Done By : : Muntaha Al-khazalleh & nayef hashem. Corrected by: nisreen obeidat & sara alzoubi

Transcription

1 Done By : : Muntaha Al-khazalleh & nayef hashem Corrected by: nisreen obeidat & sara alzoubi

2 1- B cell lymphoma بسم رلاهللا ** الدظح : اى ذاظشج طي تح فقػ سال ذاخ + ششح اىذمر س )تذ مراب( تشنو ػا ػ ا ذقس ىو Lymphoma 2- T cell or NK cell lymphoma ( T cell lymphoma ادذ ا اع اه NK cell lymphoma ) 3- Hodgkin lymphoma ( B cell origin 1- Hodgkin lymphoma (HL) اىرقس اال ه : اىرقس اىثا : ( ػي اىشغ ا ا ذؼ د ه 2- Non-Hodgkin lymphoma (NHL) include B cell and T cell lymphoma The first 3 types, their names consist of two parts leukemia & lymphoma Why!? Because the patients usually come suffering from both together ; in another cases lymphoma alone or leukemia alone. Types (1-8) : non Hodgkin lymphoma Type 9 : Hodgkin lymphoma : its origin is B cell but it differs clinically and in features so it wasn't included with them Lymphoma (1) Precursor B cell leukemia/lymphoma (B-ALL) As the name indicates: It can present as lymphoma or leukemia Leukemia: bone marrow involvement then peripheral blood picture Lymphoma: solid masses or growths in different places ( lymph nodes ; spleen ; GI ;thyroid) ; can be found in any organ has malignant lymphocytic tumor Mostly presents as leukemia (Acute lymphoblastic leukemia, ALL) Peaks in 3 year old children )young children( Much more common than precursor T cell leukemia/lymphoma 85% precursor B-ALL / 15% precursor T-ALL

3 (2) Precursor T cell leukemia/lymphoma (T-ALL) As the name indicates: It can present as lymphoma or leukemia Mostly present as thymic lymphoma We're talking about precursor T cells = immature T cells ; which are located in the thymus; so it favors the thymus Peaks in adolescent males ((B-ALL & T-ALL in general)) Both can present as leukemia or lymphoma The most common cancer in children, especially younger than 15 years Males more / Whites more / Hispanics more TDT : transcription factor and immunomarker for T&B precursors ( T-ALL & B-ALL are positive to it ), the mature form of B&T are negative to it.. )The most common cancer in pediatrics (children) is leukemia (non solid) تس ى تذ ا ؼضه اه solid ىذاى children) (the most common solid tumor in ت ص ش ذن ػ اش اء ثا ح ( neuroblastoma...tumors brain اىخ ) تس تشنو ػا تنو اهmalignant the most common cancer < <-- ع ه اى ػ ( B-ALL ) mainly. *هاي blood film صا ر ف ها.. leukemia ف عنا.. blasts بس هون هم lymphoblasts اخذناهم بال. AML مش myeloblasts ال اذا هاي الصورة عبارة عن ALL وممكن كالهما T-ALL و B-ALL عملولنا ا اها

