非霍奇金淋巴瘤(NHL)ppt课件.ppt
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1、non-Hodgkin lymphoma non-Hodgkin lymphoma(NHLNHL)Song wenjingSong wenjingThe department of pathologyThe department of pathologyIntroduction Introduction lThey are malignant tumors originating from They are malignant tumors originating from lymphoid tissue lymphoid tissue(B-cells and T-cells in diffe
2、rent B-cells and T-cells in different developed stagedeveloped stage).lIncidence:Incidence:HL,account for 8090%all lymphomas.HL,account for 8090%all lymphomas.lSite:lymph nodes(2/3)Site:lymph nodes(2/3);extranodal lymphoid tissue(1/3).extranodal lymphoid tissue(1/3).The difference between HL and NHL
3、 about clinic-The difference between HL and NHL about clinic-pathological characteristicspathological characteristicsHLNHLSite intranodeIntranode and extranodeMorphology multiplicity*R-S cell unitary Metastasis Anatomic continuously skipping Prognosis well poorIntroductionIntroductionlClassification
4、:complex;Classification:complex;related to the LC related to the LC differentation.differentation.lThe common type:The common type:Intranode:Intranode:Adult:diffuse large B cell lymphomaAdult:diffuse large B cell lymphomaChildren:acute lymphoblastic leukemia/Children:acute lymphoblastic leukemia/lym
5、phoma+Burkitt lymphomalymphoma+Burkitt lymphomaExtranode:Extranode:MALT-omaMALT-omaExtranadal NK/T-cell lymphomaExtranadal NK/T-cell lymphomaThe process of LC differentiationThe process of LC differentiationMorphology Morphology G G:lLN enlargement,soft or hard,homogeneous,grey or LN enlargement,sof
6、t or hard,homogeneous,grey or grey-yellow,may coalesce.grey-yellow,may coalesce.lExtranodal NHL presents diffuse or nodular pattern.Extranodal NHL presents diffuse or nodular pattern.Multiple lymphomas of Multiple lymphomas of stomachstomachMorphology Morphology The general characteristics on LM The
7、 general characteristics on LM:lLN structure is destroyed partly or completely;LN structure is destroyed partly or completely;lLN is replaced by the unitary neoplastic cells,LN is replaced by the unitary neoplastic cells,presents presents“cellular seacellular sea”;lThe neoplastic tissues invade the
8、capsule and fatty The neoplastic tissues invade the capsule and fatty tissue around LN.tissue around LN.lThe nodules may be formed.The nodules may be formed.Precursor B-cell and T-cell neoplasm Precursor B-cell and T-cell neoplasm(Acute Lymphoblastic Leukemia/LymphomaAcute Lymphoblastic Leukemia/Lym
9、phoma)Introduction Introduction lComposed by immature lymphoblastic cellsComposed by immature lymphoblastic cellsPrecursor B-cell neoplasmsPrecursor B-cell neoplasms:involved bone marrow involved bone marrow and blood extensively.and blood extensively.Precursor T-cell neoplasmsPrecursor T-cell neopl
10、asms:involved thymus mainly,involved thymus mainly,forming mass.forming mass.lIncidenceIncidence:Precursor B-cell(80%)Precursor B-cell(80%)Precursor T-Precursor T-cell(15%)cell(15%)Morphology Morphology lLN changes:LN changes:Lymphoblastic cells Lymphoblastic cells distributed diffusely distributed
11、diffusely lMarrow changesMarrow changes:lymphoblastic cells lymphoblastic cells accumulated in the accumulated in the marrow.marrow.lImmune phenotype:Immune phenotype:TdT(+).TdT(+).前体前体B B淋巴母细胞淋巴瘤:胞浆稀少;核较小、近圆形,染色质细致、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。细颗粒状。前体前体T T淋巴母细胞白血病(骨髓活检切片):淋巴母细胞大小不等,核淋巴母细胞白血病(骨髓
