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الخميس، 28 مارس، 2013

باثولوجى Pathology Slides : Hematopathology

Pathology Slides : Hematopathology

اضغط على الصورة للتكبير -ـ Click on image to enlarge size


Lymphomas are malignant proliferations of the lymphoid tissue, mainly of the lymph node; rarely, they can be extranodal (thymus, spleen, and mucosal associated lymphoid tissue - MALT lymphomas).
There are two major types of lymphomas :

Hodgkin's lymphoma
Non-Hodgkin's lymphoma

Leukemias are malignant proliferations of the hematopoietic stem cells in the bone marrow.

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Chronic lymphoid leukemia (liver)

Leukemia is a monoclonal malignant proliferation of stem cells of bone marrow, with replacement of normal bone marrow by leukemic cells, accumulation in peripheral blood and infiltration of organs (i.e., lymph nodes, spleen, liver, kidney). As a result of bone marrow infiltration, one or all series are suppressed, generating pancytopenia (anemia, neutropenia and thrombocytopenia).
Leukemia classification, based upon clinical and histogenetic criteria :
  • Acute leukemias (proliferation of young, immature elements)
    • Lymfoblastic
    • Myeloblastic
  • Chronic leukemias (monoclonal proliferation of non-functional lymphoid and myeloid elements)
    • Lymphocytic (lymphoid)
    • Granulocytic (myeloid)
Chronic lymphocytic (lymphoid) leukemia is a malignant lymphoid proliferation, similar to a low-grade lymphoma, but affecting mainly the bone marrow and the peripheral blood.

Chronic lymphocytic (lymphoid) leukemia (liver). Tumor lymphocytic infiltrate into the portal tracts, which appear very enlarged, lacking normal structures. These tumor lymphoid cells resemble normal lymphocytes (small, monomorphic, round hyperchromatic homogenous nuclei, reduced cytoplasm), but are immature, monoclonal and non-functional. With evolution, the tumor cells will infiltrate the lobules. (H&E, ob. x10)


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Chronic myeloid leukemia (liver)

Leukemia is a monoclonal malignant proliferation of stem cells of bone marrow, with replacement of normal bone marrow by leukemic cells, accumulation in peripheral blood and infiltration of organs (i.e., lymph nodes, spleen, liver, kidney). As a result of bone marrow infiltration, one or all series are suppressed, generating pancytopenia (anemia, neutropenia and thrombocytopenia).
Leukemia classification, based upon clinical and histogenetic criteria :
  • Acute leukemias (proliferation of young, immature elements)
    • Lymfoblastic
    • Myeloblastic
  • Chronic leukemias (monoclonal proliferation of non-functional lymphoid and myeloid elements)
    • Lymphocytic (lymphoid)
    • Granulocytic (myeloid)
Chronic myeloid leukemia is a malignant lymphoid proliferation of all hematopoietic series, prominently granulocytic precursors. In 90 % of cases, t(9;22) is present (translocation between chromosomes 22 and 9). This results in formation of Philadelphia chromosome and BCR/ABL gene (which produces an abnormal protein with strong tyrosine-kinase activity).

Chronic myeloid leukemia (liver). Pleomorphic tumor infiltrate : rare blast cells (myeloblasts, promyelocytes) and numerous myelocytes, neutrophils, basophils, eosinophils, metamyelocytes, mature leukocytes. These tumor cells infiltrate and dilate the portal tracts, but especially the sinusoids. (H&E, ob. x20)

Chronic myeloid leukemia (liver). (H&E, ob. x40)


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Hodgkin's lymphoma, Reed-Sternberg cell

