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Types of Lymphoma > Classifications (types) of lymphoma

Last update: 01/03/2014


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Difference between Non-Hodgkin's and Hodgkin's?
| Categories | Resources | Systems
 

What's New:

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Recommended: Dr. Sharman's CLL & Lymphoma Blog:
Making sense of all the different lymphomas
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Classifications - Ash Education:
The 2008 WHO classification of lymphomas: implications for clinical practice and translational research

Detailed background:  

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Revised European-American Classification of Lymphoid Neoplasms: 
A Proposal From the International Lymphoma Study Group
bloodjournal.hematology.org 
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Pathology of b-cell lymphomas  surgpathcriteria.stanford.edu/ 
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Pathology of t-cell lymphomas surgpathcriteria.stanford.edu
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PATHOLOGY OF HODGKIN’S AND NON-HODGKIN’S LYMPHOMAS  medschool.pitt.edu pdf 
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Lymphoma 101: Biology and Classification-
Richard I. Fisher, MD Transcript or  WebObtaining an Accurate Diagnosiscast

What is the difference between lymphoma and non-Hodgkins lymphoma?

We have someone in our family who has been diagnosed in the past with non-Hodgkins lymphoma and would like to know the difference. Are the treatments and prognosis the same?

Answer: Lymphoma is the broadest category of a family of related blood cancers. That is it is any blood cancer that involves lymphocytes (the cell type of origin) that is found primarily in the lymphatic system. It includes all the subtypes or variations of lymphoma.

The diagnosis is based on the type of lymphocytes involved - the so called cell of origin.

In Hodgkin's disease, the abnormal lymphocyte is the Reed-Sternberg cell (a B lymphocyte). This particular lymphocyte isn't found in other types of lymphomas.  All other types of lymphomas are called non-Hodgkin's (NHL).  There are about 30 subtypes of NHL.

Identifying the correct type of lymphoma is important because treatment for Hodgkin's and non-Hodgkin's can be very different. Pathologists can distinguish between Hodgkin's and non-Hodgkin's by examining the cell sample from a biopsy under a microscope.

Lymphomas

    Hodgkins (often curable)
        Nodular Sclerosis,  Mixed Cellularity,  Lymphocyte Depleted, Lymphocyte Predominant

    Non-Hodgkins
        Diffuse large b-cell (aggressive)
        Follicular (indolent) 
        Mantle Cell (aggressive or indolent)
        MALT (indolent)
        T-cell and NK-cell types
        . . . 

Other ways to categorize lymphomas are by the rate of growth: indolent, intermediate, and aggressive.

Another ways is by areas of presentation: such as CNS (central nervous system), which is rare, and MALT which presents in mucosal linings, such as the stomach.

Anther way to classify is by lymphocyte type: b-cell, t-cell, NK-cell. (B-cell is most common).

Treatments for the various subtypes of lymphoma can vary significantly.

This group supports all types of lymphoma. Or does it's best to find and post evidence-based information as questions comes in.

CATEGORIES OF LYMPHOMA - Based primarily on WHO
Incidence
per year
Mortality
per year
Percentage of NHL
 Hodgkin's lymphomas - Reed-Sternberg cell
 
7,000 1,300 -
 Non-Hodgkin's Lymphomas (NHL)  B-cell and T-cell types
 
54,000 24,000 100%
B-cell NHL
45,900   85%
T-cell NHL
6,885   15%
Aggressive (fast-growing) 
- High or intermediate grade B-cell  or T- cell NHL
32,400   60%
Indolent (slow-growing) 
- Low grade B-cell or T-cell NHL
21,600   40%
Most common NHL types:
Most Common
Grade
Incidence
per year
Mortality
per year
Percentage of NHL
Diffuse large B-cell High     31%
Follicular cell B-cell (Center cell) Low     22%
Precursor B-cell and T-cell NHL:
Most Common
Grade
Incidence
per year
Mortality
per year
Percentage of NHL
Lymphoblastic lymphoma - B-cell - can lead to CNS type * High      
Lymphoblastic lymphoma - T-cell High      
Mature B-cell NHL: Markers CD19, 20, 22, 23
Most Common
Grade
Incidence
per year
Mortality
per year
Percentage of NHL
Burkitt's High     2%
Chronic lymphocytic leukemia/
small lymphocytic lymphoma (CLL/SLL)
Low     6%
CNS (Central Nervous System) * High      
Diffuse large B-cell lymphoma High      
Follicular (center cell) lymphomas: Low      
large cell (Grade 3)
High      
mixed large and small (Grade 2)
Low      
small cleaved (Grade 1)
Low      
Hairy cell leukemia Low      
Large Cell immunoblastic        
Large B-cell lymphomas: High      
Follicular
High      
Mediastinal (thymic)
High      
Mantle cell lymphoma High     6%
Marginal zone lymphomas        
MALT - mucosa associated:
Low     5%
gastric, eye, skin, lung, salivary, orbit,
       
