CLLD

• Lymphocyte dominance


  • Nodular sclerosis
  • Mixed cellularity
  • Lymphocyte depletion
• Nodular sclerosis


  RS cells located in the Lacuna of the Lymph Node
• Lymphocyte depletion


  Fibrosis is diffused, cannot produce nor proliferate because the bone marrow is fibrotic, the lymphocyte still comes in the bone marrow, it only matures in the spleen and lymph node
• Ann Arbor Staging System

  • Stage I: Single lymph node/extralymphatic organ
  • Stage II: Two or more lymph nodes/ contiguous extralymphatic organ, Same side as the lymph node (either left only or right only)
  • Stage III: Lymph nodes on both sides of diaphragm Splenic/ extralymphatic involvement
  • Stage IV: Both sides of lymph nodes are affected, Diffuse one or more extralymphatic organ, Other organs are also affected
• Chemotherapy in Hodgkin Disease

  Causes rapid tumor lysis, producing intracellular substances like Uric Acid, Potassium and Phosphate
• Release of High Phosphate

  Hyperphophatemia, Hypocalcimia, Renal failure due to accumulation of BUN from Uric Acid
• Non-Hodgkin Lymphoma


  Aleuemic otherwise known as lymphosarcoma
• Non-Hodgkin Lymphoma


  • Male
  • Large lymphocytes
  • Survival: 1.5-3 years
• High Grade Non-Hodgkin Lymphoma


  • Most rapid enlargement of LN
  • Immunoblastic lymphoma: more than 50 years old, Arises in the CNS, Short survival: months to a year
  • Lymphoblastic lymphoma: teens-20's, presence of mediastinal mass, Subjected to relapse with chemotherapy
  • Small noncleaved cell lymphoma: Occurs in children to 30 years of age
• Burkitt Lymphoma


  Translocation in the C-MYC gene located in t(Ch8:14), Cytogenetic abnormality
• Non-Burkitt Lymphoma


  No cytogenetic abnormality, Various type of malignant cells
• Predisposition Factors for Non-Hodgkin Lymphoma

  • Congenital immunodeficiency (ex Wiscott Aldrich, IgA deficiency)
  • RA, Sjorgen's Syndrome, SLE
  • EBV - causative agent of infectious mononucleosis, causes also the African Burkitt Lymphoma
  • AIDS
  • HTLV1 - link with acute T leukemia and causes also lymphoma
• Malignant cells in Non-Hodgkin Lymphoma

  • Small lymphocytes
  • Small cleaved cell
  • Small noncleaved cell
  • Large cell (cleaved/non cleaved)
  • Immunoblastic large cell
  • Lymphoblastic cell
• Lymphoma Classifications


  • Low Grade: Slow growing, Small cell lymphocytes, Survival: 5-7 YEARS
  • Intermediate Grade: Rapid lymph node enlargement and extranodal disease, Large cell lymphoma
  • High Grade: Most rapid enlargement of LN
• Treatment


  • Radiation: Stage O and II low grade lymphoma
  • Chemotherapy: all stages
• Mycosis Fungoides and Sezary Syndrome

  Rare lymphoma, Neoplastic cell: mature T (helper) cells, Involved organs: skin, Early: pruritus, Progression: demarcated reddened plaques, Generalized erythroderma, Mean survival rate: 5 yrs
• Chronic Lymphoproliferative Disorders (CLLD)

  • Most affected are men with an average of 55 years old
  • Presence of HCL indicate pancytopenia, predominantly granulocytes and monocytes
  • Mononuclear cells with cytoplasmic projection ("HAIRY CELL")
• Hairy Cell


  • Cytoplasm: scant to abundant, agranular, light grayish blue
  • Plasma membrane: irregular with hairlike or ruffled projections
  • Nucleus: round to oval, folded/ bilobed
  • Chromatin: loose and lacy
  • B-Cell Marker: present
• Bone Marrow Aspiration in HCL


  Usually results to DRY TAP, Increase in reticulin fiber
• HCL vs CLL


  HCL is positive with TRAP (Tartrate resistant acid phosphatase), CLL is positive with PAS
• Treatment of HCL


