Editing Lymphoma (section)

====WHO classification====
{{Accessibility dispute|section|date=July 2024|reason=[[screen reader]]s can not read content that is .}}
The WHO classification, published in 2001 and updated in 2008, 2017, and 2022,<ref>{{cite journal |last1=Naresh |first1=Kikkeri N. |last2=Medeiros |first2=L. Jeffrey |title=Introduction to the Fifth Edition of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues |journal=Modern Pathology |date=December 2023 |volume=36 |issue=12 |pages=100330 |doi=10.1016/j.modpat.2023.100330 |pmid=37716508}}</ref> is based upon the foundations laid within the "revised European–American lymphoma classification" (REAL). This system groups lymphomas by cell type (i.e., the normal cell type that most resembles the tumor) and defining [[phenotypic]], [[molecular]], or [[cytogenetic]] characteristics. The five groups are shown in the table. Hodgkin lymphoma is considered separately within the WHO and preceding classifications, although it is recognized as being a tumor, albeit markedly abnormal, of lymphocytes of mature B cell lineage.<ref name="pmid37900448">{{Cite journal |last1=Britto |first1=TI |last2=Fattah |first2=SA |last3=Rahman |first3=M |last4=Chowdhury |first4=M |date=2023-09-25 |title=A Systematic Review on Childhood Non-Hodgkin Lymphoma: An Overlooked Phenomenon in the Health and Research Sector of Bangladesh |journal=Cureus |volume=15 |issue=9 |pages=e45937 |doi=10.7759/cureus.45937 |doi-access=free |pmid=37900448 |pmc=10601349}}</ref>

Of the many forms of lymphoma, some are categorized as indolent (e.g. [[small lymphocytic lymphoma]]), compatible with a long life even without treatment, whereas other forms are aggressive (e.g. [[Burkitt's lymphoma]]), causing rapid deterioration and death. However, most of the aggressive lymphomas respond well to treatment and are curable. The [[prognosis]], therefore, depends on the correct diagnosis and classification of the disease, which is established after examination of a biopsy by a [[pathology|pathologist]] (usually a [[hematopathology|hematopathologist]]).<ref>{{cite book |author=Wagman LD. |chapter=Principles of Surgical Oncology |chapter-url=http://www.cancernetwork.com/cancer-management-11/chapter01/article/10165/1399286 |veditors=Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ |title=Cancer Management: A Multidisciplinary Approach |publisher=CMPMedica |year=2008 |isbn=978-1-891483-62-2 |edition=11th |url=http://www.cancernetwork.com/cancer-management-11/ |url-status=live |archive-url=https://web.archive.org/web/20131004224102/http://www.cancernetwork.com/cancer-management-11/ |archive-date=2013-10-04 }}</ref>

<div style="text-align: center; background-color:#7fbfff;">Lymphoma subtypes (WHO 2008)</div>
<div style="text-align: center; background-color:#ffffec;">{{hidden begin|border=solid 1px #aaa|title=Mature [[B cell]] neoplasms}}
[[File:DNA-microarray analysis.jpg|thumb|right|DNA-microarray analysis of Burkitt's lymphoma and diffuse large B-cell lymphoma (DLBCL) showing differences in gene expression patterns. Colors indicate levels of expression; green indicates genes that are underexpressed in lymphoma cells (as compared to normal cells), whereas red indicates genes that are overexpressed in lymphoma cells.]]
