非霍奇金淋巴瘤(NHL)课件

non-Hodgkinlymphoma（NHL）SongwenjingThedepartmentofpathologyIntroductionTheyaremalignanttumorsoriginatingfromlymphoidtissue（B-cellsandT-cellsindifferentdevelopedstage）.Incidence:＞HL,accountfor80~90%alllymphomas.Site:lymphnodes(2/3)↑；

extranodallymphoidtissue(1/3)↓.ThedifferencebetweenHLandNHLaboutclinic-pathologicalcharacteristicsHLNHLSiteintranode↑IntranodeandextranodeMorphologymultiplicity*R-ScellunitaryMetastasisAnatomiccontinuouslyskippingPrognosis

wellpoorIntroductionClassification:complex;relatedtotheLCdifferentation.Thecommontype:Intranode:Adult:diffuselargeBcelllymphomaChildren:acutelymphoblasticleukemia/lymphoma+BurkittlymphomaExtranode:MALT-omaExtranadalNK/T-celllymphomaTheprocessofLCdifferentiationMorphologyG：LNenlargement,softorhard,homogeneous,greyorgrey-yellow,maycoalesce.ExtranodalNHLpresentsdiffuseornodularpattern.MultiplelymphomasofstomachMorphologyThegeneralcharacteristicsonLM：LNstructureisdestroyedpartlyorcompletely;LNisreplacedbytheunitaryneoplasticcells,presents“cellularsea”；TheneoplastictissuesinvadethecapsuleandfattytissuearoundLN.Thenodulesmaybeformed.PrecursorB-cellandT-cellneoplasm（AcuteLymphoblasticLeukemia/Lymphoma）IntroductionComposedbyimmaturelymphoblasticcellsPrecursorB-cellneoplasms：involvedbonemarrowandbloodextensively.PrecursorT-cellneoplasms：involvedthymusmainly,formingmass.Incidence：PrecursorB-cell(80%)＞PrecursorT-cell(15%)MorphologyLNchanges:LymphoblasticcellsdistributeddiffuselyMarrowchanges：lymphoblasticcellsaccumulatedinthemarrow.Immunephenotype:TdT(+).前体B淋巴母细胞淋巴瘤：胞浆稀少；核较小、近圆形，染色质细致、细颗粒状。前体T淋巴母细胞白血病（骨髓活检切片）：淋巴母细胞大小不等，核迂曲。ClinicFallillsuddenly,developquickly;Marrowfunction↓→anemia；→easytoinfection：matureWBC↓；→secondaryPt↓→hemorrhage；Bonepain；LN,liver,spleenenlargement,mediastinummass;CNSsymptoms：headache,omit,nervousparalysis.Prognosis:well.PeripheralmatureBcellneoplasmaSmalllymphocytelymphoma(Chroniclymphocyteleukemia)IntroductionAge：>50ySexuality：male>femaleOriginatefrom：matureBcellUsuallyinvademarrow,liver,spleenMorphologyLNstructureisdestroyedSmallneoplasmcellsdistributediffuselylymphoblasticfocus—havingdiagnosissignificanceImmunephenotype:expressionforBcell.B-CLL/SLLSmalllymphocytelymphomaB-cellchroniclymphocyticleukemia/smalllymphocyticlymphomaClinicDevelopslowly,asymptomaticgenerally.Non-specialsymptom:easyfatigue,weightloss,anorexia,infectioneasily;Mayoccurautoimmunediseases;LN,liverspleenenlargement;Chroniclymphocyteleukemia:WBC↑;Smalllymphocytelymphoma,theamountofWBCmaybenormal.Prognosis:different.FollicularLymphomaIntroductionOriginatefrom:germinalcenterB-cell,inertialneoplasm.Characteristic:neoplasticnoduleformation.Incidence:10%~13%Age:middle-agedperson↑,male≈femalePrognosis:survivalrate7~9years，40%maytransformtothediffuselargeB-celllymphoma.Morphology*NeoplasticnoduleformationThenoduleiscomposedofcentercellsandcentroblasticcellsMaytransformtothediffusepattern.Immunephenotype:expressionforcentrocyteBcl-2andBcl-6FollicularlymphomaofileumClinicPainlessLNenlargement;Site:inguinalLN↑;Marrowisaffectedbyneoplasm:accountforabout30-50%.Prognosis:wellDiffuselargeB-celllymphomaMorphologyNeoplasticcell:invadeddiffusely.Characteristics：