  • Alkylating agents: reduce tumor burden but makes cytopenia worse
  • Corticosteroid: Causes serious infection
  • Splenectomy: treatment of choice, allows cells sequestered by spleen to remain in circulation
• Lymphomas


  • Uninhibited growth of cellular elements found in the lymphatic tissue
  • Characterized by abnormal lymph node enlargement with disruption or replacement of the normal histologic structures
• Classification of Lymphoma


  • Hodgkin Disease/Hodgkin Lymphoma: Cellular variable/pleomorphic infiltrate, Multinucleated neoplastic cell, Unifocal, Biologic behavior neoplastic
  • Non-Hodgkin Lymphoma: B lymphocyte, T lymphocyte, Multifocal cellular
• Hodgkin Disease


  • Cause: unknown
  • Predisposition Factors: Genetic influence, Environmental hazards, Infectious agent (EPSTEIN BARR VIRUS-EBV)
  • Clinical Features: Painless enlarged lymph node, Mediastinal mass, Fever, night sweats and weight loss
• Peripheral Blood in Hodgkin Disease

  • Increased: monocyte and eosinophil
  • Presence of large abnormal lymphocyte w/little cytoplasm and irregular nucleus
  • Increased in WBC, Lymphocytopenia, Granulocytosis (basophil, eosinophil and neutrophil)
• Hodgkin disease


  Cause: unknown
• Predisposition factors (proposed)


  • Genetic influence
  • Environmental hazards
  • Infectious agent (Epstein Barr Virus-EBV)
• Hodgkin disease


  • Affects lymph nodes and even non-lymphatic tissues
  • Less predictable
• Signs of Hodgkin disease

  • Painless enlarged lymph node (but if the enlargement is rapid it becomes painful)
  • Mediastinal mass in between the lung chamber
  • Enlarged cervical nodes
  • Enlarged lymph nodes
• Symptoms of Hodgkin disease

  • Fever, night sweats and weight loss
• Suffixes of the symptoms of Hodgkin disease

  • A-no symptoms, the peripheral blood has abnormality but it doesn't present symptoms
  • B-patient has one or more symptoms
• Laboratory findings in peripheral blood for Hodgkin disease

  • Increased: monocyte and eosinophil
  • Presence of large abnormal lymphocyte w/little cytoplasm and irregular nucleus
  • Increased in WBC
  • Lymphocytopenia
  • Granulocytosis (basophil, eosinophil and neutrophil are increased)
  • Presence of large bizarre platelets (can see during progression of disease)
  • Plasma cells: Large monocytes with vacuoles, Large lymphocyte with deeply basophilic cytoplasm
• In Hodgkin disease, you will have normocytic and normochromic but there's anemia
• Bone marrow is seldom involved except in stage IV, and cannot be used to identify the type of Hodgkin disease because it's fibrotic
• Laboratory findings in bone marrow for Hodgkin disease

  • Decreased: Iron, TIBC
  • DAT (+): due to the presence of hemolytic anemia
• Definitive diagnosis of Hodgkin disease

  • Lymph node biopsy (if bone marrow biopsy is not available)
  • Confirmatory: Reed Sternberg cells
• Reed Sternberg cells


  • Multinucleated
  • Resembles an owl eyed appearance
  • Cannot be distinguished as B lymphocyte, T lymphocyte and monocyte
  • Nuclear membrane is demarcated and thick
  • Nuclei is usually eosinophilic and has a distinct halo
  • 4 to 8x size of normal lymphocyte
• Non-Hodgkin lymphoma


  • Uniformly neoplastic
  • Can be isolated and cultured
  • Can be used to diagnose the disease
• Chronic lymphocytic leukemia (CLL)

  • Proliferation of lymphocytes which are abnormal because they are unresponsive to antigenic stimuli
  • The function of lymphocytes (B-cell and T-cell) which the B-cells are supposed to produce antibodies
  • Less likely to undergo blastic transformation because it is chronic, in here mature cells are involved
• Types of autoimmune hemolytic anemia (AIHA) in CLL


  • Warm AIHA: Involves the warm antibodies; IgA and IgG in nature
  • Cold AIHA: IgM