* [[B-cell chronic lymphocytic leukemia|B-cell chronic lymphocytic leukemia/small cell lymphoma]]
:: 3–4% of lymphomas in adults
:: Small resting lymphocytes mixed with variable numbers of large activated cells, lymph nodes diffusely [[Effacement (histology)|effaced]]
:: CD5, surface [[immunoglobulin]]
:: 5-year survival rate 50%.<ref>{{cite web |title=Chronic Leukemias |work=The Merck Manual of Geriatrics |url=http://www.merck.com/mkgr/mmg/sec9/ch73/ch73b.jsp |url-status=live |archive-url=https://web.archive.org/web/20100704145645/http://www.merck.com/mkgr/mmg/sec9/ch73/ch73b.jsp |archive-date=2010-07-04 }}</ref>
:: Occurs in older adults, usually involves lymph nodes, bone marrow and spleen, most patients have peripheral blood involvement, indolent
* [[B-cell prolymphocytic leukemia]]
* [[Lymphoplasmacytic lymphoma]] (such as [[Waldenström macroglobulinemia]])
* [[Splenic marginal zone lymphoma]]
* [[Hairy cell leukemia]]
* [[Plasma cell]] neoplasms:
** [[Plasma cell myeloma]] (also known as multiple myeloma)
** [[Plasmacytoma]]
** Monoclonal immunoglobulin deposition diseases
** [[Heavy chain diseases]]
* [[Extranodal marginal zone B cell lymphoma]], also called [[MALT lymphoma]]
:: About 5% of lymphomas in adults
:: Variable cell size and differentiation, 40% show [[plasma cell]] differentiation, [[Homing (hematopoietic)|homing]] of B cells to epithelium creates lymphoepithelial lesions.
:: CD5, [[CD10]], surface Ig
:: Frequently occurs outside lymph nodes, very indolent, may be cured by local excision
* [[Nodal marginal zone B cell lymphoma]]
* [[Follicular lymphoma]]
:: About 40% of lymphomas in adults
:: Small "cleaved" [cleft] cells ([[centrocyte]]s) mixed with large activated cells ([[centroblast]]s), usually nodular ("follicular") growth pattern
:: [[CD10]], surface [[immunoglobulin|Ig]]
:: About 72–77%<ref>{{EMedicine|article|203268|Lymphoma, Follicular}}</ref>
:: Occurs in older adults, usually involves lymph nodes, bone marrow and spleen, associated with t(14;18) [[chromosomal translocation|translocation]] overexpressing [[Bcl-2]], indolent
* [[Primary cutaneous follicle center lymphoma]]
* [[Mantle cell lymphoma]]
:: About 3–4% of lymphomas in adults
:: Lymphocytes of small to intermediate size growing in diffuse pattern
:: [[CD5 (protein)|CD5]]
:: About 50<ref name=Leitch&Herrmann/> to 70%<ref name=Leitch&Herrmann>
:::: 50% for limited stage: {{cite journal | vauthors = Leitch HA, Gascoyne RD, Chhanabhai M, Voss NJ, Klasa R, Connors JM | title = Limited-stage mantle-cell lymphoma | journal = Annals of Oncology | volume = 14 | issue = 10 | pages = 1555–1561 | date = October 2003 | pmid = 14504058 | doi = 10.1093/annonc/mdg414 | doi-access = free }}
:::: 70% for advanced stage: {{cite journal | vauthors = Herrmann A, Hoster E, Zwingers T, Brittinger G, Engelhard M, Meusers P, Reiser M, Forstpointner R, Metzner B, Peter N, Wörmann B, Trümper L, Pfreundschuh M, Einsele H, Hiddemann W, Unterhalt M, Dreyling M | display-authors = 6 | title = Improvement of overall survival in advanced stage mantle cell lymphoma | journal = Journal of Clinical Oncology | volume = 27 | issue = 4 | pages = 511–518 | date = February 2009 | pmid = 19075279 | doi = 10.1200/JCO.2008.16.8435 | s2cid = 32350562 | doi-access = free }}</ref>
:: Occurs mainly in adult males, usually involves lymph nodes, bone marrow, spleen and [[Human gastrointestinal tract|GI tract]], associated with t(11;14) translocation overexpressing [[cyclin D1]], moderately aggressive
