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浙江大学医学院:Approach to the diagnosis of non-Hodgkin's lymphoma

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LYMPHOMA uang Jinwen Hematology Dept. of srrsH

LYMPHOMA Huang Jinwen Hematology Dept. of SRRSH

Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage of the disease WIKIPEDIA 日本語 -百科事典 Deutsch Espanol Die freie Enzykopadle La enciclopedia Abre 198000+Ate Francais PyccKMM M Ceo6odHaR 3HuuKnoneduA 680 000+ eTaTeM Italiano 雒 Portugues Enciclopedia bera 780000+voci 675000+atg Polski Nederlands Wolna encyklopedia De vrye encyclopedie

Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage of the disease

Lymphomas, multiple myeloma world map- Death-WHO2004 no data 36-54 108-126 126-144 than 19.8 er 100.000 inhabitants

Lymphomas, multiple myeloma world map - Death - WHO2004 (per 100,000 inhabitants)

Leukocytes White blood cells w wbc agranular granular mphocytes monocytes basophils neutrophils eosinophils 20-25% 3-8% .5-1%60-70%2-4% Oo@C T-cell. B-cell NK Cell

The Maturation Stage Type of Lymphoma of the Plasma cell of origin Waldenstrom? determines the Macroglobulinemic Diffuse large Activated B Cel B-cell lymphoma Follicular B Cell after antigen exposure Mantle cell B Cell before CLL/SLL Small Immature Non-cleaved B-cell Lymphoma(Burkitt's) Pre-B Cell Precursor B-Cell ymphoid Stem Ce‖ Acute Lymphblastic Lymphoma/Leukemias Pluripotent Chronic Myeloid Stem Cell Leukaemia(CML)

Figure 1. 4: Percentage change in age-specific incidence of NHL from 1975, persons, Great Britain 350—nder25-25-44-45-64-65-74—75+---A 300 250 6200 8 150 100 19751976-1981-1986 1991 1996 2001- 1978 1983 1988 1993 1998 2003 eriod of diagnosis

100 150 200 250 300 350 1975 1976- 1978 1981- 1983 1986- 1988 1991- 1993 1996- 1998 2001- 2003 Period of diagnosis % of 1975 rate under25 25-44 45-64 65-74 75+ All Figure 1.4: Percentage change in age-specific incidence of NHL from 1975, persons, Great Britain

NHL CANCER INCIDENCE 2002 Figure 1.5: Age-standardised incidence and mortality rates for NHL in males by region of the world, 2002 estimates Northern america Australia/New Zealand Western Europe Northern Europe Southern Europe Eastern africa Western asia South america Western africa South-Eastern asia Central america Southern africa Eastern Europe Incidence Middle africa Northern africa ■ Mortality Eastern asia South Central asia 0 5 10 15 20 Rate per 100,000 population

NHL CANCER INCIDENCE 2002 0 5 1 0 1 5 2 0 South Central Asia Eastern Asia Northern Africa Middle Africa Eastern Europe Southern Africa Central America South-Eastern Asia Western Africa South America Western Asia Eastern Africa Southern Europe Northern Europe Western Europe Australia/New Zealand Northern America Rate per 100,000 population Incidence Mortality Figure 1.5: Age-standardised incidence and mortality rates for NHL in males by region of the world, 2002 estimates

WHO Classification of Lymphoma non Hodgkin lymphoma Hodgkin lymphoma mmunodeficiency-associated lymphoproliferative disorders Mature B cell neoplasms Chronic lymphocytic leukemia/Small lymphocy Classical Hodgkin lymphomas Associated with the human Immunodeficiency virus(Hi B-cell prolymphocytic leukemia Nodular sclerosis Post-transplant Lymphoplasmacytic lymphoma(such as Wald. Mixed cellular Splenic marginal zone lymphoma ● Lymphocyte- ricl WHO Classification of Tumours of Plasma cell neoplasms Lymphocyte depl Haematopoietic and Lymphoid Tissues Plasma cell myeloma Nodular lymphocyte-pre Plasmacytoma Edied by steven H sword Monoclonal immunoglobulin deposition diseases Heav chain diseases Extranodal marginal zone B cell lymphoma, also called MALT lymphoma Mature T cell and natural killer(NK) cell neoplasms T cell prolymphocytic leukemia T cell large granular lymphocytic leukemia Aggressive NK cell leukemia Adult T cell leukemiaflymphoma Extranodal Nk/T cell lymphoma, nasal type Enteropathytype T cell lymphoma Hepatosplenic T cell lymphoma 测图 Blastic NK cell lymphoma Mycosis fungoides Sezary syndrome Primary cutaneous CD30-positive T cell lymphoproliferative disorders Primary cutaneous anaplastic large cell lymphoma Lymphomatoid papulosis Angioimmunoblastic T cell lymphoma Peripheral T cell lymphoma, unspecified Anaplastic large cell lymphoma WHO

WHO Classification of Lymphoma non Hodgkin lymphoma

What should we do when we meet a patient with suspected non-Hodgkin s lymphoma

What should we do ? when we meet a patient with suspected non-Hodgkin’s lymphoma

PAST HISTORY a personal or family history malignancy, radiation therapy immunosuppressive agents, chemotherapy, organ transplantation,etc. Relevant infectious illnesses HⅣl HTLV-1 Epstein-Barr virus(EBv) hepatitis C Pyothorax-associated lymphoma Connective tissue diseases, immunodeficiency disorders etc Agricultural to pesticides and Agent Orange

PAST HISTORY • A personal or family history • Relevant infectious illnesses • Connective tissue diseases, immunodeficiency disorders etc. • Agricultural to pesticides and Agent Orange malignancy, radiation therapy, immunosuppressive agents, chemotherapy, organ transplantation,etc. HIV-I, HTLV-I, Epstein-Barr virus (EBV), hepatitis C virus, Pyothorax-associated lymphoma

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