DIAGNOSTIC AND TREATMENT DILEMMAS IN NHL=PART 2

1,130 views

Published on

Published in: Education, Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,130
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
11
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

DIAGNOSTIC AND TREATMENT DILEMMAS IN NHL=PART 2

  1. 1. Bone Marrow Biopsy  Focal involvement by small B-cell neoplasm without significant plasmacytic differentiation (CD3-, CD20+, PAX5+, kappa IHC-, lambda IHC-, CD5-, CD10-, BCL6-, BCL2+, cyclin D1-, IgD-, Ki67 low) Courtesy of T Pongpruttipan, MD.
  2. 2. Review of Colonic Polyp Biospy Tissue HE CD20 HE HE Courtesy of T Pongpruttipan, MD.
  3. 3. Final Pathological Diagnosis  Involvement by small B-cell lymphoid neoplasm with CD10+, BCL2+, BCL6- phenotype. No evidence of large cell involvement.  Some small and large cells showed large aggregates with infiltrative growth pattern.  IMP: follicular lymphoma with focus of large cell transformation  DDx  DLBCL with accompanying follicular lymphoma  Follicular lymphoma, grade 3/3 (focal) in the background of follicular lymphoma, low grade
  4. 4. Colorectal Lymphoma  A type of extranodal lymphoma involving GI tract  Primary GI lymphoma  Stomach 40-50%  Small bowel 20-30%  Colon and rectum 10-20%  Primary GI lymphoma  No palpable, superficial LN  No enlarged mediastinal LN on CXR  Normal WBC (No and differential count)  Only regional LN involved  No involvement of liver and spleen Dawson IM, et al. Primary malignant lymphoid tumours of the intestinal tract. Report of 37 cases with a study of factors influencing prognosis. Br J Surg 1961;49:80-9.
  5. 5. Staging of Lymphoma
  6. 6. Musshoff Modifications to Ann Arbor Staging System for Extranodal Lymphoma Stage I or IE Single lymphatic organ or extranodal site II Two or more lymphatic regions on the same site of the diaphragm or a single extranodal organ and lymph node involvement at the same site of diaphragm II1 Regional lymph node involved II2 Distant lymph node involved III Lymph node involved on both sides of diaphragm IV Disseminated disease with involvement of bone marrow, liver, etc Musshoff K. Strahlentherapie 1977;153:218-21. Boot H. Best Pract Res Clin Gastroenterol 2010;24(1):3-12.
  7. 7. Common Types in Colorectal NHL  DLBCL 60%  de novo  Transformation from CLL, follicular lymphoma, MALT  MALT 15%%  Burkitt 15  Recent report from Terada T, Japan  37 cases of GI lymphoma  M:F 20:17  Median age 69 yr (46- 89)  Types  Gastric 25 (68%)  Small bowel 6 (16%)  Colon 6 (16%) Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012;2(3):194-200.
  8. 8. Gastrointestinal Lymphoma  Types  B-cell 35 (95%)  T-cell 2 (5%)  Gastric NHL 25  DLBCL 11  MALT 14  Small intestine  DLBCL 4  PTCL 2  Colon 6  DLBCL 5  FL 1  Clinical diagnosis of colon NHL at first  GIST 1  Colon carcinoma 4  Colon polyp 1  No cases of  Hodgkin lymphoma  Burkitt lymphoma  Mantle cell lymphom Terada T. Gastrointestinal malignant lymphoma: a pathologic study of 37 cases in a single Japanese institution. Am J Blood Res 2012;2(3):194-200.
  9. 9. Primary FL of GI tract: Massachusetts General Hospital, 1995-2010  Excluded cases  History of FL outside GI tract  Widespread lymphoma  Distant nodal disease within 6 months  Multifocal diseases  Splenic involvement  FL in transformation Misdraji J, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011;35:1255-63.
  10. 10. Presenting Symptoms/ Finding  Symptoms  Abdominal pain and nausea, vomiting (12),  bowel obstruction  Intussuspection (1)  Incidental finding (13) on investigation of  Reflux symptoms or Barrett esophagus  Screening for colorectal cancer  Resection of sigmoid carcinoma  Macroscopic findings  White patches or plaques  Mucosal nodularity or granularity  Nodules  Polyp (1, 2, 3)  Submucosal mass  Thickening of wall or folds Misdraji J, et al. Primary follicular lymphoma of the gastrointestinal tract. Am J Surg Pathol 2011;35:1255-63.

×