4 As a leukemia: It must be differentiated from AML (Blasts of both may be indistinguishable) flow cytometry of peripheral blood or marrow aspirate Flow cytometry is somewhat like immunohistochemistry but on fluids peripheral ا ش ف اه ف ا ت نرف myeloblasts اه lymphoblasts اه ض ت صؼة اىر ا ا *اد ىن immunohistochemistry اه ص ت ؼ و اش.. ALL ا AML ى ذذد ا اض blasts ا ي blood bone marrow aspirate ا blood peripheral ة (ت ج cytometry flow ت س.. fluids ىو ) ػ ا ت ذذد اىذاىح اى cytometer flow ت ذط تج اص اس ) ش cytology) تن.. fluid شنو سذة خاع اىؼظ ػي bone marrow aspirate *اه.bone marrow biopsy اه ) ص section(histology)) Clinically* neutropenia(will predispose the patient to infections) & thrombocytopenia (Will predispose the patient to bleeding) & anemia WBC count: > but in 50%: <10000 (aleukemic leukemia) هم )lymphocytes مثال وال neutrophils ) ولكنهم غ ر طب ع ن (مش صح انه بكون عددهم كب ر (فوق ال WBCs *ال. ) (عالفاض عن lymphoblasts عبارة عن اىذاىح تن ت ا ش اى شظ ذ ػذد مث صا WBCs ط ا اه اى ش ىن ا ش ظا شج ػي ALL )Aleukemic leukemia)* ػ ذ تن اى ع ه اه %01 ا امثش ال فؼي patients leukemia ىن WBCs و اه ػ ذ ذؼذاد قي blasts TdT ف ت ؼ و اه اىذمر س ا سأه سؤاه ا م ف ا ت سرخذ nucleus ج ا اه ساح الق ؼ transcription factor TdT ال اه immunohistochemistry *ت سرخذ )CD ا ى اش (ا CDs ح ( ثو اه اىخاسج antigens ح ا ا تر فغ ىو اىذاخي antigens أل ا ا تر فغ ىو cytometry flow اه ) ح سطخ اىخي ػي antigens ػثاسج ػ inside antigens such as TDT >>> inside the nucleus >>>Immunohistochemistry as CD s outside antigens such >>> cytometry Flow

5 (3) Chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) (precursor( ش ص ا ه ػ mature B cell neoplasm ؼ اهtumor ترن mature B cells ص اى م ا ش ف تاه inflammation chronic ثال )B lymphocytes صغاس ال اهB cells مو ا صاسخ mature ترص ش اصغش( As the name indicates: It can present as lymphoma or leukemia If the peripheral blood lymphocyte count reaches 5000, it is called CLL the most common leukemia of adults in the Western world but SLL is not a common lymphoma CLL/SLL is an indolent, slowly growing tumor indolent ؼ )بتضلها اه not behavior curable تط ئبطيئ )تسر ش )بستمر ىس اخ(.. لسنوات( ىن ا.. ت فس لكنهااى قد بنفس الوقت behavior not curable )ترعي ا يعني ال ذسر يل تاى ش ط( indolent ؼ اد ا تستهلك ت ؼط بالمريض( اىؼالج يعني ت ذف احنا اىرخف ف بنعطيػ العالج اى ش ط بهدف تسالتخفيف عن المريض بس In addition to the lymph nodes(generalized lymphadenopath), the bone marrow, spleen, and liver are involved in almost all cases(cll&sll at the same time) Absolute lymphocytosis in peripheral blood in most patients with smudge (فعل ا وجد ز ادة عدد ة ف ال cell (lymphocyte SMUDGE CELL : ؼ ص خال ا س دح ) فش دج( تاه blood film ا اىخال ا ػشظح ا ا ذؼ و )artifact( اىخال ا ص مأ صا ش ف ا )ذطيغ smudging Immunophenotype: -CD20 (as a mature B cell tumor) -CD5 (CLL/SLL & mantle cell lymphoma are the only B cell neoplasms that express CD5) ذزمش ا دائ ا ا اه CD20 ىو B cells تاىرذذ ذ ىو cells mature B ) ؼ اهmature B cell lymphomas تذث ا ج ا +CD20.. ا ا ثال اه cell lymphoma precursor B )ا ه ع دن ا ػ ( ا تن +CD20.. اك ت ا اهTdT ص ا دن ا( *ترن +CD5.. غ ا اهCD5 ش marker B cell ػي اىؼنس ىو T cells تس اىغش ة ا ف ػ اه lymphomas B cell تذث ا خز ا CD5 اى CD5 اش تاىرشخ ص فارا امرشف ا ا اىخال ا اخزج CD20 ) اض Mantle cell lymphoma SL ت شل ت ع ه اى ػ (

