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LYMPHOMALYMPHOMA

dr Putra Hendra SpPDdr Putra Hendra SpPD

UNIBAUNIBA

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 ALL ALL MMMMCLLCLL LymphomasLymphomas

Hematopoietic

stem cell

Neutrophils

Eosinophils

Basophils

Monocytes

Platelets

Red cells

Myeloid

progenitor 

Myeloproliferative disordersMyeloproliferative disorders AML AML

Lymphoid

progenitor  Tlymphocytes

Plasmacells

Blymphocytes

nanaïïveve

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Bone Marrow Aspiration/BiopsyBone Marrow Aspiration/Biopsy

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B-cell developmentB-cell development

stem

cell

lymphoid

progenitor 

progenitorB

preB

immature

Bcell

memory

Bcell

plasma cellplasma cell

DLBCL,

FL, HL

ALL

CLL

MM

germinalgerminal

center center 

BcellBcell

mature

naive

Bcell

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Disease states correlate with stages in normal B-cell development

Diseases:  AML ProBALL PreBALL BCLL!LBCL"LLBLMantle Cell lymphoma

Marginal #one lymphomaMALT$ALTHodg%ins &'(

BALL M$)*

Multiple MyeloPlasmacytoma

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Chronic lymphocytic

leu%emia

*mall lymphocytic lymphoma

+aldenstr,m-s macroglo.ulinemia

"ollicular lymphoma

Bur%itt-s lymphomaMantle /one

lymphoma

*0/ary syndrome

Mycosis fungoides

Peripheral T cell

  lymphoma

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Lymphocytic Leuemia !Lymphocytic Leuemia !

LymphomaLymphoma

LeuemiaLeuemia" widespread in#o$#ement o% BM and" widespread in#o$#ement o% BM and

presence o% $ar&e num'er o% tumor ce$$s inpresence o% $ar&e num'er o% tumor ce$$s in

periphera$ '$oodperiphera$ '$ood

LymphomaLymphoma" $ymphoid pro$i%erations as discrete" $ymphoid pro$i%erations as discrete

tissue massestissue masses

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Lymphoma classifcationLymphoma classifcation(2001 WHO)(2001 WHO)

B(ce$$ neop$asmsB(ce$$ neop$asmsprecursorprecursor

maturemature

 )(ce$$ ! N*(ce$$ neop$asms )(ce$$ ! N*(ce$$ neop$asmsprecursorprecursor

maturemature

Hod&in $ymphomaHod&in $ymphoma

Non

Hodg%inLymphomas

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Lymphomas

Hodg%insNon Hodg%ins

  B Cells Nodular sclerosing 123

  Mi4ed cellularity 562723

T Cells

813 913

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Hod&in DiseaseHod&in Disease

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Hodgkin DiseaseHodgkin Disease

DefnitionDefnitionneoplastic diso!de! "ith development o#neoplastic diso!de! "ith development o#

specifc inflt!ate containing pathologicspecifc inflt!ate containing pathologic

$eed-%te!n&e!g cells$eed-%te!n&e!g cells' t sally a!ises in' t sally a!ises in

lymph nodes and sp!eads to contigoslymph nodes and sp!eads to contigosg!ops' *+t!anodal p!esentation a!e !a!e'g!ops' *+t!anodal p!esentation a!e !a!e'

Disease is associated "ith de#ectiveDisease is associated "ith de#ective

cellla! immnity'cellla! immnity'

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REED-!ER"BER# $ R% CellREED-!ER"BER# $ R% Cell

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Hodgkin DiseaseHodgkin Disease

ncidencencidence

- 2-, cases pe! 100000 poplation yea!- 2-, cases pe! 100000 poplation yea!

