内科学淋巴瘤邹善华_第1页
内科学淋巴瘤邹善华_第2页
内科学淋巴瘤邹善华_第3页
内科学淋巴瘤邹善华_第4页
内科学淋巴瘤邹善华_第5页
已阅读5页,还剩33页未读 继续免费阅读

下载本文档

版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领

文档简介

内科学淋巴瘤邹善华Definition:AgroupofneoplasticdiseasesoflymphoidtissuesClassification:

Hodgkin′sDisease,HD(Hodgkin′sLymphoma)NonHodgkin′sLymphoma,NHL)GeneralConsiderations2021/4/272ClinicalFeatures:

Painless,progressivelymphadenectasisFever,weightloss,nightsweat;cachexiaHepatosplenomegalyEpidemiology:

Incidence:incities/inthecountry;male/female;ageHD8~11%;NHL90%GeneralConsiderations2021/4/273Virulogy:

EBvirus→Burkittlymphoma,HD

HumanT-cellLymphotropicVirustype1,HTLV-1→AdultT-celllymphoma/leukemia,ATL

HTLV-2→MycosisFungoidesHelicobacterPylori→MALTlymphomaKaposisarcoma-associatedherpesvirus→primarybodycavitylymphoma

EtiologyandPathogenesis

2021/4/274ImmuneStatesofHost:

Immunodeficiency/immunosuppressionMechanism:Antigenicstimulation→

lymphadenosis(modulation↓)→infiniteproliferation→lymphomaEtiologyandPathogenesis2021/4/275ClassificationofLymphomaHD:Reed-Sternberg(R-S)Cell

2021/4/276ClassificationofLymphoma

RyeClassification,1966LymphocytepredominanceNodularsclerosisMixedcellularityLymphocytedepletion2021/4/277ClassificationofLymphoma

WHOClassification,2001NodularlymphocytepredominanceHodgkin'slymphomaClassicalHodgkin'slymphomaLymphocyte-richclassicalHodgkin'slymphomaNodularsclerosisHodgkin'slymphomaMixedcellularityHodgkin'slymphomaLymphocytedepletionHodgkin'slymphoma2021/4/278ClassificationofLymphomaNHL:2021/4/279ClassificationofLymphomaNHL:

IWF,1982REAL,1994WHO,20012021/4/2710WorkingFormulation

Low-gradelymphomaA.smalllymphocytic,consistentwithchroniclymphocyticleukemiaplasmacytoidB.follicular,predominantlysmallcleavedcelldiffuseareassclerosisC.

follicular,mixedsmallcleavedandlargecelldiffuseareas

sclerosis2021/4/2711WorkingFormulationIntermediate-gradlymphomaD.

follicular,predominantlylargecelldiffuseareassclerosisE.diffuse,smallcleavedcellsclerosisF.

diffuse,mixedsmallandlargecellsclerosisepithelioidcellcomponentG.

diffuse,largecellcleavedcellnoncleavedcellsclerosis

2021/4/2712WorkingFormulationHigh-gradelymphomaH.mmunoblastic,largecellplasmacytoidclearcellpolymorphousepithelioidcellcomponentI.lymphoblastic,convolutedornonconvolutedcellJ.smallnoncleavedcell,Burkitt'sornon-Burkitt's2021/4/2713WorkingFormulationMiscellaneouscompositemycosisfungoideshistiocyticextramedullaryplasmacytomaunclassifiableother2021/4/2714REALClassification

B-cellneoplasmsI.PrecursorB-cellneoplasm:precursorB-lymphoblasticleukemia/lymphomaII.PeripheralB-cellneoplasms

A.B-cellchroniclymphocyticleukemia/prolymphocyticleukemia/smalllymphocyticlymphomaB.Lymphoplasmacytoidlymphoma/immunocytomaC.MantlecelllymphomaD.Folliclecentercelllymphoma,follicular1.Provisionalcytologicgrades:Ismallcell,IImixedsmallandlargecell,IIIlargecell2.Provisionalsubtype:diffuse,predominantlysmallcelltype