6 A small fraction of tumors transform to aggressive tumors resembling diffuse large B cell lymphoma (Richter transformation); after transformation occurs, the median survival is less than 1 year SLL* تمتاز بانها لد تتحول الى نوع اخر اسوأ lymphoma( )diffuse large B cell وهو عد aggressive مش indolent زي ال.. SLL بنسم هذا التحول transformation Richter وهو مهم جدا النه م زة لل SLL ) عن بكون مر ض SLL فجأة بص ر وضعه اسوأ النه صار عنده هذا التحول من SLL الى )DLBCL ف حاالت ال Lymphoma ا ش بنشوف ف ال lymph node?? * سا اهlymph node تاىشنو اىطث ؼ اى اخز ا تاه histology اى ترذر ػي paracortex cortex follicles lymphoid medulla ع ه اهfollicles ن ن primary ا.. secondary اه ىوlymph اىخ ت ا اىذاىح اهarchitecture.. centers germinal تن ج اذ secondary follicles node ت س preserved architecture ؼ ذافع ػي )غث ؼ (. ا ا ف داالخ اه lymphoma ا ضج ف ا ا ى ا ش ف اهlymph nodes ت ش ف effaced architecture ؼ disturbed( )architecture ؼ تطو اهarchitecture اىطث ؼ اى ت ؼشف صاسخ اىخال ا ػثاسج ػ sheets فش د )ترثطو اىرقس اخ اى ت ؼشف ا تاىشنو اىطث ؼ ظا شج(

7 ف ص ا اد ا شا ف تاىص سج اال ى تطيد اه lymph node تشني ا اىطث ؼ اى ت ؼشف صاسخ ػثاسج ػ cells sheet of )مو ا اى قػ اىصغ شج خال ا(.. اس ا lymphocytic lymphoma small ؼ ػ ا small mature cells ػشا ل اى قػ اى تاىص سج )اىخال ا( صغ شج. * سا تاىص سج اىثا ح ى ذطيؼ ا ػاىخال ا ػ قشب اهchromatin ذثؼ ش غث ؼ ) ش ص اهlymphocytes اى ت ؼشف ( تن اى soccer ball appearance )ص اىخي ح اى ػي ا ج ح تاىص سج( ؼ اهnuclei ذثؼر ترشث مشج اىقذ. ن رفشق ت خال ا امثش دج ا ( ص اىخي ح اى ػي ا اىس ( ا اىخال ا االمثش دج ا ترن.. prolymphocytes Immunoblasts ذ راص اهSLL ا ى ا رطيغ ػاهlymph node ر اجذ ف ا تؼط اال ام ترن فاذذح ) ؼ صخ ا ػ ا architecture effaced ت ش ف اهlymph node تؼ ذ ى ا اصسق ص اىص سج اال ى تس ل ف تؼط اال ام ترن فاذذح )vague ت س ا proliferation centers ) ش اظذح ػ ا تاىص سج اال ى دن اىذمر س( ا اال ام تن رشام ف ا ا اىخال ا اىنث شج. ؼشف ا ف اش اس proliferation centers تن تاهSLL ال ع ه ت ض ى ا اهSLL ػ اهMantle, lymphoma cell فأد ا ا تخريػ ػي اهpathologist ا ػي اىطث ة ى ا رطيغ ػاه microscope ا اى شاف lymphoma Mantle cell ال.. SLL ف اهhints اى ترخي رج ذ اه centers ج د ا اهproliferation SLL *************************************************************** (4) Follicular lymphoma (FL) B-CELL NEOPLASM 40% of the adult NHLs (non-hodgkin lymphomas) in the United States * زا ال ؼ ا ا the most common B cell lymphoma تاه adults أل اض ػي سر اه USA فقػ.. تشنو ػا DLBCL lymphoma in adults is Hodgkin-common non the most )ساح ذن ػ ا ىقذا ( As CLL/SLL, less common in Asia Greater than 85% of follicular lymphomas have a characteristic (14;18) translocation that fuses the BCL2 gene on chromosome 18 to the IgH locus on chromosome 1 *اه BCL2 شاغ anti-apoptotic ؼ ارا صاد شاغ تخي اىخي ح تر ذش.. ف ت اض اهtranslocation تص ش اهBCL2 تاىخي ح overactive )تض ذ شاغ مث ش(. FL, Clinical notes Mainly occurs in adults older than 50 years of age and affects males and females equally

