Clinical Hematology Series

Lymphoma

From pathogenesis to management — classification, presentation, staging, and immunotherapy.

15 slides·English·2026
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Title slide with a large 3D rendering of a purple lymphocyte covered in surface projections beside the deck title.
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Lymphoma

Malignant Lymphoproliferative Disorders: From Pathogenesis to Clinical Management

Physiology | Classification | Diagnosis | Immunotherapy

Three labeled cell diagrams comparing B-cells, T-cells (with surface receptors) and NK cells, with an origin note along the bottom.
02 / 15

Clinical editorial

The Defenders: Physiology of Lymphocytes

B-Cells

Humoral Immunity: Antibody production & Antigen presentation.

T-Cells

Surface markers shown on the T-cell diagram: TCR, CD28, CD2, CD3, TCR, CD4, CD8.

Cell-Mediated Immunity: Direct killing (Tc) & Regulation (Th).

NK Cells

Innate Surveillance: Rapid response to viral/tumor cells.

Origin: All lineages arise from hematopoietic stem cells in the Bone Marrow. T-cells migrate to the Thymus for mat… [text truncated at slide edge, presumably "maturation"]

Left-to-right flow diagram of B-cell maturation across three anatomical compartments with associated immunophenotype markers beneath each.
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The Journey: B-Cell Differentiation Timeline

Bone Marrow: Stem Cell → Pro-B → Pre-B → Immature B (markers: CD10+, CD19+)

Peripheral Blood: Naive B-Cell, expressing IgD and IgM (markers: IgD+, CD20+)

Lymph Node Germinal Center: Centroblast → Centrocyte → which differentiates into either Plasma Cell or Memory B-Cell (markers: CD38+, CD138+)

Two-column slide listing risk factors on the left and, beside a pair of chromosome illustrations, key genetic translocations on the right.
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Pathogenesis: Malignant Transformation

Risk Factors

  • Infections: Chronic antigenic stimulation (Viral/Bacterial)
  • Immune Status: Immunodeficiency (Post-transplant), Autoimmune diseases (SLE, RA)
  • Environmental: Immunosuppressant medications

Genetic Translocations

  • t(11,14): Cyclin D1 (Mantle Cell Lymphoma)
  • t(14,18): BCL2 (Follicular Lymphoma)
  • t(8,14): C-Myc (Burkitt Lymphoma)
Hierarchy diagram with Lymphoid Neoplasms at the top branching into four categories, each with a bulleted list of example entities.
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The WHO Classification System

Lymphoid Neoplasms branch into four categories:

Mature B-Cell Neoplasms

  • CLL/SLL
  • Follicular
  • Diffuse Large B-cell
  • Burkitt
  • Mantle Cell

Mature T/NK-Cell Neoplasms

  • Mycosis fungoides
  • Peripheral T-cell lymphoma
  • Anaplastic large cell

Hodgkin Lymphoma

  • Nodular Sclerosis
  • Mixed Cellularity

Precursor Neoplasms

  • Lymphoblastic Leukemia/Lymphoma
Cross-section diagram of a lymph node follicle showing the mantle zone and follicle center, with callouts linking each zone to the lymphomas that arise there.
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Anatomy of a Malignancy: The Germinal Center

Diagram: Lymph Node Germinal Center (Follicle), with labeled Mantle Zone and Follicle Center Center.

  • Mantle Zone → Mantle Cell Lymphoma
  • Follicle Center → Follicular Lymphoma, Burkitt Lymphoma, DLBCL
  • Post-Germinal (cells exiting the follicle) → Plasma Cell Myeloma, MALT Lymphoma
Grey body silhouette with red markers annotated by callouts describing systemic, nodal, gastrointestinal and skin manifestations of lymphoma.
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Clinical Presentation: The Great Mimicker

  • Systemic B-Symptoms: Unexplained Fever, Drenching Night Sweats
  • Weight Loss (>10%)
  • Nodal: Painless, rubbery enlargement
  • GI Mass / Obstruction
  • Rash / Mycosis Fungoides
Body silhouette overlaid with the lymphatic system, circling key nodal regions and the spleen and liver, each with a labeled callout.
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Physical Examination & Nodal Regions