2021/4/2715REALClassificationE.MarginalzoneB-celllymphoma1.Extranodal(MALT-type+/-monocytoidBcells)2.Provisionalsubtype:nodal(+/-monocytoidBcells)F.Provisionalentity:splenicmarginalzonelymphoma(+/-villouslymphocytes)G.HairycellleukemiaH.Plasmacytoma/plasmacellmyelomaI.DiffuselargeB-celllymphoma1.Subtype:primarymediastinal(thymic)B-celllymphomaJ.Burkitt’slymphomaK.Provisionalentity:high-gradeB-celllymphoma,Burkitt-like

2021/4/2716REALClassificationT-cellandputativeNK-cellneoplasmsI.PrecursorT-cellneoplasm:precursorT-lymphoblasticlymphoma/leukemiaII.PeripheralT-cellandNK-cellneoplasmsA.T-cellchroniclymphocyticleukemia/prolymphocyticleukemiaB.Largegranularlymphocyteleukemia1.T-celltype2.NK-celltypeC.Mycosisfungoides/Sezary’syndrome2021/4/2717REALClassification

D.PeripheralT-celllymphomas,unspecified1.Provisionalcytologiccategories:medium-sizedcell,mixedmediumandlargecell,largecell,lymphoepithelioidcell2.Provisionalsubtype:hepatosplenicgamma/deltaT-celllymphoma3.Provisionalsubtype:subcutaneouspanniculiticT-celllymphomaE.AngioimmunoblasticTcelllymphomaF.Angiocentriclymphoma2021/4/2718REALClassification

G.IntestinalT-celllymphoma(+/-enteropathyassociated)H.AdultT-celllymphoma/leukemiaI.Anaplasticlargecelllymphoma1.CD30+-celltype2.T-celltype3.Null-celltypesJ.Provisionalentity:anaplasticlargecelllymphoma,Hodgkin's-like

2021/4/2719WHOClassification,2001B-cellneoplasmsI.PrecursorB-cellneoplasm:

a.PrecursorB-lymphoblasticleukemia/lymphomaII.Mature(peripheral)B-cellneoplasmsaB-cellchroniclymphocyticleukemia/smalllymphocyticlymphoma

bB-cellprolymphocyticleukemiacLymphoplasmacyticlymphoma

dSpenicmarginalzoneB-celllymphoma(+/-villouslymphocytes)eNodalmarginalzonelymphoma(+/-monocytoidB-cells)fExtranodalmarginalzoneB-celllymphomaof

mucosa-associatedlymphoidtissue(MALT)type

2021/4/2720WHOClassification,2001

gHairycellleuekmiahPlasmacellmyeloma/plasmacytomaiFollicularlymphoma,folliclecenterjMantlecelllymphomakDiffuselargecellB-celllymphomaMediastinallargeB-celllymphomaIntravascularlargeB-celllymphomaPrimaryeffusionlymphomalBurkitt'slymphoma/Burkitt'scellleukemiaB-cellproliferationsofuncertainmalignantpotential

Lymphomatoidgranulomatosis

Post-transplantlymphoproliferativedisorder

2021/4/2721WHOClassification,2001T-CellandNaturalKillerCellNeoplasmsI.PrecursorTcellneoplasm:

a.PrecursorT-lymphoblasticlymphoma/leukemia

b.BlasticNKlymphoma2021/4/2722WHOClassification,2001II.Mature(peripheral)TcellandNK-cellneoplasmsaTcellprolymphocyticleukemiabT-cellgranularlymphocyticleukemiacAggressiveNKCellleukemiadAdultTcelllymphoma/leukemia(HTLV1+)eExtranodalNK/T-celllymphoma,nasaltypefEnteropathy-typeT-celllymphomagHepatosplenicgamma-deltaT-celllymphomahSubcutaneouspanniculitis-likeT-celllymphomaiMycosisfungoides/Sezary'ssyndrome2021/4/2723WHOClassification,2001

jPrimaryCutaneousAnaplasticlargecelllymphomaT/nullcellkPeripheralTcelllymphoma,unspecifiedlAngioimmunoblasticTcelllymphomamPrimarySystemicAnaplasticlargecelllymphoma,T/nullcellT-cellproliferationofuncertainmalignantpotential