8 Usually manifests as painless, generalized lymphadenopathy The bone marrow is involved at diagnosis in approximately 80% of cases ن ػ ا اىذاالخ) تس ش ىذسجح ا %01 (ب involved تن marrow bone * صخ ا اه bone marrow تاه tumor ت الق ؼ تس ا.. leukemia In about 30% to 40% of patients, follicular lymphoma progresses to diffuse large B cell lymphoma وهذا الشيء سيء Although the Natural history is prolonged (overall median survival, approximately) 10 years), follicular lymphoma is not curable not curable عا ا node lymph ذ تنو و در ترسرغشق قد غ indolent ذؼذ CLL اه ص * centrocyte centroblast Morphology,FL CD20 CD10 BCL6. : A الصورة lymph جوا ال follicles عن بتعمل follicular lymphoma من اسمها الطب ع ن follicles مش نفس ال follicles بس هضول ال.. node هاي ال.. ) الطب ع ة node lymph ال كانوا بال secondary و primary( عن طر ك architecture لل effacement بتعمل lymphoma follicular. ال بتعملها follicles هاي ال (5) Mantle cell lymphoma (MCL) Mainly in men older than 50 : B اىص سج : ا اىخال ت ش ف ػ follicle ى ا رطيغ ج ا اه cleaved شج اه ا اه صغ اىخال ا : Centrocytes ا اس خال. ) داخو ه ج ا ش nucleus ذاع اه membrane (اه ش تن ػ ذ ا دج ا مث ا اى اىخال : Centroblasts ا اس خال ن ا ا nucleoli تذث ا ع ه اه nucleus تاه nucleoli multiple nuclear تاه ( يضق membrane nuclear اذصاه غ اه ػي. )membrane *مو ا صادخ سثح اه Centroblasts اه behavior تن اس أ

9 Mantle cell lymphoma (MCL) Mainly in men older than 50 years of age. Almost all tumors have an (11;14) translocation that fuses the cyclin D1 gene to the IgH locus ها* D1 cyclin تؼ و proliferation )تخي اىخي ح ذ ش تاه )cell cycle ت اض اهtranslocation تض ذ شاغ )تص ش overactive ؼ تص شى )over expression ا ؤد اى زا اى ع اه lymphoma Positive for CD20, CD5 & cyclin-d1 *ص ا دن ا قثو ا اه SLL اه MCL اى ػ اى د ذ اه lymphomas B cell اى ت خز ا.. CD5 )تاالظافح اى ا ت خز ا CD20 غثؼا م )B.. neoplasms cell mature ت ض ت ا MCL ترن - D1-cyclin ترن ت ا اهSLL + D1-cyclin Most patients present with fatigue and lymphadenopathy and are found to have generalized disease involving the bone marrow, spleen, liver, and (often) the gastrointestinal tract MORPHOLOGY -Diffuse or vaguely nodular pattern -Proliferation centers are absent تاه lymph node ن ذ ج ػي شنو nodules ن ذن effacement diffuse The bone marrow is involved in most cases and the peripheral blood in about 20% of cases The tumor sometimes arises in the gastrointestinal tract, often manifesting as multifocal submucosal nodules that grossly resemble polyps (lymphomatoid polyposis) * اه MCL قذ ذأذ ػي شنو polyps تاه GIT ىن ش lymphoma adenomas تررس ت ا اىذاىح polyposis lymphomatoid These tumors are moderately aggressive and incurable. The median survival is 4 to 6 years. * اهMCL ترن aggressive moderately ؼ اس أ اه SLL اه follicular lymphoma اى ما ا.. indolent ىن ا ا عا not curable ص