* [[Diffuse large B-cell lymphoma]], not otherwise specified
:: About 40–50% of lymphomas in adults
:: Variable, most resemble B cells of large germinal centers, diffuse growth pattern
:: Variable expression of [[CD10]] and surface Ig
:: [[Five-year survival rate]] 60%<ref name="Turgeon">{{cite book |first=Mary Louise |last=Turgeon |title=Clinical Hematology: Theory and Procedures |url=https://books.google.com/books?id=cHAjsUgegpQC |year=2005 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-5007-3 |volume=936 |edition=4 |pages=285–6 |url-status=live |archive-url=https://web.archive.org/web/20150906095500/https://books.google.com/books?id=cHAjsUgegpQC |archive-date=2015-09-06 }}</ref>
:: Occurs in all ages, but most commonly in older adults, may occur outside lymph nodes, aggressive
* [[Diffuse large B-cell lymphoma associated with chronic inflammation]]
* [[Epstein–Barr virus positive diffuse large B-cell lymphoma, not otherwise specified]]
* [[Lymphomatoid granulomatosis]]
* [[Primary mediastinal (thymic) large B-cell lymphoma]]
* [[Intravascular large B-cell lymphoma]]
* [[ALK+ large B-cell lymphoma]]
* [[Plasmablastic lymphoma]]
* [[Primary effusion lymphoma]]
* [[Large B-cell lymphoma arising in HHV8-associated multicentric Castleman's disease]]
* [[Burkitt's lymphoma|Burkitt lymphoma/leukemia]]
:: < 1% of lymphomas in the United States
:: Round lymphoid cells of intermediate size with several nucleoli, [[starry-sky appearance]] by diffuse spread with interspersed [[apoptosis]]
:: CD10, surface Ig
:: Five-year survival rate 50%<ref>{{cite journal | vauthors = Diviné M, Casassus P, Koscielny S, Bosq J, Sebban C, Le Maignan C, Stamattoulas A, Dupriez B, Raphaël M, Pico JL, Ribrag V | display-authors = 6 | title = Burkitt lymphoma in adults: a prospective study of 72 patients treated with an adapted pediatric LMB protocol | journal = Annals of Oncology | volume = 16 | issue = 12 | pages = 1928–1935 | date = December 2005 | pmid = 16284057 | doi = 10.1093/annonc/mdi403 | doi-access = free }}</ref>
:: Endemic in Africa, sporadic elsewhere, more common in immunocompromised and children, often visceral involvement, highly aggressive
{{hidden end}}
{{hidden begin|border=solid 1px #aaa|title=Mature [[T cell]] and [[natural killer cell|natural killer]] (NK) cell neoplasms}}
* [[T-cell prolymphocytic leukemia]]
* [[T-cell large granular lymphocyte leukemia]]
* [[Aggressive NK cell leukemia]]
* [[Adult T-cell leukemia/lymphoma]]
* [[Extranodal NK/T-cell lymphoma, nasal type]]
* [[Enteropathy-associated T-cell lymphoma]]
* [[Hepatosplenic T-cell lymphoma]]
* [[Blastic NK cell lymphoma]]
* [[Mycosis fungoides]]/[[Sézary syndrome]]
:: Most common cutaneous lymphoid malignancy
:: Usually small lymphoid cells with convoluted nuclei that often infiltrate the epidermis, creating [[Pautrier microabscesses]]es
:: [[CD4]]
:: [[Five-year survival rate|5-year survival]] 75%<ref>{{cite journal | vauthors = Kirova YM, Piedbois Y, Haddad E, Levy E, Calitchi E, Marinello G, Le Bourgeois JP | title = Radiotherapy in the management of mycosis fungoides: indications, results, prognosis. Twenty years experience | journal = Radiotherapy and Oncology | volume = 51 | issue = 2 | pages = 147–151 | date = May 1999 | pmid = 10435806 | doi = 10.1016/S0167-8140(99)00050-X }}</ref>
