Chapter 105. Malignancies of Lymphoid Cells (Part 2)

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Non-Hodgkin's lymphomas were separated from Hodgkin's disease by recognition of the Sternberg-Reed cells early in the twentieth century. The histologic classification for non-Hodgkin's lymphomas has been one of the most contentious issues in oncology. Imperfect morphologic systems were supplanted by imperfect immunologic systems, and poor reproducibility of diagnosis has hampered progress. In 1999, the World Health Organization (WHO) classification of lymphoid malignancies was devised through a process of consensus development among international leaders in hematopathology and clinical oncology. The WHO classification takes into account morphologic, clinical, immunologic, and genetic information and attempts to divide non-Hodgkin's lymphomas and other lymphoid malignancies...

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Chapter 105. Malignancies of Lymphoid Cells (Part 2) Non-Hodgkin's lymphomas were separated from Hodgkin's disease by recognition of the Sternberg-Reed cells early in the twentieth century. The histologic classification for non-Hodgkin's lymphomas has been one of the most contentious issues in oncology. Imperfect morphologic systems were supplanted by imperfect immunologic systems, and poor reproducibility of diagnosis has hampered progress. In 1999, the World Health Organization (WHO) classification of lymphoid malignancies was devised through a process of consensus development among international leaders in hematopathology and clinical oncology. The WHO classification takes into account morphologic, clinical, immunologic, and genetic information and attempts to divide non-Hodgkin's
lymphomas and other lymphoid malignancies into clinical/pathologic entities that have clinical and therapeutic relevance. This system is presented in Table 105-3. This system is clinically relevant and has a higher degree of diagnostic accuracy than those used previously. The possibilities for subdividing lymphoid malignancies are extensive. However, Table 105-3 presents in bold those malignancies that occur in at least 1% of patients. Specific lymphoma subtypes will be dealt with in more detail below. Lymphomas associated with HIV infection are discussed in Chap. 182. Table 105-3 WHO Classification of Lymphoid Malignancies B Cell T Cell Hodgkin's Disease Precursor B cell Precursor T cell Nodular neoplasm neoplasm lymphocyte- predominant Hodgkin's disease Precursor B Precursor T lymphoblastic lymphoblastic
leukemia/lymphoma lymphoma/leukemia (precursor B cell acute (precursor T cell acute lymphoblastic leukemia) lymphoblastic leukemia) Mature (peripheral) B Mature (peripheral) T Classical cell neoplasms cell neoplasms Hodgkin's disease B cell chronic T cell prolymphocytic Nodular lymphocytic leukemia sclerosis Hodgkin's leukemia/small disease lymphocytic lymphoma B cell T cell granular Lymphocyte- prolymphocytic leukemia lymphocytic leukemia rich classic Hodgkin's disease Lymphoplasmacytic Aggressive NK cell Mixed- lymphoma leukemia cellularity Hodgkin's disease Splenic marginal Adult T cell Lymphocyte-
zone B cell lymphoma (± lymphoma/leukemia (HTLV- depletion Hodgkin's villous lymphocytes) I+) disease Hairy cell leukemia Extranodal NK/T cell lymphoma, nasal type Plasma cell Enteropathy-type T myeloma/plasmacytoma cell lymphoma Extranodal Hepatosplenic γd T marginal zone B cell cell lymphoma lymphoma of MALT type Mantle cell Subcutaneous lymphoma panniculitis-like T cell lymphoma Follicular Mycosis lymphoma fungoides/Sézary syndrome Nodal marginal zone Anaplastic large cell
B cell lymphoma (± lymphoma, primary cutaneous monocytoid B cells) type Diffuse large B cell Peripheral T cell lymphoma lymphoma, not otherwise specified (NOS) Burkitt's Angioimmunoblastic lymphoma/Burkitt cell T cell lymphoma leukemia Anaplastic large cell lymphoma, primary systemic type Note: HTLV, human T cell lymphotropic virus; MALT, mucosa-associated lymphoid tissue; NK, natural killer; WHO, World Health Organization. Malignancies in bold occur in at least 1% of patients. Source: Adapted from Harris et al.