Lymphoid Leukemias

Disease

Histology: Blood

Smear BMA/ LNB

Age Clinical Features

LABS & Immuno-

histochemistry

Flow Cytometry Cytogenetics Prognosis

General Specific General Specific General Specific

Precursor B&T cell

Neoplasms

Acute Lymphoblasti

c Leukemia (ALL)

Large cells,

heterogeneous

chromatin,

irregular nuclear

shape, and large

nucleolus.

B

Children>

adults

Fever, dyspnea, fatigue,

palpitations,

COMPLICATIONS

Bleeding, recurrent infections

Splenomegaly

Anemia,

Neutropenia,

Thromboc-ytopenia

MPO-ve

TdT+ve

CD-10< T-

cells &

CD-10> B-

cells

Typical

Hyperploidy

t(9,22)

Philadelphia

chr.

Good

T Mediastinal mass Bad

Lymphoblastic Lymphoma

Medium-sized cells ,fine chromatin nuclei are round & nucleoli are inconspicuous.

T Young adults

Lymphadeno-pathy &

mediastinal mass, may compress

SVC.

TdT +ve Elevated

LDH

Typical

Translocations at a & d T-cell

receptor

Depends

on Staging

Peripheral B-cell

neoplasm

Chronic Lymphocytic

Leukemia

Large atypical, cleaved cells are

seen on the smear

Elderly > 60 years

Often asymptomatic

(CLL) Hepatosplenome

galy. (CLL) Lymphadenopat

hy (both)

Spherocytes (CLL)

Lymphocytosis > 3

months (CLL)

Smudge cells.

Also CD-5 +ve , sIg

50% of cases have deletions

of 13q

Mostly benign

Some with deletions in

17p , 11q Bad

Small Lymphocytic Lymphoma

-- Staging

Hairy Cell Leukemia

Dry Tap , BMB reveals Fried-egg

app. ,Hair-like cytoplasmic

projections of cell surface.

Middle- Aged

Marked Splenomegaly

Ass. With autoimmune dis and atypical Inf.

+ TRAP

cyclin D1

protein, sIg

Deletions of 5q

Benign

MYELOID Leukemias

Disease Of

BoneMarrow Type

Histology: BMA

Age Risk

Factors

Clinical Features

LABS & Immuno-

histochemistry

Flow cytometry Cytogenetics Prognosis

General Specific General Specific

Myeloid Neoplasms

Acute Myelogenous

Leukemia (AML)

M3 or (Acute

promyelocytic leukemia) is

MC type. Have numerous intra-cytoplasmic

granules , Called Auer-rods, & >50% blasts on

BMA

Any Age Group,

MC elderly

Alkylating agents,

MDS,

Poly.Vera,

Aplastic Anemia

Fever, dyspnea, fatigue,

palpitations

COMPLICATIONS Bleeding, Recurrent infections

May develop DIC and cells may

infiltrate tissues , graulocytic sarcoma, gingivitis

Anemia,

Neutropenia,

Thromboc-ytopenia

MPO or Sudan

Black +ve Auer-rods

on peripheral

blood smear

Elevated PT

CD-33 +ve

t(15;17) Good

Normal gene Bad

-5, -7 worse

Chronic Myelogenous

Leukemia (CML)

Hypercellular bone with all cell lines

increased in no. due to clonal expansion of pluripotent stem

cells

ionizing radiation

fever, weight loss

COMPLICATION Bleeding,

Massive splenomegaly

Anemia

Variable platelets

Leukocytosis

Decreased LAP

----- t(9;22)

Philadelphia chr.

Depends on

Sokal score

Non Hodgkin Lymphoma (NHL): Lymphomas are tumors originating in the Lymph nodes

Peripheral B-cell neoplasm Peripheral T-cell

Neoplasm

Disease Follicular

Lymphoma

Diffuse Large B-cell Lymphoma

Small non-cleaved

Lymphoma (Burkitt

Lymphoma)

Small cleaved cell Lymphoma (Mantle cell Lymphoma)

Marginal Zone Lymphoma

Lymphoplasmacytic Lymphoma

Cut. T-cell Lymphoma

Mycosis Fungiodes (MC)

Immuno-deficiency associated

Body-cavity

Age Median Age 6th decade , Young adults ( Burkitt)

Histology: Bone Marrow asp.

/Lymph Node asp. or involved site

Well differentiated B-cell neoplasm

with follicular pattern of growth

High-grade Large B-cell neoplasm with diffuse

growth pattern

High grade Intermediate B-cell Neoplasm with starry sky

app.

Malignant B-cells, arising from the mantle zone of Lymph nodes

B-cell neoplasm arise from

Lymphatic tissue of GIT

Small B-lymphocytes showing plasmacytic differentiation

Malignant CD4 T-cell with nuclei that are hyperchromatic and convoluted or

cerebriform.

Clinical Presentations

Peripheral adenopathy (except MALT) , Fever, night sweats, weight loss and weakness , Extra-nodal involvement in High grade lymphomas

Disseminated LN spread

EBV HHV-8

Anorexia, Abdominal

tenderness and abdominal mass

(HIV) & Mandibular or maxillary mass

(EBV)

Generalized lymph-adenopathy

Massive Spleomegaly

Constipation, tarry stools,

dyspnea Ass. With as

Sjogren dis. or H. pylori gastritis

Infiltration of LN spleen (hepatosplenomegaly) and

bonemarrow (HCV)

Generalized pruritic erythematous Rash

(SS) , Pautrier microabscess, May be associated with

HTLV-1

LABS

neutropenia, anemia, thrombocytopenia, Elevated LDH, Hyperuricemia Lymphocytosis (low-grade)

Typical Typical Typical + Lymphocytosis Typical IgM spike , Elevated ESR, Rouleaux formation , BJ

proteins in urine

Peripheral CBC reveal CD4 T-cells AKA Sezary Cells

Cytogenetics

t(14;18) Random t(8;14) t(11;14) t(11;18) Deletions of 6q -----

Flow cytometry

Typical : CD-10< T-cells, CD-10 > B-cells and sIg

Typical

Typical Typical CD 5 also CD 20 mostly Typical Typical

Complications

Spinal cord compression , Superior vena cava (SVC) syndrome , Infection, Bleeding , GI obstruction, perforation (MALT) , visual problems (LL)

Prognosis Depends on Staging