largecell,obviouslyatypia.Immunephenotype:expressionforBcell.DiffuselargeB-celllymphoma(centroblasticvariation)DiffuselargeB-celllymphoma(immunoblasticvariation)ClinicLateadultmale↑;Growthquickly;Usuallydidn’taffectliver,spleen,marrow;Prognosis:invasiveability↑,death-rate↑.BurkittlymphomaIntroductionClinictype:Endemic（Africa）

SporadicHIVinfectorOriginatefrom:centerB-cell,invasiveability↑.Cause:relatedtoEBV.MorphologyNeoplasticcellsaremedium-sized,unitary,invasiondiffusely;Mitosis↑,apoptosis↑;Macrophagesengulfthenecroticnoeplasticcells,andscattered_“starrysky”.Immunephenotype:expressionforBcell.IleocecalBurkittlymphomaClinicChildren↑,youngperson↑;Site:jaw↑→mass;LNusuallywasn’tinvolved;Leukemiaisrare;Highmalignant,buttheresultofchemotherapyiswell.BurkittLymphomaMarginalzonelymphomaMucosaAssociatedLymphoidTissue,MALT-omaIntroductionIntranodeorextronodeB-celllymphoma.Thereareusuallysomebasicdiseases:eg,chronicinflammation,autoimmunediseases,specialpathogeninfection;Thelesionmayconfinetheprimaryfocusforalongtime;Ifthecausescanberemove,thetumormayrecover.PositionMorphologyM:Centrocytelikecells↑Lympho-epitheliallesions.StomachMALT-omaBreastMALTomaParotidMALT-omaEndometrialMALT-omaMultipleMyelomaPeripheralT-cellandNKcellNeoplasmsPeripheralT-celllymphoma,UnspecifiedMorphologyLNstructureisdestroyed.Thelesionstarttheparacortex,PCV↑.Neoplasticcell:pleomorphism,invasivegrowth,nucleartwist.Therearemanykindsofnon-neoplasticreactivecells.Collagenproliferation.Immunephenotype:expressionforTcell.PeripheralT-celllymphomaPeripheralT-celllymphoma(unspecified)PeripheralT-celllymphoma(unspecified)Extranodalnaturalkiller

/T-celllymphomaIntroductionOriginatefrom:NKcell.Site；2/3nose↑.Causes:EBV.Characteristics；invasion↑，highmalignant.G：themassobstructthenasalcavity,bonedestruction,intensivehemorrhageandnecrosis.M：theneoplasticcellsdistributediffusely,different-sized,pleomorphic,destroythebloodvessels.Extranodalnaturalkiller/T-celllymphomaadd：Complicationsoflymphoma

lymphomainvadeCompress,invasionmarrowspleenimmunedysfunction

marrowinhibitionautoimmunefunction↓hemolysis

anemia

infectionMyeloidneoplasmDefinition:Arisefromhematopoieticstemcells.Thenon-lymphoctictumorcellsproliferateclonely,andthenormalmarrowcellsarereplacedbytumorcells.Fourtypes:Acutemyeloblasticleukemia,AMLChronicmyeloproliferativedisorders,CMPDMyelodysplasticsyndromes,MDSMDS/MPD

HistocyticneoplasmaDefinition:Isaproliferativedisorderofhistocytesandmacrophages.Includes:Histocyticl