A 48 year old women was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dl, platelet count 2.7 x lO’/L and total leukocyte count 40 x WfL, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD 19, CD 5, CD20 and CD23 and were negative for CD 79 B and FMC – 7. The histopathological examination ofthe lymph node in this patient will most likely exhibit effacement of lymph node architecture by –
Correct Answer: A difiuse proliferation of medium to large lymphoid cells with high mitotic rate.
Description: Lymphoid tumors: Cytologic classification: - undifferentiated stem cells; - histiocytes, reticular cells; - lymphoblastic, lymphocytic, poorly differentiated; - prolymphocytic and lymphocytic, lymphocytic, well differentiated; - Hodgkin-like; Anatomical classification: - multicentric; - thymic; - digestive; - cutaneous; - solitary. Lymphocytic leukemia. Plasmacytic tumors, multiple myeloma, plasmacytoma. Thymoma: - predominantly epithelial; - predominantly lymphocytic. At present, RAPPAPO's classification, WHO and other classifications are considered obsolete, being replaced by the classification proposed by KIEL and the National Cancer Institute classification . The classification of lymphoproliferative diseases of the International Lymphoma Study Group, corrected by the Revised European-American Lymphoma (REAL) system is under way. This classification compares KIEL's classification to that proposed by the international group Classification according to anatomoclinical criteria acute leukemia: lymphoblastic, myeloid and undifferentiated; chronic leukemia: lymphoid, myeloid, and tricholeukocytic leukemia; malignant lymphomas: Hodgkin's disease, non-Hodgkin malignant lymphomas, reticulosarcomas and lymphosarcomas. Classification according to pathophysiological criteria - Myeloproliferative syndromes: - chronic: primitive polyglobulia or Vaquez's disease or true polycytemia; chronic myeloid leukemia; essential thrombocytemia; essential myelofibrosis or myeloid splenomegaly and mastocytoma; - acute: acute myeloid leukemia; acute myelomonocytic leukemia; eosinophilic leukemia; basophilic leukemia; erythroleukemia; acute mega-karyocytic leukemia; undifferentiated leukemia; oligoblastia and aleukemia. - Lymphoproliferative syndromes: Waldenstrom's macroglobulinemia; multiple myeloma or Kahler's disease, thymoma, fungoid mycosis; lymphoid leukemia and malignant lymphomas TUMORS OF LYMPHOID SYSTEM B-Cell Lymphoid Neoplasms 1.1 Precursor B-cell neoplasms 1.1.1 B-cell lymphoblastic leukemia/lymphoma 1.2 Mature B-cell neoplasms 1.2.1 B-cell chronic lymphocytic leukemia/lymphoma 1.2.2 B-cell lymphocytic lymphoma intermediate type (LLI) 1.2.3 Lymphoplasmacytic lymphoma (LPL) 1.2.4 Follicular lymphomas 1.2.4.1 Mantle cell lymphoma (MCL) 1.2.4.2 Follicular center cell lymphoma I 1.2.4.3 Follicular center cell lymphoma II 1.2.4.4 Follicular center cell lymphoma III 1.2.4.5 Nodal marginal zone lymphoma 1.2.4.6 Splenic marginal zone lymphoma 1.2.5 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) 1.2.6 Hairy cell leukemia 1.2.7 Plasmacytic tumors 1.2.7.1 Indolent plasmacytoma 1.2.7.2 Anaplastic plasmacytoma 1.2.7.3 Plasma cell myeloma 1.2.8 Large B-cell lymphomas 1.2.8.1 T-cell-rich B-cell lymphoma 1.2.8.2 Large cell immunoblastic lymphoma 1.2.8.3 Diffuse large B-cell (noncleaved, cleaved) lymphoma 1.2.8.4 Thymic B-cell lymphoma (mediastinal B) 1.2.8.5 Intravascular large B-cell lymphoma 1.2.9 Burkitt-type lymphoma 1.2.9.1 High-grade B-cell lymphoma, Burkitt-like T-Cell and NK-Cell Lymphoid Neoplasms 2.1 Precursor T-cell neoplasms 2.1.1 T-cell lymphoblastic leukemia/lymphoma 2.2 Mature T-cell and NK-cell neoplasms 2.2.1 Large granular lymphoproliferative disorders (LGL) 2.2.1.1 T-cell chronic lymphocytic leukemia 2.2.1.2 T-cell LGL lymphoma/leukemia 2.2.1.3 NK-cell chronic lymphocytic leukemia 2.2.2. Cutaneous T-cell neoplasms 2.2.2.1 Cutaneous epitheliotropic lymphoma (CEL) 2.2.2.1.1 CEL, mycosis fungoides type 2.2.2.1.2 CEL, pagetoid reticulosis (Woringer-Kolopp) type 2.2.2.2 Cutaneous nonepitheliotropic lymphoma 2.2.3 Extranodal/peripheral T-cell lymphoma (PTCL) 2.2.3.1 PTCL, mixed lymphoid type 2.2.3.2 PTCL, mixed inflammatory type 2.2.4 Adult T-cell-like lymphoma/leukemia 2.2.5 Angioimmunoblastic lymphoma (AILD) 2.2.6 Angiotropic lymphoma 2.2.6.1 Angiocentric lymphoma 2.2.6.2 Angioinvasive lymphoma 2.2.7 Intestinal T-cell lymphoma 2.2.8 Anaplastic large cell lymphoma (ALCL Ref Davidson 23rd edition pg 1317
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