This document discusses the classification and characteristics of mature lymphoid neoplasms. It covers several types of B-cell and T-cell/NK-cell neoplasms as well as Hodgkin's lymphoma. Chronic lymphocytic leukemia is described in more detail, including that it involves the accumulation of B lymphocytes in the blood, bone marrow, lymph nodes and spleen. Diagnosis involves blood tests and bone marrow aspiration showing lymphocytic dominance. Hodgkin's lymphoma is characterized by the presence of Reed-Sternberg cells in lymph node biopsies and generally has a high survival rate when detected early.

1. Mature Lymphoid Neoplasms
By
Ahmed Riyadh Abdul Rahman
Al-Noor University College

2. Classification of mature Lymphoid Neoplasms
A. B cell Neoplasms e.g.;
• Chronic lymphocytic leukaemia /small lymphocytic
lymphoma
• Plasma cell myeloma
• Hairy cell leukaemia
• Lymphoplasmacytic lymphoma
• Marginal zone lymphoma
• Follicular lymphoma
• Mantle cell lymphoma
• Diffuse large B-cell lymphoma
• Burkitt lymphoma

3. Classification of mature Lymphoid Neoplasms
A. B. Mature T-cell and NK-cell Neoplasms
e.g.;
• T-cell prolymphocytic leukaemia
• T-cell large granular lymphocytic leukaemia
• Aggressive NK-cell leukaemia
• Adult T-cell leukaemia/lymphoma
• Extranodal NK/T-cell lymphoma, nasal type
• Mycosis fungoides Sézary syndrome

4. Classification of mature Lymphoid Neoplasms
A. B. Mature T-cell and NK-cell Neoplasms •
T-cell prolymphocytic leukaemia
• T-cell large granular lymphocytic leukaemia
• Aggressive NK-cell leukaemia
• Adult T-cell leukaemia/lymphoma
• Extranodal NK/T-cell lymphoma, nasal type
• Mycosis fungoides Sézary syndrome
C. Hodgkin Lymphomas
• Nodular lymphocyte predominant Hodgkin
lymphoma
• Classic Hodgkin lymphoma

5. Lymphoma versus Leukaemia
The distinction between lymphoma and lymphoid
leukaemia is often confusing , but as a general rule , a
neoplasm of lymphocytes or lymphocyte precursors that
manifests primarily as a tumor of lymph nodes or related
organs (e.g spleen , liver , or other solid tissues) is
considered as lymphoma ,
while a neoplasm of lymphocytes or lymphocyte
precursors that manifest primarily as a proliferation of
abnormal cells in the blood and bone marrow is
considered as lymphoid leukaemia .

6. Chronic Lymphocytic Leukaemia (CLL)
 CLL is a B-cell clonal lymphoproliferative disease in
which lymphocytes accumulate in the blood, bone
marrow, lymph nodes and spleen (absolute clonal B
lymphocyte count >5.0 × 109/L).
 CLL has a peak incidence between 60 and 80 years of age.
The disease occurs in older subjects with only 15% of cases
before 50 years of age. The male to female ratio is 2:1.
 The cause is unknown.
 The most common chromosome changes are trisomy 12,
a 13q deletion and deletions of 11q including the
ataxia telangiectasia (ATM) gene.

7. Clinical features of CLL
 Most patients are diagnosed without symptoms as the
result of a routine blood test.
 CLL patients present with enlargements of lymph nodes
, which are discrete , and non-tender.
 Features of anaemia and thrombocytopenia (bruising
or purpura) may be seen.
 Splenomegaly and , less commonly hepatomegaly are
common in later stages.
 Immunosupression due to hypogammaglobulinaemia
and cellular immune dysfunction results in bacterial ,
fungal and viral infections.

8. Staging of CLL

9. Diagnosis of CLL
- Blood films show lymphocytosis (70-90%) of white blood
cells appear as small lymphocytes. Total leukocyte count
ranges between 30-300x109/L.
- Anemia and thrombocytopenia may be also seen.
- The immunophenotyping of the lymphocytes shows them to
be B cells , which express surface markers CD5+ and CD23+ .
- Bone marrow aspiration shows lymphocytic replacement of
normal marrow elements. lymphocytes comprise about 25-
95% of all the cells.
- Auto immune hemolytic anemia is most frequent in CLL.

10. HODGKIN'S LYMPHOMA
 Also known as Hodgkin's disease is a type of lymphoma
first described by Thomas Hodgkin in 1832.
 It is characterized clinically by the orderly spread of disease
from one lymph node group to another and by
development of systemic symptoms with advanced disease.
 Pathologically , the disease is characterized by the presence
of Reed-Sternberg cells (RS cells) on examination of
affected lymph node biopsies or aspiration.
 The survival rate is generally around 90% when the disease
is detected early , making it one of the more curable forms
of cancer.

11. Mature
Lymphocytes in CLL
Reed-Sternberg
cells (RS cell)