10 (6) Extranodal marginal zone lymphoma Extranodal marginal zone lymphoma is an example of a cancer that arises within and is sustained by chronic inflammation It tends to develop within tissues that are involved by chronic inflammation triggered by autoimmune disorders (such as the salivary gland in Sjögren syndrome and the thyroid gland in Hashimoto thyroiditis) or that are the sites of chronic infection (such as H. pylori gastritis) ال marginal zone lymphoma ف منها 3 انواع : 1- Splenic marginal zone lymphoma 2- Nodal marginal zone lymphoma ( in lymph nodes ) )وهاض النوع ال بدنا نحك عنه) -3 Extranodal marginal zone lymphoma *م زتها انها تعد مثال لوي على cancer ممكن ج بسبب.. inflammation ال inflammation ك pathogenesis )ك pathologic (process ال ؤدي الى cancer لكن ف بعض االورام بت ج على chronic انو وجود predisposing disease عن عبارة عن.. chronic inflammation mucosaassociated lymphoid tissue lymphoma (MALToma) inflammation ف نس ج عرضه انه تحول ف ما بعد الى.. cancer واهم مثال هو ال ال هو عبارة عن extranodal marginal zone lymphoma بالمعدة.. سببه H.pylori الت لد تسبب chronic inflammation لدرجة لد تؤدي الى حدوث MALToma *والغر ب بال MALToma انه عالج ال H.pylori عالجها )مع انها )lymphoma.. بس هذا االش فمط اذا كانت محدودة داخل المعدة وما تمدمت وانتشرت بالجسم وصار الوضع اسوأ. *امثلة اخرى مهمة على.. extranodal marginal zone lymphoma انها بت ج بانسجة مصابة ب autoimmune diseases ت حدث ف ها التهابات مزمنة inflammations( )chronic بشكل مستدام.. ومن االمثلة على هذا االش : 1- Hashimoto thyroiditis : Thyroid بسبب مرض ذات المناعة اسمه..Hashimoto وممكن هاي الحالة تعرض المر ض انه تحول وهو التهاب مزمن ف ال gland الوضع عنده ف ما بعد الىlymphoma Extranodal marginal zone 2- Sjögren syndrome : مرض ذات.. salivary gland حدث التهابات مزمنة بشكل طو ل ومستدام بال salivary gland لد تؤدي الى المناعة ص ب ال extranodal marginal zone lymphoma ف ها.

11 (7) Diffuse large B cell lymphoma (DLBCL) The most common type of lymphoma in adults, accounting for approximately 35% of adult NHLs Aggressive, but somehow: curable! الل حك نا عنها لبل incurable عن هون ممكن روح المرض لفترات طو لة بالعالج على عكس االنواع ال The median age at presentation is about 60 years One-third of diffuse large B cell lymphomas have rearrangements of the BCL6 gene and an even higher fraction of tumors have activating point mutations in the BCL6 promoter double-hit lymphoma ولتها تسمى.. او بكون واحد مضروب وبعد فترة بنضرب الثان.. ج نات بنفس الولت 3 من هضول ال 0 *اح انا بنضرب single-hit lymphoma من ال behavior الخ ) وه بتكون اسوأ.. BCL6 و BCL2 او اذا انضرب MYC و BCL6 (مثال اذا انضرب Another 30% of tumors have a (14;18) translocation involving the BCL2 gene that results in over expression of BCL2 protein BCL2 over activity بص ر عنا.. IgH مع BCL2 ال هو follicular ( زي تاع ال 14;18) The remaining tumors have other diverse driver mutations, such as translocations involving the MYC gene The neoplastic B cells are large (at least three to four times the size of resting lymphocytes) ()mature B cell lymphoma )اك د (كونها -CD20-positive

