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Lymphomas
The document discusses several types of lymphomas and tumors that can occur in the mediastinum. It compares mediastinal large B-cell lymphoma to Hodgkin's lymphoma and other entities through immunophenotype analysis. It also examines differential diagnoses between thymoma, T-cell lymphoblastic lymphoma, and other mediastinal masses. Distinct gene expression profiles are noted for mediastinal large B-cell lymphoma compared to other lymphomas.
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Lymphomas
- 1. Lymphomas in theMediastinum
- 2. Mediastinal Large BCell Lymphoma
- 3. Mediastinal Large BCell Lymphoma CD20 CD30
- 4. Immunhistochemische Differentialdiagnose Nodale Diffuse MLBCL Large B Cell Lymphoma CD20, CD79a +++ +++ CD30, CD23 ----/+ +++ IgM, Light chain ++ > ---- ---- CD10 ++ > ---- ---- HLA-DR +++ ---- Bcl-6 +++/- ----
- 5. Mediastinal Large BCell Lymphoma Möller, WHO 2004
- 6. Combined Hodgkin Lymphom& MLBCL CD30+CD15-CD20+ CD30+CD15+CD20-
- 7. Hodgkin Lymphoma ina Mediastinal Lymph Node CD30
- 8. Hodgkin Lymphoma inthe Thymus CD30 CK19
- 9. Pseudoepitheliomatous Hyperplasia &Thymic Cysts CK19 Search for Lymphoma, Thymoma, LCH, Metastasis, Germ Cell Neoplasia
- 10. Immunhistochemische Differentialdiagnose Hodgkin Lymphoma MLBCL (Classical Type; usually NS) CD30 +++ +++ > ---- CD15 + > ---- ----- CD20 -/+ +++ CD79a ---- +++ PanLeu (CD45) ---- +++
- 11. Borderline Cases between HLand Mediastinal Large B Cell Lymphoma ? YES !
- 12. Distinct Gene ExpressionProfile of MLBCL (PMBL)
- 14. Survival of MLBCL(PMBL) Patients
- 16. Conclusions Distinct gene expressionprofile of PMBL (molecular diagnosis) PMBL patients are clinically distinct Close Relationship of PMBL to Hodgkin Lymphoma
- 17. DD between MLBCLand ALCL CD3 CD30 ALK-1
- 18. Immunohistochemical Differential Diagnosis Anaplastic Large Cell MLBCL Lymphoma CD30 +++ +++ > ---- CD15 ---- ----- CD20, CD79a ---- +++ CD3, CD5, CD43, TIA-1 -/++ ----- ALK-1 -/++ -----
- 19. T-LBL des Thymus Infiltrationof Mediastinum & Heart; Pleural Effusions; +/- Leukemia
- 20. Differential Diagnosis ofB1/B2Thymom vs. T-LBL Thymom T-LBL Cytokeratin 19 CD1a Ki67
- 21. DD of StronglyProliferative Mediastinal Processes Thymus Thymoma T-LBL Ki67 not different between Normal Thymus, Thymoma and T-LBL
- 22. Lymphocyte Differentiation inthe Thymus WHO, 2004
- 23. If there isno Abnormal Phenotype of Immature T cells Loss of CD1a, CD3, CD4, CD5, CD8 Overexpression of CD34 > CD10 JH-PCR is monoclonal in ~ 80% of T-LBL Cases
- 24. 42 Year-old Patientwith Sjogren‘s Syndrome
- 26. No Cortico-medullary Differentiation,No Capsule
- 27.
- 28. MALT Lymphoma ofthe Thymus CD20+, CD5-, CD10-, CD23- κ
- 29. Lymphoepithelial Lesions inMALT-Lymphoma of the Thymus Cytokeratin 19 LEL
- 30. 78 year-old Female,No Symptoms, Progressibe Lymphocytosis Mediastinal Mass
- 31. What is DifferentCompared to the Previous Case? HC
- 32.
- 33.
- 34.
- 35.
- 36. Diagnosis : T-ProlymphocyticLeukemia (TPLL)
- 37. Conclusion All Peripheral LymphomasCan Occur in the Mediastinum
- 38. Clinical Relevance ofthe New WHO Classification?
- 39. Therapeutic Decisions inThymoma Patients a) Masaoka Stage b) WHO Histotype c) Resection status 1,0 1,0 Stage 1 1,0 p < 0.05 Type A, AB, B1 ,9 Probability of Survival Probability of Survival Probability of Survival ,9 Stage 3 ,9 ,8 ,8 Stage 2 ,7 R0 resection ,7 ,8 ,6 Type B2 ,6 ,5 ,7 Type B3 ,5 ,4 R 1+2 resection Type C Stage 4 ,4 ,6 ,3 0 10 20 30 0 10 20 30 0 10 20 30 Survival (Years) Survival (Years) Survival (Years) JCO Cancer, 2003; J Clin Oncol, 2004
- 40. Therapeutic Decisions inThymoma Patients Stage Histology OP, RX CHEM Resection Status
- 41. Therapeutic Decisions inThymoma Patients A, AB, B1 B2, B3 Thymomas & Thymome (50%) Thymic Carcinomas (50%) Surgery (RO) Surgery Stage I Stage II Stage III/IV R1, R2 Wait-and-See W&S ? Rx CHEMO Rx & Rx
- 42. C-KIT Expression inThymic Carcinoma A AB B2 B3 SCC 0/112 Type A-B2 1/28 Type B3 19/24 SCC
- 43. ma ma mo mo 1 2 3 T WT - WT - WT - MU thy thy T T IT IT KI KI CK CK B3 B2 5 6 CC CC CC CC ST pe pe C C Responder TS TS TS TS TS TS Ty Ty GI KIT(+) KIT(-) GIST Patient B., A. 100 c-KIT 100 phospho-c-KIT 100 phospho-AKT 100 1 phospho-BAD 20 5 phospho-MAPK (p42+p44) 10 1 phospho-STAT-1 100 1 phospho-STAT-3 Immunohistochemistry CD117 N.E.J.Med. 2004
- 44. Imatinib (-) Imatinib (+)
- 45. Summary • The newWHO Thymoma Classification describes histological, genetic und clinical entities • In addition to tumor stage and resection status, the histological thymoma subtype according to WHO criteria contributes significantly to therapeutic decisions in thymoma patients • Type A, AB and probably B1 thymomas even at stage II do not require any adjuvant treatment after R0-Resection
- 46. Acknowledgements Philipp Ströbel (allin Würzburg) DFG Masayoshi Inoue & W.-Y. Chuang Andreas Zettl Deutsche Hans Konrad Müller-Hermelink Krebshilfe European Thymoma Network Peter Rieckmann (Würzburg) Ralf Gold (Göttingen) EU Wilfried Nix (Mainz) THYMAIDE Berthold Schalke (Regensburg) Reinhard Kiefer (Münster) Michael Semik (Münster) Francesco Scaravilli (London) Nick Willcox, Angela Vincent (Oxford) Alexander Pärt Peterson (Tartu) von Humboldt Foundation