:: Localized or more generalized skin symptoms, generally indolent, in a more aggressive variant, [[Sézary's disease]], skin [[erythema]] and peripheral blood involvement
* Primary cutaneous CD30-positive T-cell lymphoproliferative disorders
** [[Anaplastic large cell lymphoma#Primary cutaneous anaplastic large cell lymphoma|Primary cutaneous anaplastic large cell lymphoma]]
** [[Lymphomatoid papulosis]]
* [[Peripheral T-cell lymphoma not otherwise specified]]
:: Most common T cell lymphoma
:: Variable, usually a mix small to large lymphoid cells with irregular nuclear contours
:: [[CD3 (immunology)|CD3]]
:: Probably consists of several rare tumor types, often disseminated and generally aggressive
* [[Angioimmunoblastic T-cell lymphoma]]
* [[Anaplastic large cell lymphoma]]: [[Anaplastic large cell lymphoma#ALK-positive anaplastic large cell lymphoma|ALK-positive]] and [[Anaplastic large cell lymphoma#ALK-negative anaplastic large cell lymphoma|ALK-negative]] types
* [[Anaplastic large cell lymphoma#Breast implant-associated anaplastic large cell lymphoma|Breast plant-associated anaplastic large cell lymphoma]]
{{hidden end}}
{{hidden begin|border=solid 1px #aaa|title=Precursor lymphoid neoplasms}}
* [[Precursor B-cell lymphoblastic leukemia|B-lymphoblastic leukemia/lymphoma not otherwise specified]]
* [[Precursor B-cell lymphoblastic leukemia|B-lymphoblastic leukemia/lymphoma with recurrent genetic abnormalities]]
* [[T-lymphoblastic leukemia/lymphoma]]
:: 15% of childhood [[acute lymphoblastic leukemia]] and 90% of [[lymphoblastic lymphoma]].<ref name="Jaffe_2011_1"/>{{rp|635}}
:: [[Lymphoblast]]s with irregular nuclear contours, condensed chromatin, small nucleoli and scant cytoplasm without granules
:: [[Terminal deoxynucleotidyl transferase|TdT]], [[CD2]], [[CD7]]
:: It often presents as a [[mediastinal mass]] because of involvement of the [[thymus]]. It is highly associated with ''[[NOTCH1]]'' mutations, and is most common in [[adolescent]] males.{{hidden end}}
{{hidden begin|border=solid 1px #aaa|title= Hodgkin lymphoma }}
* Classical [[Hodgkin lymphoma]]s:
** [[Nodular sclerosis]] form of Hodgkin lymphoma
:: Most common type of Hodgkin lymphoma
:: Reed–Sternberg cell variants and inflammation, usually broad sclerotic bands that consist of collagen
:: [[CD15]], [[CD30]]
:: Most common in young adults, often arises in the [[mediastinum]] or [[cervical lymph node]]s
** Mixed cellularity Hodgkin lymphoma
:: Second-most common form of Hodgkin lymphoma
:: Many classic Reed–Sternberg cells and inflammation
:: CD15, CD30
:: Most common in men, more likely to be diagnosed at advanced stages than the nodular sclerosis form [[Epstein–Barr virus]] involved in 70% of cases
** Lymphocyte-rich
** Lymphocyte depleted or not depleted
* [[Nodular lymphocyte-predominant Hodgkin lymphoma]]
{{hidden end}}
{{hidden begin|border=solid 1px #aaa|title=Immunodeficiency-associated lymphoproliferative disorders}}
* Associated with a primary immune disorder
* Associated with the human immunodeficiency virus ([[HIV]])
* Post-transplant
* Associated with [[methotrexate]] therapy
* [[Primary central nervous system lymphoma]] occurs most often in immunocompromised patients, in particular those with AIDS, but it can occur in the immunocompetent, as well. It has a poor prognosis, particularly in those with AIDS. Treatment can consist of [[corticosteroids]], [[radiotherapy]], and [[chemotherapy]], often with methotrexate.
{{hidden end}}</div>