Hodgkin's lymphoma is a primary malignant tumor of the lymph nodes, rarely affecting the extranodal lymphoid tissue. The diagnosis criteria are: tumor component (Reed-Sternberg cell - typical and variants) and a reactive component (normal mature lymphocytes, eosinophils, plasma cells, neutrophils, fibrosis and capillaries).
Histological classification of Hodgkin's lymphoma (according to lymph node architecture, ratio between tumor and non-tumor components, morphology of Reed-Sternberg cell and compositon of reactive infiltrate) :
  1. (Non-classical) Nodular lymphocyte predominant Hodgkin's lymphoma (5 %)
  2. Classical Hodgkin's lymphoma
    1. Nodular sclerosing (60 - 80 %)
    2. Lymphocyte-rich (5 %)
    3. Mixed cellularity (15 - 30 %)
    4. Lymphocyte depleted (< 1 %)
Variants of Reed-Sternberg cell (RSC) :
  • Hodgkin's cell (atypical mononuclear RSC)
  • Lacunar Reed-Sternberg cell (RSC)
  • Pleomorphic Reed-Sternberg cell (RSC)
  • Limfo-histiocytic ("pop-corn") variant
  • "Mummy" Reed-Sternberg cell (RSC)
Presence of typical Reed-Sternberg cell and reactive component are mandatory for diagnosis of Hodgkin's lymphoma. Characteristics of typical Reed-Sternberg cell : size between 20 - 50 microns; abundant, amphofilic, finely granular/homogenous cytoplasm; two mirror-image nuclei ("owl eyes") each with an eosinophilic nucleolus and a thick nuclear membrane (chromatin is distributed on the inner surface of the nuclear membrane, generating a halo image around the nucleolus). Reed-Sternberg cell has a B-cell origin. (H&E, ob.x40)

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Reed-Sternberg cell

Hodgkin's lymphoma is a primary malignant tumor of the lymph nodes, rarely affecting the extranodal lymphoid tissue. The diagnosis criteria are : tumor component (Reed-Sternberg cell - typical and variants) and a reactive component (normal mature lymphocytes, eosinophils, plasma cells, neutrophils, fibrosis and capillaries).
Histological classification of Hodgkin's lymphoma (according to lymph node architecture, ratio between tumor and non-tumor components, morphology of Reed-Sternberg cell and compositon of reactive infiltrate) :
  1. (Non-classical) Nodular lymphocyte predominant Hodgkin's lymphoma (5 %)
  2. Classical Hodgkin's lymphoma
    1. Nodular sclerosing (60 - 80 %)
    2. Lymphocyte-rich (5 %)
    3. Mixed cellularity (15 - 30 %)
    4. Lymphocyte depleted (< 1 %)
Variants of Reed-Sternberg cell (RSC) :
  • Hodgkin's cell (atypical mononuclear Reed-Sternberg cell (RSC)
  • Lacunar Reed-Sternberg cell (RSC)
  • Pleomorphic Reed-Sternberg cell (RSC)
  • Limfo-histiocytic ("pop-corn") variant
  • "Mummy" Reed-Sternberg cell (RSC)
Hodgkin's lymphoma (H&E, ob.x20)
Typical Reed-Sternberg cell : size between 20 - 50 microns; abundant, amphofilic, finely granular/homogenous cytoplasm; two mirror-image nuclei ("owl eyes") each with an eosinophilic nucleolus and a thick nuclear membrane (chromatin is distributed on the inner surface of the nuclear membrane, generating a halo image around the nucleolus).


Sternberg-Reed cell (II)

Hodgkin's lymphoma. Variants of Reed-Sternberg cell (H&E, ob.x20) :
  • Hodgkin's cell (atypical mononuclear Reed-Sternberg cell is a variant of Reed-Sternberg cell, which has the same characteristics, but is mononucleated
  • Lacunar Reed-Sternberg cell is large, with a single hyperlobated nucleus, multiple, small nucleoli and eosinophilic cytoplasm which is retracted around the nucleus, creating an empty space ("lacunae")
  • Pleomorphic Reed-Sternberg cell has multiple irregular nuclei
  • "Pop-corn" Reed-Sternberg cell (lympho-histiocytic variant) is a small cell, with a very lobulated nucleus, small nucleoli.
  • "Mummy" Reed-Sternberg cell has a compact nucleus, no nucleolus and basophilic cytoplasm
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Diffuse lymphocytic non-Hodgkin's lymphoma

Non-Hodgkin's malignant lymphomas comprise a heterogeneous group of malignancies of the immune system (except Hodgkin's lymphoma). The majority (85%) results from a proliferation of B-cells; only 15 % derives from T/NK cells.
Non-Hodgkin's malignant lymphomas comprise a heterogeneous group of malignancies of the immune system (except Hodgkin's lymphoma). The majority (85%) results from a proliferation of B-cells; only 15 % derives from T/NK cells.

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