淋巴瘤406710724-(精选·公开·课件).ppt

淋巴瘤（lymphoma）是一组原发于淋巴结或淋巴组织的恶性肿瘤，在肿瘤组织中有大量淋巴细胞或组织细胞增生。 淋巴瘤可分为霍奇金病（Hodgkin disease,HD）和非霍奇金淋巴瘤（non-Hodgkin lymphoma,NHL）两大类。 临床典型表现为无痛性淋巴结肿大，肝脾也常肿大。晚期出现贫血、发热和恶病质。据统计我国发病率男性为1.39/10万，女性为0.84/10万。 B-cell development Epidemiology of lymphomas 5th most frequently diagnosed cancer overall for both males and females males females incidence NHL increasing over time Hodgkin lymphoma stable Incidence of lymphomas in comparison with other cancers in Canada Age distribution of new NHL cases in Canada Age distribution of new Hodgkin lymphoma cases in Canada 病因和发病机制 一、病毒学说 二、免疫学说 The challenge of lymphoma classification 病理和分类 一、霍奇金病（HD） 二、非霍奇金淋巴瘤（NHL） Lymphoma classification(based on 2001 WHO) B-cell neoplasms Precursor B-cell neoplasms (2 types) Mature B-cell neoplasms (19) B-cell proliferations of uncertain malignant potential (2) T-cell NK-cell neoplasms Precursor T-cell neoplasms (3) Mature T-cell and NK-cell neoplasms (14) T-cell proliferation of uncertain malignant potential (1) Hodgkin lymphoma Classical Hodgkin lymphomas (4) Nodular lymphocyte predominant Hodgkin lymphoma (1) Three types of lymphoma worth knowing about Follicular lymphoma Diffuse large B-cell lymphoma Hodgkin lymphoma 淋巴瘤共点: ①大多为B细胞起源，破坏免疫机制; ②淋巴滤泡破坏,某些B细胞源肿瘤可重演滤泡生长过程; ③单克隆性肿瘤,瘤细胞带有独特抗原或受体: Hodgkin lymphoma Hodgkin lymphoma cell of origin: germinal centre B-cell Reed-Sternberg cells (or RS variants) in the affected tissues most cells in affected lymph node are polyclonal reactive lymphoid cells, not neoplastic cells Reed-Sternberg cell RS cell and variants A possible model of pathogenesis WHO分类:1结节性淋巴细胞为主型; 2经典型; 1结节性淋巴细胞为主型： 结节样,背景小淋巴细胞多,上皮样组织细胞混合,“爆米花样”细胞。 Hodgkin lymphomaHistologic subtypes Classical Hodgkin lymphoma lymphocyte-rich mixed cellularity nodular sclerosis (most common subtype) lymphocyte depleted 经典型HL： ⑴结节硬化型(nodular sclerosis)HL: 陷窝细胞多,镜影R-S细胞少；境界清结节,纵隔包块；女青年多见。免组:CD15,CD30(+)。 ⑵混合细胞型(mixed cellularity)HL 50岁↑,男多，单核,双核R-S细胞多; ⑶淋巴细胞为主型(lymphocyte predominance