【内科PPT课件】 淋巴瘤

➢ Two categories:
➢ Hodgkin’s lymphoma (HL)
±15%
➢ non-Hodgikin’s lymphoma (NHL) 80-90%
2015-9-15
淋巴瘤的发生
罗京
高仓健 李开复
Incidence
➢ Male: 1.39/100,000；Female:
0.84/100,000 ➢ NHL increasing over time ➢ HD stable during the years
➢ 在常见肿瘤中分别占第9(男性),第10(女性) ➢ 发达国家：12-15/10万；中国：1.6-2.1/10
万 ➢ 淋巴瘤在欧美国家占恶性肿瘤死亡的第6位，
我国位于第10位。 ➢ 每年发病率平均增加4％,增长最迅速的恶性
肿瘤
Thomas Hodgkin (1798-1866)
新发PET-CT
PET-CT
Diagnosis
The diagnosis is usually established by biopsy，the
histopathological classification * Need enough tissue to assess cells & architecture Imprint of the biopsy of lymph node, smear from aspirated material, imprint of the skin lesion could aid to make the diagnosis Staging Procedures ➢ Symptoms and Signs ➢ Chest X-ray film ➢ CT scan: chest and abdomen ➢ BM examination ➢ Blood biochemistry study ➢ Biopsy: lymph nodes and other organs
Infiltration of tissues surrounding the capsule by the tumor cells; Damage of capsule and the subcapsular sinuses.
正常的淋巴结直径约1mm,淋巴窦 是确定淋巴结最可靠的结构 T区：副皮质区+滤泡间区; B区：淋巴滤泡
病史：发热、盗汗及体重减低；淋巴结肿大；组织器官侵润 实验室: 血液ESR, LDH, β2MG – poor prognosis；
IgH and TCR gene rearrangement； Bone marrow aspirate and biopsy；
影像学检查: X-ray，超声检查、CT，MRI及PET-CT 病理学：
➢ Immunological:
Monoclonal antibody–B/T cell NHL,
➢ Karyotypic/Genetic:
t(14;18) – Follicular lymphoma（Bcl-2） t(11;14) – mantle cell lymphoma（bcl-1/JH重组基因） t(8;14) – Burkitt lymphoma（myc）
Stage I II
III
Definition
Involvement of single lymph node region (I) or of a single extralymphatic organ or site (IE)
➢ ESR, High serum LDH, β2-microglubin：poor prognosis ➢ IgH and TCR gene rearrangement：PCR
➢ Bone marrow aspirate and biopsy
Normal, or late involvement. Trephine biopsy- diffuse or follicular infiltration
Measles virus（MV）
Helicobacter pylori (Hp): MALT
Immune Dysfunction:
Autoimmune disorders, Congenital or acquired immunodeficiency, etc.
Genetic Lesions: HL Others: Environmental factors, Occupational exposure, x-ray
淋巴瘤（ Lymphoma ）
Outline for Lymphoma
Definition Incidence Etiology Clinical Manifestation Diagnosis Differential Diagnosis Treatment Prognosis
Lymphoma
3. Infiltration
① Thoracic cavity: mediastina, lung, trachea, esophagus, heart, etc，
② Abdomen: stomach, gut, spleen, liver, bladder, etc. ③ CNS: compression of spinal cord, high intracranial
pressure, etc
④ Bone: pain, pathological fracture ⑤ Skin: mass, ulcer, pruritus, subcutaneous nodule, etc. ⑥ Waldeyer’s tonsillar ring（咽部淋巴环） ⑦ Bone Marrow
Laboratory Findings
➢ Complete blood cell count
Normocytic normochromic anemia Leucocytosis, lymphocytosis Leukoerythroblastic picture - BM infiltration
subcapsular sinuses, 包膜下窦
Clinical Manifestations
1. Systemic manifestations: fever, weight loss, night sweet, pruritus
• severity: asymptomatic to extremely ill • time course: evolution over weeks, months, or
• 全身症状：发热、盗汗及体重减低（皮肤瘙痒）；淋巴结肿大； 组织器官侵润
• 特点
➢ 临床起病：单个或多个淋巴结或结外组织和器官病变 ➢ 发生部位：身体各处 ➢ 早期表现：无痛性进行性淋巴结肿大。
HL Manifestations
➢ Enlarged lymph nodes-painless ➢ Contiguous spread ➢ Extranodal sites relatively uncommon except in advanced
years
2. Regional lymph node presentations
• Firm rubbery lymph nodes without pain. • Cervical, supraclavicular, axillary
lymphadenopathy may be the initial complaint without pain.
disease ➢ “B” symptoms: pruritus
➢ Pel-Ebstein fever（周期性发热 ）: 1/6 cases
NHL Manifestations
➢ Enlarged lymph nodes-painless ➢ Distant spread ➢ Extranodal sites involved are common ➢ High fever ➢ Aggressive
B症状
实验室检查
• 查血 • 查骨髓 • 查脑脊液
影像学及其他
• X线 • CT • 超声 • PET • 镓67 • 心电图 • 内窥镜等
病理学
• 形态学 • 免疫学检查 • 遗传学检查 • 分子生物学
基因芯片
基因突变
FISH
PCR定量
Clinical Staging
(Ann Arbor Classification, 1971)
Pathological Features
➢ Characteristics of typical pathological changes in lymph glands of lymphoma
Destruction of normal follicular structure by a great number of abnormal lymphocytes or histiocytes;
形态学：分型 免疫学检查：Monoclonal antibody–B/T cell NHL, 遗传学检查：t(14;18) – Follicular ；t(11;14) – Mantle
cell lymphoma；t(8;14) – Burkitt lymphoma
分子生物学：基因芯片、基因突变，FISH, PCR定量
Imaging Studies
➢ X-ray: Chest ➢ Ultrasound Study ➢ CT scan: thorax, abdomen, skull, neck ➢ MRI: thorax, abdomen ➢ PET-CT:
PET-CT in Lymphoma
➢ Positron emission tomography CT scan showing persisting areas of active disease in the mediastinum and cervical region (arrows).