12、活检切片):淋巴母细胞大小不等,核迂曲。迂曲。Clinic Clinic lFall ill suddenly,develop quickly;Fall ill suddenly,develop quickly;lMarrow functionMarrow function anemia anemia;easy to infectioneasy to infection:mature WBCmature WBC;secondary Pt hemorrhagesecondary Pt hemorrhage;lBone painBone pain;lLN,liver,spleen enlargem
13、ent,mediastinum mass;LN,liver,spleen enlargement,mediastinum mass;lCNS symptomsCNS symptoms:headache,omit,nervous paralysis.headache,omit,nervous paralysis.lPrognosis:well.Prognosis:well.Peripheral mature B cell neoplasmaPeripheral mature B cell neoplasmaSmall lymphocyte lymphomaSmall lymphocyte lym
14、phoma(Chronic lymphocyte leukemia)(Chronic lymphocyte leukemia)Introduction Introduction lAgeAge:50y50ylSexualitySexuality:malefemalemalefemalelOriginate fromOriginate from:mature B cellmature B celllUsually invade marrow,liver,spleenUsually invade marrow,liver,spleenMorphology Morphology lLN struct
15、ure is LN structure is destroyeddestroyedlSmall neoplasm cells Small neoplasm cells distribute diffuselydistribute diffuselyllymphoblastic focuslymphoblastic focushaving diagnosis having diagnosis significancesignificancelImmune phenotype:Immune phenotype:expression for B cell.expression for B cell.
16、B-CLL/SLLB-CLL/SLLSmall lymphocyte lymphomaSmall lymphocyte lymphomaB-cell chronic lymphocytic leukemia/small B-cell chronic lymphocytic leukemia/small lymphocytic lymphomalymphocytic lymphomaClinic Clinic lDevelop slowly,asymptomatic generally.Develop slowly,asymptomatic generally.lNon-special symp
17、tom:easy fatigue,weight loss,Non-special symptom:easy fatigue,weight loss,anorexia,infection easily;anorexia,infection easily;lMay occur autoimmune diseases;May occur autoimmune diseases;lLN,liver spleen enlargement;LN,liver spleen enlargement;lChronic lymphocyte leukemia:WBC;Chronic lymphocyte leuk
18、emia:WBC;lSmall lymphocyte lymphoma,the amount of WBC may Small lymphocyte lymphoma,the amount of WBC may be normal.be normal.lPrognosis:different.Prognosis:different.Follicular LymphomaFollicular LymphomaIntroduction Introduction lOriginate from:germinal center B-cell,inertial Originate from:germin
19、al center B-cell,inertial neoplasm.neoplasm.lCharacteristic:neoplastic nodule formation.Characteristic:neoplastic nodule formation.lIncidence:10%13%Incidence:10%13%lAge:middle-aged person,male femaleAge:middle-aged person,male femalelPrognosis:survival rate 79 yearsPrognosis:survival rate 79 years,4
20、0%may 40%may transform to the diffuse large B-cell lymphoma.transform to the diffuse large B-cell lymphoma.Morphology Morphology l*Neoplastic nodule*Neoplastic nodule formation formation lThe nodule is composed of The nodule is composed of center cells and center cells and centroblastic cellscentrob
21、lastic cellslMay transform to the May transform to the diffuse pattern.diffuse pattern.lImmune phenotype:Immune phenotype:expression for expression for centrocytecentrocyteBcl-2 and Bcl-6Bcl-2 and Bcl-6Follicular lymphoma of ileumFollicular lymphoma of ileumClinic Clinic lPainless LN enlargement;Pai
22、nless LN enlargement;lSite:inguinal LN;Site:inguinal LN;lMarrow is affected by neoplasm:account for about Marrow is affected by neoplasm:account for about 30-50%.30-50%.lPrognosis:wellPrognosis:wellDiffuse large B-cell lymphomaDiffuse large B-cell lymphomaMorphology Morphology lNeoplastic cell:Neopl
23、astic cell:invaded diffusely.invaded diffusely.lCharacteristicsCharacteristics:large cell,obviously large cell,obviously atypia.atypia.lImmune phenotype:Immune phenotype:expression for B cell.expression for B cell.Diffuse large B-cell lymphoma(centroblastic Diffuse large B-cell lymphoma(centroblasti
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