- &imodal age dist!i&tion - &imodal age dist!i&tion

1.-/. yea!s and a&ove .0 yea!s1.-/. yea!s and a&ove .0 yea!s

- male p!edominance 1341- male p!edominance 1341

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+pidemio$o&y , Hod&in-s+pidemio$o&y , Hod&in-s

Bimoda$Bimoda$

Postu$atedPostu$ated

to ha#eto ha#ein%ectiousin%ectious

associationassociation

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Classical Hodg&in L'mphoma

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5linical 6!esentation5linical 6!esentation 7ontende! lymph nodes enla!gement ( localised )7ontende! lymph nodes enla!gement ( localised )

neck and sp!aclavicla! a!eaneck and sp!aclavicla! a!ea 80-90:80-90: mediastinal adenopathymediastinal adenopathy .0:.0:

othe! ( a&dominal3 e+t!anodal disease )othe! ( a&dominal3 e+t!anodal disease ) systemic symptoms (B symptoms)systemic symptoms (B symptoms) /0:/0:

#eve!#eve! night s"eatsnight s"eats ne+plained "eight loss (10: pe! 8 months)ne+plained "eight loss (10: pe! 8 months)

6el-*&stein #eve!6el-*&stein #eve!''

!elapsing3 high-g!ade #eve! that can !each 10.-108;3!elapsing3 high-g!ade #eve! that can !each 10.-108;3pe!iodicity o# 4-10 days' eve! spikes a&!pt in onsetpe!iodicity o# 4-10 days' eve! spikes a&!pt in onset

and !esoltionand !esoltion othe! symptomsothe! symptoms

#atige3 "eakness3 p!!its#atige3 "eakness3 p!!its cogh 3 chest pain3 sho!tness o# &!eath3 vena cava synd!omecogh 3 chest pain3 sho!tness o# &!eath3 vena cava synd!ome a&dominal pain3 &o"el dist!&ances3 ascitesa&dominal pain3 &o"el dist!&ances3 ascites &one pain&one pain

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(el-E)stein Fever 

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In#esti&ationsCBPCBP ""

Anemia . normochromic / normocytic0 eosinophi$Anemia . normochromic / normocytic0 eosinophi$

neutrophi$ia0 $ymphopenianeutrophi$ia0 $ymphopenia +S1+S1 22 L3)( .$i#er in4$ / o's at porta hepatisL3)( .$i#er in4$ / o's at porta hepatis13)( prior to treatment13)( prior to treatmentUrate 0 5a0Urate 0 5a0 LDH ( ad#erse pro&nosisLDH ( ad#erse pro&nosisCXR- mediastinal massCXR- mediastinal massCT thorax / abdomen / pelvis-for stagingCT thorax / abdomen / pelvis-for stagingOther: Gallium san! P"T!Other: Gallium san! P"T! Lymphan&io&raphy 0Lymphan&io&raphy 0

LaporotomyLaporotomy +6cisiona$ 'iopsy o% a $ymph node+6cisiona$ 'iopsy o% a $ymph node

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*tage * *tage ** *tage *** *tage *+

%taging o# lymphoma%taging o# lymphoma

A: a.sence of B symptoms

B: fever; night s

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A practica$ way to thin o% $ymphomaA practica$ way to thin o% $ymphoma

Categor' rvival o

ntreated

patients

Cra)ilit' !o treat or

not to treat

"on-Hodg&in

l'mphoma

=ndolent >ears $enerally not

cura.le

Generally defer

Rx if

asymptomatic

 Aggressive Months Cura.le in

some

Treat

?ery

aggressive

+ee%s Cura.le in

some

Treat

Hodg&inl'mphoma

 All types ?aria.le 5months to

years

Cura.le inmost

Treat

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Non Hod&in LymphomaNon Hod&in Lymphoma

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"ormer "irst Lady

@acueline ennedy nassis

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ing Hussein of @ordan

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*mall lymphocytic =mmuno.lastic

Mantle cell Large Cell

Types of NonHodg%in-s Lymphoma

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+tio$o&y o% NHL+tio$o&y o% NHL

Immune suppressionImmune suppressioncon&enita$ .7isott(A$drichcon&enita$ .7isott(A$drich

or&an transp$ant .cyc$osporineor&an transp$ant .cyc$osporine

AIDSAIDS

increasin& a&eincreasin& a&e

DNA repair de%ectsDNA repair de%ectsata6ia te$an&iectasiaata6ia te$an&iectasia

6eroderma pi&mentosum6eroderma pi&mentosum

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+tio$o&y o% NHL+tio$o&y o% NHL