12 * ال DLBCL ف منها اصناف واشكال ( هم مش انواع ال DLBCL لكنهم ه ن اصناف مم زة ) وهم مش بالضرورة انه كونو common *هذا الشكل بحب ج بال immunocompromis patients مثل مرضى ال.. elderly وال. AIDS والل عامل ن ( transplantation كونهم بوخذوا immunosuppressive ) therapy *اسمه primary mediastinal lymphoma بحب ج بال mediastinum عند ال.. women وبحب نتشر لل abdominal viscera وال CNS *هذا الشكل بحب ج associated with KSHV(HHV-8) اسمه الثان primary effusion.. lymphoma بحب ج بال pleural cavity او بال peritoneal cavity ك effusion )فجأة المر ض بص ر عنده pleural..effusion بالوالع ف lymphoma صا رة هنان( *سبك وحك نا عن KSHV انه بعمل بروت نات تؤدي الى تكاثر سرطان بالخال ا.. مثل اش بشتغل شغل ال.. cyclin D1 وبهذه الطر مة ال KSHV بسبب ال primary effusion lymphoma )او بسبب Kaposi sarcoma زي ما حك نا لبل(

13 Patients typically present with a rapidly enlarging, often symptomatic mass at one or several sites Extranodal presentations are common. The gastrointestinal tract is the most common extranodal site ولكن مش spleen و liver و bone marrow )ما بتحب ت ج ف هم(.. بالعادة other sites مثل ال GIT )وه )the most common site وممكن مثال ت ج بال gum )اللثة(.. طبعا ال extranodal nodal ه اصال already عن )lymph nodes( وه اصال موجودة كمان باماكن ثان ة presentations كمان. Unlike the more indolent lymphomas (e.g., follicular lymphoma), involvement of the liver, spleen, and bone marrow is not common at diagnosis (8) Burkett lymphoma (b-cell neoplasm) Endemic in parts of Africa and occurs sporadically in other geographic areas Translocations involving the MYC gene on chromosome 8 that result in over expression of the MYC transcription factor... Most translocations fuse MYC with the IgH gene on chromosome 14 In most endemic cases and about 20% of sporadic cases, the tumor cells are latently infected with EBV

14 ال Burkett lymphoma نادرا ما تشخصها ب lymph node بل ه.. extranodal بتشخصها مثال بال jaw ف حالة افر م ا بتكون الحاالت عاملة الtumor endemic عالعظم )الل هنان بافر م ا( و بالjaw )عال %01 من maxilla الحاالت او عال )mandible sporadic )الل مش بافر م ا( بتكون EBV مع associated mainly children and young adults usually extranodal Endemic tumors often manifest as maxillary or mandibular masses, whereas abdominal tumors involving the bowel, retroperitoneum, and ovaries are more common in North America Leukemic presentations sometimes occur and must be distinguished from ممكن تعمل اش شبه ال.. ALL وطبعا الزم نم زه عن ال ALL النه هاي عالجها ختلف. ALL, which treated with different drug regimens Positive for CD20, CD10 and BCL6 وهاي الخال ا بتمتاز بانها germinal center markers بنسم هم و CD10 BCL6.. ال Burkett lymphoma بتطلع من ال B cells ال كان اصلهم بال germinal centers وال CD10 لل BCL6 positive Burkett lymphoma Lymphocytes Tiangble body *هاي الصورة بسموها starry sky appearance )السماء المل ئة بالنجوم(.. كل هاي الخال ا الصغ رة الل لونها ازرق ه ال malignant cells ال عامل ن ال.. Burkett lymphoma والخال ا ال عامل ن زي النجوم )الل لونهم فاتح( هم tiangible body macrophages *ال tiangble body macrophages بتكون اصال موجودة بشكل طب ع بال thymus وبال germinal centers الل بال.. lymph nodes وه بتبتلع الخال ا ال بص رلها apoptosis وبتموت اثناء تكاثرها بشكل كب ر)اثناء الturnover لهاي الخال ا( *الlymphoma Burkett متاز بكثرة هاي tiangble body macrophages النه ال Burkett lymphoma نموا ف جسم االنسان macrophages هو الورم االسرع.. ف كث ر من الخال ا المكونة لهاض الورم بص رلها apoptosis وبتموت وبتبلعها هاي ال tiangble body

