LYMPHOID DISORDERS

Lymphocyte Development

Lymph Node

Lymph Node Enlargement

Infections
Acute
Chronic
TB
Toxoplasma
HIV, LGV
Cat Scratch disease
Infectious mononucleosis

Autoimmune
Disorders

Neoplasms
Lymphomas
Metastasis

Lymphadenopathy
L- Lymphoma, Leukemia
Y-Yersinia Pestis (Plague)
M-Mononucleosis or CMV
P-Parasite - Toxoplasmosis
H-Hodgkins Disease or HIV infection
N-Neoplasm or metastasis
O-Obvious local infection or inflammation
Other systemic infections: Hep B, Rubella,
Cat scratch
D-Drug- Procainamide , Phenytoin
(Dilantin)
E-Endocrine - Addisons, Hypothyroid
S- Syphilis
SLE/Rheumatoid arthritis
Serum sickness, Sarcoid

INFECTIOUS
MONONUCLEOSIS

Self limiting lymphoproliferative disease

EBV
Young adults 14 24 yrs
Virus - infects resting B cells

Clinical Features
Pharyngitis
Splenomegaly
Hepatomegaly, jaundice
Skin rashes

Hematological findings
TLC -
Lymphocytosis
Atypical /reactive lymphocytes + (CD8 Cells)
Downy I
Downy II

Heterophile Ab -
Monospot test
Paul Bunnell test

Atyp. Lympocytes
Ab. Cytoplasm
Clear vaculations
Azurophilic

LYMPHOID NEOPLASMS

What is the difference between

Lymphoma & Leukemia???

Leukemia Widespread
involvement of BM & peripheral
blood

Lymphoma Proliferations arising

as discrete tissue masses

WHO Classification
Precursor B-Cell Neoplasms
B cell acute lymphoblastic leukemia/ lymphoma
(B-ALL)

WHO Classification
Peripheral B-Cell Neoplasms
Chronic lymphocytic leukemia/ small
lymphocytic lymphoma (CLL/SLL)
B-cell prolymphocytic leukemia
Lymphoplasmacytic lymphoma
Splenic and nodal marginal zone lymphomas
Extranodal marginal zone lymphoma
Mantle cell lymphoma

WHO Classification
Peripheral B-Cell Neoplasms
Follicular lymphoma
Marginal zone lymphoma
Hairy cell leukemia
Plasmacytoma/plasma cell myeloma
Diffuse large B-cell lymphoma
Burkitt lymphoma

WHO Classification
Precursor T-Cell Neoplasms
T cell acute lymphoblastic leukemia/ lymphoma
(T-ALL)

WHO Classification
Peripheral T-Cell and NK-Cell Neoplasms
T-cell prolymphocytic leukemia
Large granular lymphocytic leukemia
Mycosis fungoides/Szary syndrome
Peripheral T-cell lymphoma, unspecified
Anaplastic large cell lymphoma
Angioimmunoblastic T-cell lymphoma

WHO Classification
Peripheral T-Cell and NK-Cell Neoplasms
Enteropathy-associated T-cell lymphoma
Panniculitis-like T-cell lymphoma
Hepatosplenic T-cell lymphoma
Adult T-cell leukemia/lymphoma
NK/T-cell lymphoma, nasal type
NK-cell leukemia

WHO Classification
Hodgkin Lymphoma
Classical subtypes

Nodular Sclerosis
Mixed Cellularity
Lymphocyte rich
Lymphocyte depletion

Lymphocyte Predominance

CHRONIC LYMPHOCYTIC
LEUKEMIA/SLL

Definition
Proliferation of small mature B lymphocytes

Clinical Features

Old age, >50 yrs,male

Fatigue
Lymphadenopathy, organomegaly
May have Ab production and auto-immune
hemolytic anemia

Criteria for Diagnosis

Sustained lymphocyte count >4000/c mm
> 30% lymphocytes in bone marrow
Monoclonal B cells

Hematological Findings
Hb
TC- 20,000 to 50,000/c mm
Lymphocytosis >10,000
Smudge cells
Hypercellular marrow

FAB Classification
CLL Prolymphocytes <10%
CLL-PLL Prolymphocytes 11-55%
PLL Prolymphocytes >55%

Immunophenotyping
Cells positive for
Pan B cell Markers CD19 & CD20
CD23
CD5

HAIRY CELL LEUKEMIA

Abnormal mononuclear cells

Hairy cytoplasmic projections
Adults
M>F
Marked splenomegaly

Hematological findings
Pancytopenia
Normocytic anemia
Cells with hair like
cytoplasmic projections
Cells + for TRAP
( Tartrate Resistant Acid
Phosphatase)

Immunophenotyping
Cells positive for
Pan B cell Markers CD19 & CD20
CD11c
CD25
CD103

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