Different NHL.(non-hodgkin lymphoma)

PLASMA CELL NEOPLASMS

(Bonemarrow aspirate)
(Eccentric nuclei and Perinuclear Halo)

MULTIPLE MYELOMA

It is the neoplasm of PLASMA CELL

Infection of marrow macrophages with HHV – 8 IL 6 release Myeloma cell proliferation

Patients presents with

1. MULTIFOCAL DESTRUCTIVE BONE LESIONS throughout the skeletal system

VERTEBRA (MC site) > Ribs > Skull > Pelvis > Femur > Clavicle > Scapula

The focal lesion begin in the medullary cavity erode the cortical bone PATHOLOGICAL FRACTURES (MC site is vertebra)

2. Bone marrow show INCREASED NUMBER OF PLASMA CELLS (>30%)

Many variants of plasma cell can be seen: Plasma blasts, FLAME CELLS (Red), MOFF CELLS (Blue)

Many inclusions are also seen in these cells: RUSSEL BODIES cytoplasmic and DUTCHER BODIES nuclear.

3. Plasma cell infiltration of various organ tissue of the body

Clinical features

1. Due to Skeletal destruction

BONE PAIN

Pathological fracture

HYPERCALCEMIA

Punched out lesion on SKULL X RAY

2. Due to excessive abnormal monoclonal Ig

MC serum monoclonal Ig is IgG (followed by IgA)

HYPERVISCOSITY. Waldenstrom macroglobulinemia – serum proteins increases – viscosity.

HYPOGAMMAGLOBULINEMIA (Decreased production of Normal Ig)

3. RENAL FAILURE

It is due to Hypercalcemia + Light chain proteinuria + Pyelonephritis

Manifested as BENCE JONES (Ig light chain) Proteinuria

MC – IgG Kappa light chain

4. Due to bone marrow depression

Anemia

Thrombocytopenia

Clinical triad of multiple myeloma

MARROW PLASMACYTOSIS (>10%)

LYTIC BONE LESIONS

SERUM / URINE Myeloma (M) protein on electrophoresis

PERIPHERAL T CELL LYMPHOMA

Most are CD 4 +ve few are CD 8.

Has a DIFFUSE pattern of lymph node involvement

ANGIOGENESIS may be seen

Carries WORST PROGNOSIS of all NHL

CUTANEOUS T CELL LYMPHOMA

Also called MYCOSIS FUNGOIDES

Neoplastic proliferation of peripheral CD 4 + T cells characterized by the involvement of SKIN

There is infiltration of EPIDERMIS & UPPER DERMIS

Disease progression is characterized by extra-cutaneous spread, most commonly to LN & BM

SEZARY SYNDROME – A variant of mycosis fungoides in which skin involvement is characteristically manifested as GENERALIZED EXFOLIATIVE ERYTHRODERMA & CIRCULATING TUMOR CELLS

ADULT T CELL LYMPHOMA

Neoplasm of CD 4 + T cells infected with HTLV-1 virus

Seen in Japan & Caribbean

Characterized by

SKIN LESIONS (papules, plaques, ulcers)

HYPERCALCEMIA

PERIPHERAL BLOOD LYMPHOCYTOSIS

Peripheral smear Abnormal CD 4 + cells (FLOWER or CLOVERLEAF CELLS)

Another manifestation of HTLV-1 is TROPICAL SPASTIC PARALYSIS because of progressive demyelination of CNS.