histology)
----Starry Sky
Pattern

- Nuclei of "Large B-Cells" should

be BIGGER than RBCs
- Very monotonous cell
population
- (But can look like a lot of
different things, not just one
kind)

- Phenotype:
---CD3, CD4, CD43,
CD45ro
---CD30 (strong)
---ALK-1 protein
Genotype:
---TCR rearrangement
--t(2;5)(p23;p35)ALK/NP
M

- Complete/partial nodal
effacement
- Sinusoidal infiltrate
- "Hallmark" cells
----abundant cytoplasm,
eccentric reniform nucli,
"doughnut cells
- Reed-Sternerg Cells (1-5% of
tumor cell population)
---multi/bi/mono-nuclear
---mummified
---lacunar
- Inflammatory background
- Collagen fibrous bands/capsular
fibrosis

Pearls

Other Notes

- "Small cleaved
cells"

- Most common low grade non-Hodgkin

lymphoma
- 22% of all new NHL diagnoses
- FLIPI - 5 Adverse Prognostic factors
----Age > 60 yo
----Ann Arbor Stage 3-4
----Hb < 12
----# of nodal areas > 4
----LDH > Upper limit of normal

- Most common Non-Hodgkin

Lymphoma (adults and children)
----A lot of other lymphomas can
progress to this
- R-IPI - 5 Adverse Prognostic Factors
----Age > 60 yo
----ECOG > 2
----Extranodal site > 1
----Stage 3-4 of disease
----LDH > Upper limit of normal

- Starry Sky Pattern - One of the fastest growing tumors that

- C-myc abnormality exist (doubling time 24-48 hrs)
(Chromosome 8)
- 3 Types (African, American,
Immunodeficiency-associated)
CLUES:
- Very high LDH (due *Patients high risk for CNS cancer spread
to spontaneous
(intrathecal chemo prophylaxis needed)
apoptosis)
and tumor lysis syndrome

- EBV associated
(and malaria)

- Accounts for 1-2% of Lymphomas in

adults and up to 40% of lymphomas in
children

- Primarily occurs in HIV patients

- 30-50% of NHL in HIV patients

EBV-associated

Drug
Alkylating Agents
Chlorambucil
Cyclophosphamide
Ifosfamide
Melphalan
Mechlorethamine
Bendamustine

Mechanism of Action