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Lymphoma and Myeloma | Kristine Krafts, M.D.

Lymphoma and Myeloma | Kristine Krafts, M.D. Hematologic Malignancies. Leukemia Malignancy of hematopoietic cells Starts in bone marrow , can spread to blood, nodes Myeloid or lymphoid Acute or chronic Lymphoma Malignancy of hematopoietic cells

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Lymphoma and Myeloma | Kristine Krafts, M.D.

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  1. Lymphoma and Myeloma | Kristine Krafts, M.D.

  2. Hematologic Malignancies Leukemia • Malignancy of hematopoietic cells • Starts in bone marrow, can spread to blood, nodes • Myeloid or lymphoid • Acute or chronic Lymphoma • Malignancy of hematopoietic cells • Starts in lymph nodes, can spread to blood, marrow • Lymphoid only • Hodgkin or non-Hodgkin

  3. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias Lymphomas • Hodgkin lymphoma • Non-Hodgkin lymphoma Plasma cell disorders • Multiple myeloma

  4. Leukemias Hematologic Malignancies • Acute leukemias • Chronic leukemias Lymphomas • Hodgkin lymphoma • Non-Hodgkin lymphoma

  5. Lymphadenopathy

  6. Lymphadenopathy

  7. Causes of lymphadenopathy • Most common cause overall: benign reaction to infection • Most common malignant cause: metastatic carcinoma

  8. Lymph node anatomy

  9. Reactive lymph node

  10. Reactive lymph node

  11. Reactive lymph node

  12. Benign (L) vs. malignant (R)

  13. Non-Hodgkin Lymphoma • Malignant proliferation of lymphoid cells (blasts or mature cells) in lymph nodes • Skips around • Many subtypes • Most are B cell Things you must know

  14. Symptoms of NHL • Painless, firm lymphadenopathy • Extranodal manifestations • “B” symptoms: weight loss, night sweats, fever

  15. NHL presenting as gingival lesion

  16. NHL involving gingiva

  17. NHL presenting as palatal lesion

  18. Older patients Indolent (incurable!) Small, mature cells Non-destructive Children, sometimes Aggressive (curable?) Big, ugly cells Destructive Features of Low-Grade vs. High-Grade NHL Low-grade High-grade

  19. Small lymphocytic lymphoma Malt lymphoma Follicular lymphoma Mycosis fungoides Low-grade Types of NHL High-grade • Large cell lymphoma • Lymphoblastic lymphoma • Burkitt lymphoma

  20. Small Lymphocytic Lymphoma • Small mature lymphocytes • Same thing as CLL • CD5+ • Long course; death from infection Things you must know

  21. Small lymphocytic lymphoma

  22. Small lymphocytic lymphoma

  23. MALT Lymphoma • Occurs in mucosa-associated lymphoid tissue • Associated with Helicobacter pylori • Early on, can be cured with antibiotics Things you must know

  24. MALT lymphoma

  25. MALT lymphoma

  26. Follicular Lymphoma • Follicular pattern (later diffuse) • Small cleaved cell, mixed or large cell • Grade 1, 2, or3 • t(14;18) - IgH and bcl-2 Things you must know

  27. Follicular lymphoma

  28. I II III Follicular lymphoma

  29. Follicular lymphoma

  30. Staging and Prognosis of Follicular Lymphoma Stage I Stage II Stage III Stage IV Single node Two or more nodes on same side of diaphragm Lymph nodes on both sides of the diaphragm Diffuse extranodal involvement 90% 5ys 40% 5ys A = no additional symptoms B = weight loss, night sweats, fever

  31. Mycosis Fungoides/Sézary Syndrome • Skin lesions • Blood involvement • Cerebriform lymphocytes • T-cell immunophenotype Things you must know

  32. Mycosis fungoides/Sézary syndrome

  33. Mycosis fungoides/Sézary syndrome

  34. Mycosis fungoides/Sézary syndrome

  35. Mycosis fungoides/Sézary syndrome

  36. Mycosis fungoides/Sézary syndrome

  37. Mycosis fungoides/Sézary syndrome

  38. Diffuse Large-Cell Lymphoma • Large B cells • Extranodal involvement • Grows rapidly • Bad prognosis Things you must know

  39. Diffuse large-cell lymphoma

  40. Diffuse large-cell lymphoma

  41. Lymphoblastic Lymphoma • Typical patient: teenage male with mediastinal mass • Lymphoblasts in diffuse pattern • Same as ALL* * Which kinds of ALL? Things you must know

  42. T-Lymphoblastic lymphoma

  43. T-cell lymphoblastic lymphoma/T-cell ALL

  44. Burkitt Lymphoma • Children, young adults • Fast-growing • Extranodal mass • Starry-sky pattern Things you must know

  45. Burkitt lymphoma

  46. Burkitt lymphoma

  47. Burkitt lymphoma

  48. Hodgkin Lymphoma • Younger patients, good prognosis • Contiguous spread • Five subtypes • Reed-Sternberg cell Things you must know

  49. Hodgkin lymphoma

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