4. The non-Hodgkin’s lymphomas are a heterogeneous group of
neoplastic disorders of lymphoid tissue,
Each group has different
clinical,
morphological,
immunological,
and genetic characteristics.
introduction
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5. • NHL is categorized into immature and mature B or T-cell NHL.
• NHL is a systemic illness
• NHL is the fifth most common diagnosis of pediatric cancer in
• 6% childhood cancer , 60% of childhood lymphomas
• children under the age of 15 years
introduction
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6. Non-Hodgkin lymphoma (NHL) – INFO
develops in the lymph nodes or in lymphatic tissue
in one or many sites in the body (nodal, extranodal)
Lymphoid tissue : found in organs such as the stomach,
intestines BM. CNS or skin.
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7. Non-Hodgkin lymphoma (NHL) – INFO
Share in some characteristics
Caused by DNA injury of a lymphocyte
It is acquired
Affected 50-60yrs old
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and children
12. Indolent lymphoma: slow growing and spreading
The most common form of NHL is the follicular lymphoma
Why called FL? abnormal B lymphocytes (cancerous cells) grow in lymph
nodes in clusters to form nodules or follicles in the tissues they invade
(histological feature)
It is a low grade lymphoma.
Follicular lymphoma -FL
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13. Consist 21% of B cells lymphoma
Specific B cells are uncontrolled division
Affected people over 50 yrs
Rare in children
Follicular lymphoma -FL
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14. Indolent lymphoma: slow growing and spreading
Not need therapy- wait &watch closely
Difficult to cure
Can transformed to
Diffuse large B cell lymphoma DLBCL
follicular lymphoma
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15. Localized disease
Single lymph node
Above the diaphragm
Two or more
lymph nodes
Above the
diaphragm
Two or more
lymph nodes
Above or lower
the diaphragm
Wide spread
multiple organs
Above or lower the
diaphragm
Murphy staging system
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16. include:
A symptoms
•Swollen glands (the lymph nodes)
•Sites: in the neck, armpit, abdomen, or groin,
•Pain: painless;
•B symptoms
•Deeper located : associated with pain
•Loss of appetite or weight
•Fever of unknown reason
•Tiredness and ongoing fatigue
•Excessive sweating
The classic symptoms of follicular lymphoma
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17. include:
History of the patient
Physical examination: have painless enlargement of
superficial lymph nodes of small to medium size
Diagnosis of FL
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19. include:
Blood tests
CBC -This is done to rule out leukaemia
a bone marrow biopsy –(stage VI)
Blood chemistry : Serum LDH and β2-microglobulin are useful prognostic
markers in malignant lymphomas.
Diagnosis
Histological test
Gives Accurate diagnosis
a lymph node biopsy (in which all or part of the lymph node is
removed and examined) is needed to confirm the diagnosis.
a tumor markers
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20. PET/CT scan PET-CT is more sensitive and specific
(stage and localized of FL)
x-rays,
CT scans,
Radiological tests -Diagnosis
immunophenotyping:Tumor cells are positive for the B-cell markers
CD10, CD19, CD22, and CD20, but always negative for CD5
Cytogenetic analysis: t (14;18) which turns on the bcl-2 oncogene
leading to uncontrolled proliferation of B-cells
Immunophenotyping –Cytogenetic analysis
positron emission tomography -PET
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22. Aggressive lymphoma: fast growing and spreading
The most common is the diffuse large B cell lymphoma (DLBCL)
high-grade (fast growing) non-Hodgkin lymphoma.
Consist 31% of B cells lymphoma
DLBCL accounts for about 8 to 10% of all NHL in childhood.
Diffuse large B cell lymphoma - DLBCL
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23. It is called diffuse large B-cell lymphoma because:
it develops from abnormal B cells
the abnormal cells are larger than normal, healthy B cells
the abnormal cells are spread out (diffuse) rather than grouped together
when they’re examined under a microscope
Diffuse large B cell lymphoma - DLBCL
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24. B symptoms are observed in approximately
30% of patients
Need immediate therapy
Response will to treatment
Diffuse large B cell lymphoma - DLBCL
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26. Primary mediastinal large B-cell lymphoma (PMLBL)
accounts for 2-4% of all non-Hodgkin
lymphomas.