Lymphomatoidpapulosis2021/4/2724ClinicalFeatures2021/4/2725

HDNHL

Age

Youngpeople

Moreofteninmiddle-agedpeople

Superficiallymphnodes

60~80%

50%

(firstobservedastumefactionofcervicalorsupraclavicularlymphnodes)

Mediastinallymphnodes

50%

20%

Retroperitoneallymphnodes

Seldominvaded

Ofteninvaded

Fever

Oftenoccurred

Seldominearlyperiod

Itchofskin

Oftenoccurredinsomeyoungfemalepatients

Seldomoccurred

Specificskinlesion

Seldomoccurred

OftenoccurredExtranodalsites

Seldomoccurred

Oftenoccurred

(Waldeyer’sring,gastrointestinaltract,bonemarrow,CNS,liver,lung,pleura,bone,skin,kidney)

Wayofdissemination

Metastasistonearbylymphnodes

Inajumpingway

Bonemarrowinvolvement

SeldomoccurredOftenoccurred

Progress

Slower

Faster

Prognosis

Better

Worse

2021/4/2726LabandOtherFindingsPeripheralBloodandBoneMarrowHD:Eosinophilia;R-Scell NHL:Lymphocytosis;ComplicatedleukemiaLDH,β2-MG,Coombstest,globulinRadiologicstudiesChestX-rayCT,MRIRadioactivenuclidePET-CTB-ultrasoundBiopsyImmunophenotypeCytogeneticandMolecularStudies2021/4/2727Diagnosis

Painless,progressivelymphadenectasis→Biopsy

SkinLesion→BiopsyBoneMarrowAspirationandBiopsyBiopsyofOtherSites

DiagnosisandDifferentialDiagnosis2021/4/2728StagingoflymphomaStageDefinitionⅠInvolvementofasinglelymphnoderegionorofasingleextranodalorganorsite(ⅠE)ⅡInvolvementoftwoormorenoderegionsonthesamesideofthediaphragm,orlocalizedinvolvementofanextranodalsiteororgan(ⅡE)andoneormorelymphnoderegionsonthesamesideofthediaphragmⅢInvolvementoflymphnoderegionsonbothsidesofthediaphragmwhichmayalsobeaccompaniedbylocalizedinvolvementofanextranodalorgansorsite(ⅢE)orspleen(Ⅲs)orboth(ⅢsE)ⅣDiffuseordisseminatedinvolvementofoneormoredistantextranodalorganswithorwithoutassociatedlymphnodeinvolvementBsymptomsFever>38℃,nightsweats,and/orweightloss>10%ofbodyinthe6months2021/4/2729Stagingoflymphoma2021/4/2730DifferentialDiagnosisLymphadenectasis:

ChroniclymphadenitisTuberculouslymphadenitisTumournodemetastasesFever:Septicaemia,Tuberculosis,RheumaticdiseaseExtranodalLymphoma:OthermalignanttumerDiagnosisandDifferentialDiagnosis2021/4/2731RadiationTherapy

60Co,acceleratorlinearDosage:30~40GY,3~4WMethods:

Localfieldirradiation(LFI)

MantleorinvertedYirradiationTotalnodalirradiation(TNI)Treatment2021/4/2732TreatmentFields2021/4/2733Indication:HDⅠA,ⅡA:Extendedfieldirradiation(EFI)ⅠB,ⅡB,ⅢA:TNIand/orcombination

温馨提示

  • 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
  • 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
  • 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
  • 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
  • 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
  • 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
  • 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

评论

0/150

提交评论