非霍奇金淋巴瘤(NHL)ppt课件.ppt

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 different 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 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 poorIntroductionIntroductionlClassificationcomplex;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/lymphoma+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,soft 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 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 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/Lymphoma）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 neoplasms：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 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 enlargement,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 lymphoma(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 structure 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.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 symptom: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 leukemia: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:germinal 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，40%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 cellscentroblastic 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;Painless 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:Neoplastic 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(centroblastic variation)variation)Diffuse large B-cell lymphoma(immunoblastic Diffuse large B-cell lymphoma(immunoblastic variation)variation)Clinic Clinic lLate adult male;Late adult male;lGrowth quickly;Growth quickly;lUsually didnUsually didnt affect liver,spleen,marrow;t affect liver,spleen,marrow;lPrognosis:invasive ability,death-rate.Prognosis:invasive ability,death-rate.Burkitt lymphomaBurkitt lymphomaIntroduction Introduction lClinic type:Clinic type:l Endemic Endemic（AfricaAfrica）l SporadicSporadicl HIV infector HIV infectorlOriginate from:center B-cell,invasive ability.Originate from:center B-cell,invasive ability.lCause:related to EBV.Cause:related to EBV.Morphology Morphology lNeoplastic cells are medium-sized,unitary,invasion Neoplastic cells are medium-sized,unitary,invasion diffusely;diffusely;lMitosis,apoptosis;Mitosis,apoptosis;lMacrophages engulf the necrotic noeplastic cells,and Macrophages engulf the necrotic noeplastic cells,and scattered_scattered_“starry skystarry sky”.lImmune phenotype:expression for B cell.Immune phenotype:expression for B cell.Ileocecal Burkitt Ileocecal Burkitt lymphomalymphomaClinic Clinic lChildren,young person;Children,young person;lSite:jaw mass;Site:jaw mass;lLN usually wasnLN usually wasnt involved;t involved;lLeukemia is rare;Leukemia is rare;lHigh malignant,but the result of chemotherapy is High malignant,but the result of chemotherapy is well.well.Burkitt LymphomaBurkitt LymphomaMarginal zone lymphoma Marginal zone lymphoma Mucosa Associated Lymphoid Tissue,MALT-oma Mucosa Associated Lymphoid Tissue,MALT-oma Introduction Introduction lIntranode or extronode B-cell lymphoma.Intranode or extronode B-cell lymphoma.lThere are usually some basic diseases:eg,chronic There are usually some basic diseases:eg,chronic inflammation,autoimmune diseases,special inflammation,autoimmune diseases,special pathogen infection;pathogen infection;lThe lesion may confine the primary focus for a The lesion may confine the primary focus for a long time;long time;lIf the causes can be remove,the tumor may recover.If the causes can be remove,the tumor may recover.PositionPositionMorphology Morphology lM:M:Centrocyte like cellsCentrocyte like cellsLympho-epithelial lesions.Lympho-epithelial lesions.Stomach MALT-omaStomach MALT-omaBreast MALTomaBreast MALTomaParotid MALT-omaParotid MALT-omaEndometrial MALT-omaEndometrial MALT-omaMultiple Myeloma Multiple Myeloma lSpecific changes:the multiple osteolytic lesion.Specific changes:the multiple osteolytic lesion.lG G：yellow-red,colloid,soft.yellow-red,colloid,soft.lM M：differentiation well plasma cells invade differentiation well plasma cells invade diffussely.diffussely.lClinic:5060y.Clinic:5060y.invade bonepathologic fracture,chronic bone invade bonepathologic fracture,chronic bone pain.pain.hypercalcemia hypercalcemia anemia,WBC,Pt anemia,WBC,PtlLab test:blood Ig(IgGLab test:blood Ig(IgG）urine Bence Jones proteinurine Bence Jones proteinlX-ray/CT:bone defect.X-ray/CT:bone