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Leukemia and Lymphoma

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Hameed Tareen:
ASALAMU ALYKUM!!!!!

Dear i have aproblem in classification of different types of leukemia and lymphoma,and also the different types mix up,can any body help me?

Dr.Habiib:

Lymphoma:

Are common primary malignant neoplasms arising from lymphoreticular tissues.

Classifications of lymphoma:

Basically Lymphoma are classified into:

1. Hodgkin`s lymphoma.
2. Non- Hodgkin`s lymphoma.

Hodgkin`s lymphoma:

It is a common lymphoma occurs any age. It is usually starts in cervical lymph nodes of neck.

Histological classification of Hodgkin`s lymphoma (Rye`s classification):

Rye`s classified Hodgkin`s lymphoma into five subclasses according to predominant cell as following.

a. Nodular lymphocytes predominant type (5%):
  It is characterized by nodes of reactive lymphocyte with their central portion showing (atypical lymphocytes and Histiocytes) with no or few Reed -Sternberg cell (RC cell). Prognosis is good.

b. Lymphocyte rich type (5%):
It is characterized by a diffuse background composed of reactive lymphocytes with many mononuclear Hodgkin`s cells and very rare Reed-Sternberg cell. Good prognosis.

c. Nodular sclerosing type (60%):
It is characterized by numerous lacunar cells in addition to Reed-sternberg cells. There are variable reactive cells. Thick bands of collagen occur and may divide the node into nodules. It has relatively good Prognosis.

d. Mixed cellular type (25%):
It is characterized by numerous of Reed-Sternberg cells and Hodgkin`s mononuclear cells  associated with  a mixture of reactive cells (lymphocytes, plasma cells, neotraphils, histiocytes).
This type is more aggressive the above types.

e. Lymphocyte depletion type (1-5 %):
It is characterized by very numerous Reed-Sternberg cells and Mononuclear Hodgkin`s cells. Lymphocytes are very few. Necrosis and diffuse fibrosis may occur. Prognosis is poor.
NB. Recently there is trend to classify this type in dependent to of Hogdkin`s lymphoma.

Non- Hodgkin`s lymphoma:
Classification of this type is very complicated so be carefully and try to understand step by step.
There is three major classification of non-Hodgkin`s lymphoma as the following.

1. The working formulation classification of Non-Hodgkin`s lymphoma:

According to working formulation lymphoma are classify into: low grade, intermediate grade, high grade.

Low grade:
a. Small lymphocytic consistent with chronic lymphocytic leukemia.
b. Follicular, predominantly small-cleaved cell.
c. Follicular, mixed small-cleaved, and large cell.

Intermediate grade:
a. Follicular: predominantly large cell.
b. Diffuse: small-cleaved cell.
c. Diffuse mixed: small and large cell.
d. Diffuse large cell: cleaved, or noncleaved cell

High grade:
a. Large cell: Immunoblastic.
b. Lymphoblastic lymphoma.
c. Burkitt`s lymphoma.

NB. Nowdays this classification is not popular (does not include many lymphoma types).

2. Kiel classification:

Kiel classified non-hodgkin`s lymphoma into B-cell lymphoma and T-cell lymphoma and each this two into low grade and high grade as following.

a. B cell lymphoma:

Low grade B-cell lymphomas :

-Lymphocytic -chronic lymphocytic and prolymphocytic leukemia -hairy-cell leukemia.
- Lymphoplasmacytic/cytoid (LP immunocytoma).
- Plasmacytic.
- Centroblastic/centrocytic  diffuse.
- Centrocytic.


High grade B-cell lymphomas:
- Centroblastic.
- Immunoblastic.
- Large cell anaplastic.
- Burkitt's lymphoma.
- Lymphoblastic.

b. T-cell lymphoma:

Low grade T-cell lymphoma.
- Lymphocytic -chronic lymphocytic
- Small, cerebriform cell -mycosis fungoides, Sézary's syndrome
- Lymphoepithelioid (Lennert's lymphoma)
- Angioimmunoblastic.
- T-zone lymphocytic.
- Pleomorphicm, small cell.

High grade T-cell lymphomas:
- Pleomorphic, medium and large cell.
- Immunoblastic.
- Large cell anaplastic
- Lymphoblastic.


3. Real / WHO classification of non-Hodgkin`s lymphoma (2001):
This the last updated classification of non-Hodgkin`s lymphoma according to cells arising into:
a. Precursors cell lymphoma:
b. Peripheral B-cell neoplasms:
c. Peripheral T-cell and Natural killer cell neoplasms.


Leukemia:
Is a serious condition of neoplastic proliferation of leucocytes forming tissues (Bone marrow  and lymphoid tissues).

Classification of Leukemia:


1. Acute Leukemia : This type may be a. Myloid type or b. lymphatic type.
2. Chronic Leukemia:  also this may be  a. Myloid type or b. lymphatic type.
3. Rare Types   of leukemia: may be one of the following.
a.Hairy cell leukemia.
b. Histiocytic Leukemia.
c. Stem  cell leukemia.
d. Erythrolekemia (erythromyoblastic leukemia, DiGuglielmo`s disease).
e. Plasma cell leukemia.



Questions:
Hameed tareen  if you  understand  this classification answer this few questions:

Complete the following:

1. Lymphoma are classified into.  a:……………………………………… and b………………………………………..

2. Rye`s classification of Hodgkin`s lymphoma into. A: ……………………..B:………………. C…………………. D:………………………… E:…………………………….

3. Name only two of most common classes of leukemia: a:………………………. B:…………..

4. Non-Hodgkin`es  lymphoma are classified into, so mention three of this classification:
A:……………………………………….. B:……………………………………….  C:………………………………

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