The
Lymphohem
atopoietic
Systems
Chapter 9
Zhou Hongyan
Lymphohematopoietic
system:
myeloid tissue
lymphoid tissue
nomal lymph node
follicular
LYMPHOID NEOPLASMS
? Arise in bone marrow
and circulate in the
peripheral blood,
? Appear as tumor masses
within either lymph nodes
or other organs.
relevant principles:
1.Most lymphoid neoplasms(80%-
85%) are of B-cell origin.
2,The normal architecture of the
lymph nodes is effaced.
3,Disrupt normal immune regulatory
mechanism.
4.Monoclonal neoplasms.
5.NHL---widely disseminated at the
time of diagnosis.
HL—spreads methodically to
contiguous lymph node groups.
relevant principles:
Classification:(REALand WHO)
three major categories:
(1)tumors of B cells
(2)tumors of T cells and NK cells
(3)Hodgkin lymphoma
LYMPHOID NEOPLASMS:
Hodgkin lymphoma
--------- (HL)
non - Hodgkin lymphoma
--------- (NHL)
Hodgkin
lymphoma
HL:
Hodgkin lymphoma:
1.It arises almost invariably
in a single node or a chain of
nodes and spreads
characteristically to the
anatomically contiguous nodes,
Hodgkin
lymphoma
2,Reed-Sternberg(R-S) cell
which are admixed with a
variable infiltrate of reactive,
non-malignant inflammatory
cells.
mirror-image cell
Classification:
1.nodular sclerosis
2.mixed-cellularity
3.lymphocyte predominance
4.lymphocyte deplesion
1.nodular sclerosis
2.mixed-cellularity
3.lymphocyte predominance
4.lymphocyte deplesion
1.nodular sclerosis
⑴ lacunar cell
⑵ collagen bands divide
the lymphoid tissue into
circumscribed nodules
⑴ lacunar cell:
This cell is large and has a
single hyperlobate nucleus
with multiple small nucleoli
and abundant,pale-staining
cytoplasm,
lacunar cell
lacunar cell
1.nodular sclerosis
2.mixed-cellularity
3.lymphocyte predominance
4.lymphocyte deplesion
(1)This is the most common form
of Hodgkin lymphoma in patients
older than the age of 50 and overall
comprises about 25% of cases.
(2)There is a male predominance.
(3)Typical RS cells are plentiful.
2.mixed-cellularity:
“classic” RS cell----mirror-image cell:
Particularly characteristic are two
mirror-image nuclei or nuclear
lobes,each containing a large
acidophilic nucleolus surrounded by
a distinctive clear zone ;together
they impart an owl-eyed
appearance.
The nuclear membrane is distinct.
mirror-image cell
mirror-image cell
mirror-image cell
1.nodular sclerosis
2.mixed-cellularity
3.lymphocyte predominance
4.lymphocyte deplesion
3.lymphocyte predominance:
(1) small mature-looking reactive
lymphocytes
(2) popcorn cell
(3) an excellent prognosis
d
popcorn cell
?popcorn cell
1.nodular sclerosis
2.mixed-cellularity
3.lymphocyte predominance
4.lymphocyte deplesion
4.lymphocyte depletion:
(1) very rare
(2) lymphocytes---depleted
(3) RS cell
follicular
lymphoma
NHL:B cell neoplasms
1 Morphology:
? follicular
? centrocytes and centroblast-
like cell
? a high mitotic rate
follicular lymphoma
follicular lymphoma
follicular lymphoma
follicular lymphoma
2 Immunophenotype:
pan-B cell markers,
such as CD19 and CD20
protein Bcl-2
3 Karyotype:
t(14;18)
18q21,gene bcl-2
4 Clinical Features:
mainly affects adults
about 7-9 years in survival time
lack reaction with chemotherapy
Burkitt
lymphoma
NHL:B cell neoplasms
BURKITT LYMPHOMA
Is endemic in some parts of
Africa and sporadic in other
areas,
1 Morphology:
? The tumor cells are monotonous
and intermediate in size.
? Have round or oval nuclei
containing two to five nucleoli.
? A high mitotic rate
?,starry sky”—macrophages ingest
nuclear debris,
2 Immunophenotype:
IgM ;
pan-B cell markers:
such as CD19 and CD10
3 Karyotype:
t(8;14)
C-myc gene t(8;14)
4 Clinical Features:
Mainly affects children or young
adults.
Rarely arises in lymph nodes.
A high-grade tumor that may be the
fastest growing human neoplasm.
With very aggressive chemotherapy
regimens,the majority of patients
can be cured.