Age: children and adults (25-40yrs of age)
Gender :It is twice as common in women as
in men
Site: Develops in the mediastinum (in the
chest)
Symptoms: include breathlessness, persistent cough, difficulty swallowing
(dysphagia), swelling of the neck and face, dizziness and headaches.
Treatment :involves chemotherapy, often followed by radiotherapy
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27. T-cell/histiocyte-rich large B-cell lymphoma
accounts 10% of people with DLBCL develop this type.
Cells: three types of cells present- T-cells, histiocytes and large B-cells
(histopathology finding)
Site: Develops in liver,spleen, abdomen
Symptoms: include Symptoms include swollen lymph nodes, fever and
swelling of the liver , spleen and abdominal swelling
Treatment :involves chemotherapy, often followed by radiotherapy
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29. Anaplastic
A term used to describe cancer cells
that divide rapidly and have little or
no resemblance to normal cells.
Anaplasia is a cellular condition
characterized by inadequate
differentiation
30. Anaplastic Large Cell Lymphoma (ALCL)
Definition
ALCL is a cancer of mature T-cell
It is a form of NHL.
Consist about 10% of NHL in children
Sites
May be localized
May be advanced (widespread in chest, skin. lungs, abdomen or bones)
With fever,weight loss ,(B-symptoms)
Markers
All has CD30 positive
Some ALK-GENE positive (>90%)
Some are ALK-GENE
chromosomal translocation t(2;5) (85% of cases)
Anaplastic Lymphoma Kinase gene
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31. Anaplastic large cell lymphoma (ALCL)
1-Primary systemic ALCL, ALK-positive,
is a fast-growing (aggressive) cancer, involve many organs.
most common in children and young adults.
This type of cancer usually responds well to chemotherapy treatments.
Anaplastic Lymphoma Kinase gene
Types
2-Primary systemic ALCL, ALK-negative,
is an aggressive cancer that
primarily affects older adults.
Hard treatment, Has relapse post therapy with Worse prognosis
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32. Anaplastic large cell lymphoma
(ALCL)
Types
3-Primary cutaneous ALCL
causes skin changes, like bumps
or a rash.
In most cases (90% of the time),
it doesn’t spread beyond the
skin.
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33. Figure 1 Skin rashes (A) before treatment and (B) after chemotherapy]
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34. Anaplastic large cell lymphoma
(ALCL)
Types
4-Breast implant-associated ALCL
(BIA-ALCL)
forms around breast implants.
BIA-ALCL is usually diagnosed
about 10 years following a breast
augmentation or breast
reconstruction procedure.
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36. Lymphoblastic Lymphoma (LL)
Cells affected
immature
T- lymphocyte T-LL
B-lymphocyte B-LL
It is one of the three most common types of NHL In children
Present in similar way to one another and similar to ALL
Age:0-15yrs –more common between 10-14 yrs.
Types of Lymphoblastic Lymphoma (LL)
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37. T-Lymphoblastic Lymphoma (TLL)
TLL arise from precursor T lymphoblasts at different stages of
differentiation
Consist 30% of all NHL of children
It is aggressive
Good prognosis 85% cured
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38. consist about 80% of childhood LL
sites:
thymus present as a mediastinal mass
(mass behind the breast bone but in
front of the windpipe, with breathing
shortness)
Precursor T-cell lymphoblastic Lymphoma
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40. Precursor B-cell lymphoblastic Lymphoma
consist about 20% of childhood LL
sites: Begins in lymph nodes outside the mediastinum (Neck, tonsils, or
skin tumors)
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41. Symptoms of Lymphoblastic Lymphoma -LL
the first symptoms notice a lump or several lumps, don't go away
sites of lumps; head, neck, chest, armpit or groin (are swollen lymph nodes)
advance stages: can spread to the lungs, (mediastinal mass) , liver, bones
lumps
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42. the common symptoms of lymphoblastic lymphoma include
painless swelling of lymph nodes
easy bruising, persistence infections
advance stages: can spread to the lungs, (mediastinal mass)
shortness of breath, Cough, fatigue, prurittus
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43. Target for best treatmeant
Early stage (stage 1 and 2)
Advanced stage (stage 3 and 4)
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44. Lymph node biopsy
B.M biopsy (Leukemia or Lymphoma) 25% or more blasts in
the bone marrow
CBC, ESR, LFT
Chest X-ray, PET/CT positron emission tomography -PET
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