  • Cervical & Supraclavicular (Virchow's Node): High risk for thoracic/abdominal malignancy
  • Axillary & Epitrochlear: Arm drainage
  • Axillary & Epitrochlear: Arm drainage
  • Spleen & Liver: Assess for organomegaly
  • Inguinal: Lower extremity drainage
Three-column table listing paraneoplastic syndromes with their clinical presentation and the associated malignancy or antibody.
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Paraneoplastic Syndromes

SyndromePresentationAssociated Malignancy/Antibody
Limbic Encephalitis (Ophelia Syndrome)Memory loss, confusionHodgkin Lymphoma (Anti-mGLU5)
Cerebellar DegenerationAtaxia, balance issuesHodgkin Lymphoma (Anti-Tr)
Myasthenia GravisMuscle weaknessThymoma / Lymphoma
DermatomyositisSkin rash + muscle weaknessNHL
Four large icon cards spelling P-U-C-K with up or down arrows depicting the electrolyte derangements of tumor lysis syndrome, plus a management line below.
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Medical Emergency: Tumor Lysis Syndrome (TLS)

Metabolic complications caused by rapid cell death.

  • P – HyperPhosphatemia (increased): Causing calcium precipitation
  • U – HyperUricemia (increased): Causing renal failure/crystals
  • C – HypoCalcemia (decreased): Causing seizures, tetany
  • K – HyperKalemia (increased): Causing arrhythmias

Management: Aggressive hydration, Allopurinol, Rasburicase

Text-only clinical case slide organized into History, Physical Exam, Labs and a Diagnostic Dilemma section.
11 / 15

Case Study: 22-Year-Old Female

History:

  • 8 months of fatigue, weight loss, joint pain (knees).
  • Hair loss.

Physical Exam:

  • Hepatomegaly & Splenomegaly present.
  • No superficial lymphadenopathy.

Labs:

  • Leucopenia, Normocytic anemia.
  • High LDH.
  • Positive ANA.

The Diagnostic Dilemma: Positive ANA + Joint Pain suggests Lupus (SLE), but High LDH + Organomegaly raises suspicion for Malignancy.

Two-panel comparison contrasting fine needle aspiration on the left with excisional biopsy of a lymph node on the right.
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The Diagnostic Challenge: Tissue is the Issue

Fine Needle Aspiration (FNA)

Cytology only. Loss of architecture. Result: 'Reactive lymphoid proliferation' (False Negative).

Excisional Biopsy

Gold Standard. Preserves architecture. Result: Accurate WHO Classification.

Anatomical skeleton illustration with glowing liver and spleen labeled, beside a bulleted list on imaging modalities and case resolution.
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Staging and Imaging

Illustration labels: Liver and Spleen.

  • PET/CT: Metabolic assessment identifying 'hot spots' of rapid cell division.
  • CT Scan: Assess organ involvement (Liver/Spleen size).
  • Case Resolution: Imaging confirmed aggressive disease despite initial reactive biopsy.
Diagram of Rituximab binding the CD20 antigen on a B-cell, marking it for destruction by an immune effector cell, beside a numbered list of treatment pillars.
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Therapeutic Strategies: Focus on Immunotherapy

Diagram: Rituximab (Monoclonal Antibody) binds the CD20 Antigen on a B-cell, which is then Marked for Destruction.

Four Pillars of Treatment

  1. Chemotherapy (CHOP)
  2. Radiotherapy
  3. Immunotherapy (Anti-CD20)
  4. Targeted Molecular Therapy
Checklist slide summarizing five key clinical takeaways, each with a checkbox and bold lead-in term.
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Clinical Takeaways

  1. Definition: Malignancy of mature lymphocytes arising in lymph nodes or extranodal tissue.
  2. Pathogenesis: Driven by genetic translocations (e.g., t(14,18)) and immune dysregulation.
  3. Diagnosis: The "Great Mimicker." Excisional biopsy is mandatory to assess nodal architecture.
  4. Emergency: Monitor for Tumor Lysis Syndrome (Hyperkalemia, Hyperuricemia).
  5. Treatment: Accurate histological classification guides targeted immunotherapy (Anti-CD20).