演題詳細

シンポジウム / Symposium

【E】シンポジウム3 (Symposium 3) : New Trends and Challenges in the Management of Malignant Lymphoma
(共催:日本リンパ網内系学会 / The Japanese Society for Lymphoreticular Tissue Research)

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日程
2013年10月11日(金)
時間
13:55 - 16:25
会場
第2会場 / Room No.2 (さっぽろ芸文館 3F 瑞雪)
座長・司会
木下 朝博 (Tomohiro Kinoshita):1、吉野 正 (Tadashi Yoshino):2
1:Aichi Cancer Center Hospital, Japan、2:Department of Pathology, Okayama University, Japan
 
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The WHO classification of lymphomas -the present and beyond: Illuminating the incipient events in lymphoid neoplasms

演題番号 : SY3-1

Elaine S. Jaffe:1

1:Laboratory of Pathology, Hematopathology Section, National Cancer Institute, National Institutes of Health, USA

 

Why are there no “benign lymphomas”? This fact is related to the nature of lymphoid cells to circulate and home as part of their normal function. Thus, benign clonal expansions of lymphocytes are only rarely recognized when localized. Since the publication of the WHO classification in 2001, there has been a greater recognition of the earliest steps in lymphoid neoplasia. In the 2008 WHO classification several new entities were incorporated that define clonal lymphoid proliferations of limited malignant potential. Many of these are counterparts of well-recognized lymphomas or lymphoid leukemias, such as follicular lymphoma in situ (FLIS), mantle cell lymphoma in situ (MCL-IS), and monoclonal B-lymphocytosis (MBL). These clonal proliferations carry many of the molecular hallmarks of their malignant counterparts, such as BCL2/IGH and CCND1/IGH translocations associated with FLIS and MCL-IS respectively. Similarly, MBL has some of the cytogenetic alterations associated with chronic lymphocytic leukemia (CLL). Molecular characterization of these disorders and their malignant counterparts can serve to indentify the key alterations associated with clinical progression, and may help to predict whether progression to lymphoma will occur.

There are other clonal lymphoid proliferations of uncertain malignant potential that are not counterparts of established lymphoma subtypes. These include the pediatric variants of follicular lymphoma and marginal zone lymphoma, which typically present with localized disease, and can be managed conservatively in most instances. Indolent clonal T-cell proliferations also have been recognized. For example, seroma-associated anaplastic large cell lymphoma associated with breast implants is a cytologically alarming lesion that is self-limited if confined to the seroma cavity. An indolent form of T-cell lymphoproliferative disease affecting the gastrointestinal tract has been described. Usually, CD8+, the clonal cells are confined to the mucosa. The clinical course is chronic, but non-progressive. NK-cell enteropathy is a clinically similar condition, composed of cytologically atypical NK-cells that may involve the stomach, small bowel or colon. Atypical lymphoid proliferations that lie at the border of benign and malignant can serve as instructive models of lymphomagenesis. It is also critical that they be correctly diagnosed, to avoid unnecessary and potentially harmful therapy.

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