nasopharynx, larynx, breast
       
Nodal +/- Moncytotal b-cells
Low      
Splenic with Villous Lymphocytes
Low      
Plasma cell myeloma / plasmacytomas        
Primary amyloidosis        
Primary effusion lymphoma        
Solitary plasmacytoma of bone        
Waldenström’s Macroglobulinemia (Lymphoplasmacytic)       1%

 

T-cell and NK-cell NHL
(Mature cell stage unless "precursor cell" is indicated)
Markers CD2, 3, 4, 5, NK: CD16, 56
Most Common
Grade
Incidence
per year
Mortality
per year
Percentage of NHL
Adult T-cell  High      
Aggressive NK cell leukemia High      
Anaplastic large cell lymphoma - CD30 positive  Subtype: Ki-l-positive        
Angioimmunoblastic T-cell lymphoma (13%)        
Blastic NK cell lymphoma (precursor cell)        
Enteropathy type T-cell lymphoma        
Extranodal NK/T cell lymphoma, nasal type (Angiocentric)  High      
Gamma-delta T-cell phenotype 1 - provisional subtype        
Hepatosplenic T-cell lymphoma        
Lymphomatoid papulosis (uncertain malignant status)        
Mycosis fungoides - cutaneous (skin) t-cell lymphoma (CTCL) Subtype: Angiocentric Low      
Peripheral T-cell lymphomas, unspecified       15 -20%
Precursor T-cell lymphoma (precursor cell)        
Primary cutaneous anaplastic large cell lymphoma 
(favorable prognosis)
       
Sezary syndrome - leukemic form of Mycosis fungoides        
Subcutaneous panniculitis-like T-cell lymphoma        
T-cell Large granular lymphocytic leukemia        
T-cell proliferation of uncertain malignant potential        
T-cell prolymphocytic leukemia - T-cell CLL (1% of CLL)        
       

"About 85% of non- Hodgkin's lymphomas arise in B-cells; the rest occur in T-cells. Activation of a gene called BCL-2 is believed to be partly responsible for many B-cell lymphomas. This defect prevents apoptosis in the lymphoma cells (a natural process whereby cells self- destruct)."   

"
Lymphomas are also grouped by certain properties:  

    Size (large versus small).
 
    Shape (round versus irregular). 
 
    Whether they are or resemble blood plasma cells.
 
    Whether they are follicular (organized in round clusters) 
    or diffuse (spread evenly throughout the lymph node)."     - ucdavis.edu

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Systems for classifying non-Hodgkin's Lymphoma

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Rappaport: Based on morphology (how the cells look in the microscope) alone; used until the 1970s.
 

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Kiel: Based on morphologic and immunologic (what types of proteins are produced by the cell) characteristics; updated in 1992; used mainly in Europe
 

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National Cancer Institute's Working Formulation (IWF): Divided lymphomas into low-grade, intermediate-grade and high-grade, with ten sub-groups labeled A to J.
 

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Revised European-American Classification of Lymphoid Neoplasms (REAL): Describes the different types of lymphomas as entities, with each type classified according to cell origin, based on morphologic, immunologic and genetic characteristics; introduced in 1994.
 

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World Health Organization (WHO): Uses the latest information on the appearance and growth pattern of the cancerous cells and genetic features. It also offers a more accurate description of the different types of tumors and identifies several new categories of non-Hodgkin's lymphatic cancer; updated version of REAL. Introduced in 2001 as an international standard. 

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Resources

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Background information on NHL - FDA
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Table of contents-Lymphomas and Plasma cell neoplasms pathologyoutlines
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WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues  Cancer.gov
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The Revised European-American Classification of Lymphoid Neoplasms
(REAL classification)  umich.edu
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Pathology of Lymphomas  ncl.ac.uk
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professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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