15 هذا النوع عود الى b-cell origin ولكن لها مم زات خاصة ف ها (HL) (9) Hodgkin lymphoma -A distinctive group of neoplasms that are characterized by the presence of a tumor giant cell, the RS (Reed-Sternberg) cell -Unlike most NHLs, Hodgkin lymphomas arise in a single lymph node or chain of lymph nodes and typically spread in a stepwise fashion to anatomically contiguous nodes هذه الصورة مم زة لل Hodgkin lymphoma ^Owl eye appearance^ هذا وصف للخل ة الت تسمى cell) Reed-Sternberg cell (RS وه الخل ه المم زه لل HL )االساس ف نشخ ص ال )HL RS cell تمتاز بانها Giant cell كب رة الحجم, بالعادة بت ج multinucleated والمظهر ال typical هو ال binucleated مثل الصوره, االنو ة الب ضاء وما ب نهم الس توبالزم وداخل النواه نفسها عنا inclusion like nucleolus كب ره جدا وتسمى nucleolus (eisinophilic) عن وكأنها جسم متواجد داخل النواه, اح انا بص ر عنا veriant مثال ممكن ت ج اكثر من نوات ن او ان الس توبالزم كاشش على بعضه وصا ر حول ه فجوةclear واسمه ف هاي الحاله retraction lacunar variant of RS cell الل هو )artifact) ** من اهم مم زات هذا النوع من االورام : -0 كل الخال ا ف background عبارة عن reactive cells (benign (lymphocyte / neutrophil,.)) اما الخال ا) malignant )RS cell& Hodgkin cell بتكون scattered متفرلة عن بعضها البعض. 0- ) clinically )تبدأ من lymph node مع نة وبتمش ع نفس السلسلة المتعلمه بها وعاالغلب بتكون بمنطمة ال, neck اما االنواع السابمه بتكون generalized lymphadenopathy عنا 5 انواع من HL اول 4 عبارة عن Classical types والخامس. non classical Positive for CD15 &CD 30 + negative for LCA (CD45) & CD20 خال ا ال classical بتم زا بانهم النوع الخامس non classical بكون العكس positive for LCA & CD20 + Negative for CD15 & CD30 عن مثل كل انواع ال LYMPHOMA الل حك نا عنهم من لبل

16 HL, 5 subtypes (1) Nodular sclerosis (2) Mixed cellularity (3) Lymphocyte rich RS and Hodgkin cells are positive for CD15 and CD30 and negative for CD45 (the leukocyte common antigen (LCA)) or B or T cell antigens (4) Lymphocyte depletion (5) Lymphocyte predominant (non-classical) Have popcorn cells not RS cell HL, nodular sclerosis type have lacunar RS Cell -The most common HL -Equally frequent in men and in women -Striking propensity to involve the lower cervical, supraclavicular, and mediastinal lymph nodes -Most patients are adolescents or young adults Sclerosis mean that we found thickened collagen(septa) inside the tumor HL, mixed cellularity type -The most common HL in patients over 50 years -This subtype is more likely to be disseminated and to be associated with يعد اسوأ من النوع االولsubtype systemic manifestations than the nodular sclerosis -70% are associated with EBV

17 كل ما كانوا الخال ا ال background اكثر بكون الورم سلوكة افضل النهم عبارة عن benign cells عن ال lymphocyte depletion type اافضل سلوكا من lymphocyte rich type Better Wildeyer ring هو الtissue lymphoid الموجود ف منطمة ال tonsils مشان ه ن اذا اجا مر ض عنده.DLBCL ع االغلب بتكون HL المفروض نستبعد انها عبارة عن tonsils ال lymphomaف ه ثالث اعراض مم زه لل LYMPHOMA وه عباره عن : 1- FEVER 2- WEIGHT LOSS 3- NIGHT SWEET (also in TB) T-cell ال fungus ب وح انه الها دخل بال Mycosisاالسم fungoides لكن ه اش منفصل تماما عنها وه عباره عن lymphoma involving the skin, لما تنتشر وتص ر ع مستوى الجسم كله بص ر اسمها Sezary syndrome Lymphoma (LCA + & Cytokeratin -) Carcinoma ( LCA - & Cytokeratin +)