defect.lPrognosis:different.Prognosis:different.Peripheral T-cell and NK cell NeoplasmsPeripheral T-cell and NK cell NeoplasmsPeripheral T-cell lymphoma,Unspecified Peripheral T-cell lymphoma,Unspecified Morphology Morphology lLN structure is destroyed.LN structure is destroyed.lThe lesion start the paracortex,PCV.The lesion start the paracortex,PCV.lNeoplastic cell:pleomorphism,invasive growth,Neoplastic cell:pleomorphism,invasive growth,nuclear twist.nuclear twist.lThere are many kinds of non-neoplastic reactive There are many kinds of non-neoplastic reactive cells.cells.lCollagen proliferation.Collagen proliferation.lImmune phenotype:expression for T cell.Immune phenotype:expression for T cell.Peripheral T-cell lymphomaPeripheral T-cell lymphomaPeripheral T-cell lymphoma(unspecified)Peripheral T-cell lymphoma(unspecified)Peripheral T-cell lymphoma(unspecified)Peripheral T-cell lymphoma(unspecified)Extranodal natural killerExtranodal natural killer/T-cell lymphoma/T-cell lymphoma Introduction Introduction lOriginate from:NK cell.Originate from:NK cell.lSiteSite；2/3 nose.2/3 nose.lCauses:EBV.Causes:EBV.lCharacteristicsCharacteristics；invasioninvasion，high malignant.high malignant.lG G：the mass obstruct the nasal cavity,bone the mass obstruct the nasal cavity,bone destruction,intensive hemorrhage and necrosis.destruction,intensive hemorrhage and necrosis.lM M：the neoplastic cells distribute diffusely,the neoplastic cells distribute diffusely,different-sized,pleomorphic,destroy the blood different-sized,pleomorphic,destroy the blood vessels.vessels.Extranodal natural killer/T-cell lymphomaExtranodal natural killer/T-cell lymphoma add add：Complications of lymphomaComplications of lymphoma lymphoma lymphoma invade invadeCompress,invasionCompress,invasion marrow spleen immune dysfunction marrow spleen immune dysfunction marrow inhibition autoimmune marrow inhibition autoimmune functionfunction hemolysis hemolysis anemiaanemia infectioninfectionMyeloid neoplasmMyeloid neoplasmlDefinition:Definition:Arise from hematopoietic stem cells.The non-Arise from hematopoietic stem cells.The non-lymphoctic tumor cells proliferate clonely,and the lymphoctic tumor cells proliferate clonely,and the normal marrow cells are replaced by tumor cells.normal marrow cells are replaced by tumor cells.lFour types:Four types:Acute myeloblastic leukemia,AML Acute myeloblastic leukemia,AML Chronic myeloproliferative disorders,CMPD Chronic myeloproliferative disorders,CMPD Myelodysplastic syndromes,MDS Myelodysplastic syndromes,MDS MDS/MPD MDS/MPD Histocytic neoplasmaHistocytic neoplasmalDefinition:Is a proliferative disorder of histocytes Definition:Is a proliferative disorder of histocytes and macrophages.and macrophages.lIncludes:Includes:lHistocytic lymphomaHistocytic lymphoma：malignantmalignantlLangerhans cell histiocytosis=histiocytosis XLangerhans cell histiocytosis=histiocytosis Xeosinophilic granulomaeosinophilic granuloma：benign;benign;Hand-Schueler-Christian syndromeHand-SchuelerChristian syndrome：borderlineborderline；Letterer-Siwe diseaseLetterer-Siwe disease：malignant.malignant.Leukemoid reactionLeukemoid reactionlEtiologyEtiology：severe infection,some malignant tumors,drug severe infection,some malignant tumors,drug poison,severe hemorrhage or hemolytic reaction.poison,severe hemorrhage or hemolytic reaction.lManifestation:peripheral blood WBCManifestation:peripheral blood WBC，juvenile juvenile cell(+).cell(+).lCharacteristics Characteristics（different from leukemiadifferent from leukemia）：）：Removal causes,hemogram can recover;Removal causes,hemogram can recover;Anemia(-)and Pt(-);Anemia(-)and Pt(-);There are severe morphologic changes of leukocytes;There are severe morphologic changes of leukocytes;AKP activity and glucogen of neutrophils;AKP activity and glucogen of neutrophils;No chromosomal abnormality.No chromosomal abnormality.后面内容直接删除就行后面内容直接删除就行资料可以编辑修改使用资料可以编辑修改使用资料可以编辑修改使用资料可以编辑修改使用主要经营：网络软件设计、图文设计制作、主要经营：网络软件设计、图文设计制作、发布广告等发布广告等公司秉着以优质的服务对待每一位客户，做公司秉着以优质的服务对待每一位客户，做到让客户满意！到让客户满意！致力于数据挖掘，合同简历、论文写作、致力于数据挖掘，合同简历、论文写作、PPTPPT设计、计划书、策划案、学习课件、各设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求类模板等方方面面，打造全网一站式需求The user can demonstrate on a projector The user can demonstrate on a projector or computer,or print the presentation or computer,or print the presentation and make it into a film to be used in a and make it into a film to be used in a wider fieldwider field