Page 444 - Robbins Basic Pathology by Vinay Kumar, Abul K. Abbas, Jon C. Aster

430 C H A P T E R 11 Hematopoietic and Lymphoid Systems T cell neoplasms
THYMUS
B cell neoplasms
BONE MARROW DN
CLP
DP
Precursor B BLB Precursor T
lymphoblastic NBC lymphoblastic
lymphoma/ PC
leukemias lymphoma/
Small lymphocytic leukemias
lymphoma
Chronic CD4 CD8
lymphocytic
leukemia

Multiple myeloma

Mantle cell lymphoma MC

Follicular lymphoma PTC Peripheral
Burkitt lymphoma T cell
Diffuse large B cell
lymphomas
lymphoma
Hodgkin’s lymphoma GC MZ

Diffuse large B cell lymphoma LYMPH NODE
Marginal zone lymphoma
Small lymphocytic lymphoma
Chronic lymphocytic leukemia

Figure 11–13 Origin of lymphoid neoplasms. Stages of B and T cell differentiation from which specific lymphoid and tumors emerge are shown. BLB,
pre-B lymphoblast; CLP, common lymphoid progenitor; DN, CD4−/CD8− (double-negative) pro-T cell; DP, CD4+/CD8+ (double-positive) pre-T cell;
GC, germinal center B cell; MC, mantle zone B cell; MZ, marginal zone B cell; NBC, naive B cell; PC, plasma cell; PTC, peripheral T cell.

• Precursor B and T cell lymphoblastic lymphoma/ Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma
leukemia—commonly called acute lymphoblastic leuke-
mia (ALL) Acute lymphoblastic leukemia (ALL) and lymphoblastic
lymphoma are aggressive tumors, composed of immature
• Chronic lymphocytic leukemia/small lymphocytic lymphocytes (lymphoblasts), that occur predominantly in
lymphoma children and young adults. The various lymphoblastic
tumors are morphologically indistinguishable, often cause
• Follicular lymphoma similar signs and symptoms, and are treated similarly.
• Mantle cell lymphoma These tumors are therefore considered together here.
• Diffuse large B cell lymphomas
• Burkitt lymphoma Just as B cell precursors normally develop within the
• Multiple myeloma and related plasma cell tumors bone marrow, pre-B cell tumors usually manifest in the
• Hodgkin lymphoma bone marrow and peripheral blood as leukemias. Similarly,
pre-T cell tumors commonly manifest as masses involving
Together these neoplasms constitute more than 90% of the the thymus, the normal site of early T cell differentiation.
lymphoid tumors seen in the United States. However, pre-T cell “lymphomas” often progress rapidly
to a leukemic phase, and other pre-T cell tumors seem to
The salient features of the more common lymphoid leu- involve only the marrow at presentation. Hence, both pre-B
kemias, non-Hodgkin lymphomas, and plasma cell tumors and pre-T cell tumors usually take on the clinical appearance of
are summarized in Table 11–8. Hodgkin lymphomas will ALL at some time during their course. As a group, ALLs con-
be discussed later. Also included in the following discus- stitute 80% of childhood leukemia, peaking in incidence at
sion are a few of the uncommon entities with distinctive age 4, with most cases being of pre-B cell origin. The pre-T
clinicopathologic features. cell tumors are most common in male patients between 15
and 20 years of age.