5hronic in8ammation and anti&enic stimu$ation5hronic in8ammation and anti&enic stimu$ation#eliobater p$lori#eliobater p$lori in8ammation0 stomachin8ammation0 stomachChlam$dia psittaiChlam$dia psittai in8ammation0 ocu$ar adne6a$in8ammation0 ocu$ar adne6a$

tissuestissues

S9:&ren-s syndromeS9:&ren-s syndrome;ira$ causes;ira$ causes+B; and Buritt-s $ymphoma+B; and Buritt-s $ymphomaH)L;(I and ) ce$$ $euemia($ymphomaH)L;(I and ) ce$$ $euemia($ymphoma

H)L;(; and cutaneous ) ce$$ $ymphomaH)L;(; and cutaneous ) ce$$ $ymphomaHepatitis 5Hepatitis 5

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Crrent p ront treatment regimens or aggressive l'mphomas

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Regimen Drgs

CH.( Cyclophosphamide; !o4oru.icin; ?incristine; Prednisone

BAC.( Bleomycin; !o4oru.icin; Cyclophosphamide; ?incristineDPrednisone

M-BAC.D Methotre4ate; Leucovorin; Bleomycin; Cyclophosphamide;

?incristine; !e4amethasone

(roMACE/M.(( Prednisone; Methotre4ate; Leucovin; !o4oru.icin;Cyclophosphamide; Etoposide

MAC.(-B Methotre4ate; Leucovorin; !o4oru.icin; Cyclophosphamide;?incristine; Bleomycin; Prednisone; Trimethoprimsulfametho4a/ole

Crrent p-ront treatment regimens or aggressive l'mphomas

&)sed at various doses;

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 )reatment Options in )reatment Options in

Ad#anced Indo$ent LymphomasAd#anced Indo$ent Lymphomas

O'ser#ation on$y" 1itu6an0 Be66ar0

?e#a$in

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 Age  Average age is FGDG

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Mu$tip$e Mye$omaMu$tip$e Mye$oma

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Mu$tip$e Mye$omaMu$tip$e Mye$oma

More than @ p$asma ce$$s in the 'oneMore than @ p$asma ce$$s in the 'one

marrow

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5$inica$ 3eatures5$inica$ 3eatures

Bone marrow %ai$ureBone marrow %ai$ure

( Anemia0 throm'ocytopenia0( Anemia0 throm'ocytopenia0

neutropenianeutropenia

1ena$ %ai$ure1ena$ %ai$ure

Bone disease with se$eta$ destructionBone disease with se$eta$ destruction

$ytic $esions$ytic $esions

&enera$iFed decrease in 'one density&enera$iFed decrease in 'one density

Hyperca$cemiaHyperca$cemia

Di i d St iDi i d St i

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Dia&nosis and Sta&in&Dia&nosis and Sta&in&

7orup7orupBone marrow 'iopsy and aspirateBone marrow 'iopsy and aspirate

SerumSerum protein e$ectrophoresis andprotein e$ectrophoresis and

immuno46ationimmuno46ation

Se$eta$ sur#eySe$eta$ sur#eyP$ain 6(rays are 'etter than 'one scan

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*erum Protein Electrophoresis

 Total protein GDF αF glo.ulin 2D1

 al.umin 7D1 β glo.ulins 2DG α8 glo.ulin 2D81 γ  glo.ulin 8D7

Total protein GDJ αF glo.ulin 2DI

al.umin 6DJ β glo.ulins 2DGα8 glo.ulin 2D8J γ  glo.ulin FD7

Normal Monoclonal *pi%e

  Al)0 1  2  β  γAl)0 1  2  β  γ

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Monoc$ona$ Immuno&$o'u$inMonoc$ona$ Immuno&$o'u$in SpieSpie

on Serum Protein +$ectrophoresison Serum Protein +$ectrophoresis

.SP+P.SP+P Mu$tip$e mye$omaMu$tip$e mye$omaNon(Hod&in-s $ymphomaNon(Hod&in-s $ymphoma

Monoc$ona$ &ammopathy o%Monoc$ona$ &ammopathy o%

undetermined si&ni4cance .MUS

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http:872DF18D1D82FPathologyO=mageshttp: