Non-Hodgkin's lymphoma pathological complex and diverse. Since the 60 years since the variety of classification schemes have been proposed. With biology, immunology and molecular genetics of development, the new classification scheme will be more suitable for clinical application. When the diagnosis of the disease, the patient must be clear what type of membership, can help the clinician make the right therapeutic strategy. Histological and immunohistochemical staining is necessary for pathological diagnosis and molecular genetics of checks will help to further typing.
1. Non-Hodgkin's lymphoma in the work of the sub-type (working formulation)
Work type (Table 19.1) made in 1982, non-Hodgkin lymphoma classification system, this classification is mainly based on morphological (growth pattern and lymph node cytologic features of tumor cells) and biological progression ( low, medium and high grade) standards, predict patient survival and cure of a certain value. The disadvantage of this type is no difference between B and T cells in the tumor origin, and because of not using immunological and molecular genetic techniques, failed to identify some of the important types. However, because of its use in the clinical classification of a long duration and simple, there are still some reference value.
2. lymphomas of the WH02001 classification
Progress in immunology and genetics, scientists recognize the tumor with morphology, immunology and genetics of the three would be classified NHL of clinical guidance may have greater value. In 1994, the International Lymphoma Study Group based on the morphology of non-Hodgkin lymphoma, immunological and genetic characteristics of the revised proposed REAL classification of lymphoma in Europe and America (RevisedEuropean-American lymphoid neoplasms classification).
In 2001, the REAL classification, based on more than 100 pathologists from around the world, blood disease scientists and oncologists to participate in the development of the WHO lymphoma classification (Table 19.2). This classification is currently the most authoritative and widely used classification. The most notable feature is the type of lymphoma, each identified as a true independent disease (disease entity), morphology, immunophenotype, genetics and clinical features to define each of lymphoma. Morphology is still important, the main basis for some types of morphology to determine; some types of immune phenotype to be based on the diagnosis; there is some type of specific genetic abnormalities; you also need some type of clinical data (such as nodal or extranodal, disseminated or limitations, special anatomic site, etc.) before diagnosis.
Non-Hodgkin's lymphoma, lymphoid neoplasms WH02001 type into 3 categories: B cell neoplasms, T cell and NK cell carcinoma and Hodgkin lymphoma. Many lymphoid neoplasms may manifest as lymphoma and leukemia, such as B cell chronic lymphocytic leukemia and small lymphocytic lymphoma, lymphoblastic lymphoma and lymphoblastic leukemia, Bur-kitt lymphoma and Burkitt leukemia. Thus, WHO classification includes lymphoma and lymphocytic leukemia. In the B cell and T / NK cells in the tumor can be based on two types of tumor cell differentiation into the earliest stages of differentiation and differentiation of precursor cells in the tumor stage of more mature or mature cells around the tumor. These two categories of non-Hodgkin's lymphoma, there are many separate diseases, each disease has its special independent epidemiology, etiology and clinical features, and often have different responses to treatment. Pathologists and clinicians must be aware of each individual disease and clinical behavior of the morphological changes in the scope of the multidisciplinary discussion is possible to accurately diagnose what subtypes.