curs nr 15 limfoame maligne mai 2013
DESCRIPTION
limfom malignTRANSCRIPT
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LIMFOAME MALIGNE
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Studiul celulelor hematopoietice:
• Examen citologic si histologic
• Imunofenotipare
• Biologie moleculara
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• Centrale: - maduva hematogena
• - timusul
• Periferice: - ganglioni
• - splina
• - tesut limfoid atasat
mucoaselor ( MALT)
ORGANELE LIMFOIDE:
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ORGANELE LIMFOIDE
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ORGANELE LIMFOIDE
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ORGANELE LIMFOIDE
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NODULUL LIMFATIC
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NODULUL LIMFATIC
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LIMFOAME MALIGNE
DEFINITIE
• Grup heterogen de neoplazii solide cu
originea in celulele sistemului imun
• incidenta 2- 3 % cazuri noi / an
• Organe interesate:
ganglioni limfatici
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DIAGNOSTIC DIFERENTIAL AL
ADENOPATIILOR
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DIAGNOSTIC DIFERENTIAL AL
ADENOPATIILOR
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CARACTERISTICI CLINICE ALE
ADENOPATIILOR
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• Incidenta 1,5-5/100000/an
• Varsta: distributie bimodala 20- 29 ani
• 60 ani
• in Romania distributie unimodala – 20-29 ani
• Sex : raport B: F= 1,3 / 1,4
Limfomul (Boala) Hodgkin
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ETIOPATOGENIE
• Etiologie necunoscuta
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ETIOPATOGENIE
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1. BH predominanta limfocitara (PL)
2. Forma clasica cu 4 subtipuri:
• BH forma clasica bogata in limfocite
• BH Scleroza Nodulara (SN)
• BH Celularitate Mixta ( CM)
• BH Depletie Limfocitara ( DL)
CLASIFICARE HISTOLOGICA
REAL / WHO
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• Semne generale (30%):
- febra fara alta cauza
- pierdere in greutate
- transpiratii nocturne
alte manifestari; prurit, anorexie
• Semne legate de infiltarea tumorala
- adenomegalie
- hepatomegalie / splenomegalie
- extraganglionara ( digestiv, respirator, os )
TABLOU CLINIC
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TABLOU CLINIC- ADENOPATII
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EXAMEN DE LABORATOR
HEMOGRAMA
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EXAMEN DE LABORATOR
MODIFICARI IMUNOLOGICE
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BIOPSIE ganglionara / tesut implicat
- amprenta = Ex. citologic
- sectiuni in parafina
= Ex. histologic
= Ex. Imunohistochimic
- Ex. genetic
DIAGNOSTIC
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DIAGNOSTIC
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DIAGNOSTIC HISTOLOGIC
• 3 criterii:
• Celula maligna= Celula Reed Sternberg,
provine din limfocite B
• Prezenta liniilor celulare reactive:
- Limfocite,
- Eozinofile,
- Plasmocite,
- Granulocite
• Modificarea arhitecturii ganglionare normale-
aspect de GRANULOM
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Celula REED-STERNBERG
Celula mare 20-50 μ, nucleu mare polilobat, nucleoli mari, cromatina
nucleara reticulata, citoplasma abundenta, margini neregulate
Celula Hodgkin -mare, nucleu unic, nucleol unic
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DIAGNOSTIC DIFERENTIAL
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STADIALIZARE ANN ARBOR 1971
modificata 1989
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SCORUL INTERNATIONAL DE
PROGNOSTIC(SIP)
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TRATAMENT
1. RADIOTERAPIE
2. CHIMIOTERAPIE – polichimioterapie-
diferentiat pe stadii de boala
3. TRATAMENT IMUNOLOGIC- in
Limfom Hodgkin (LH) cu
predominenta limfocitara nodulara-
RITUXIMAB- anticorpi monoclonali
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RADIOTERAPIA (RT)
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SCHEME DE POLICHIMIOTERAPIE
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SCHEME DE POLICHIMIOTERAPIE
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SCHEME DE POLICHIMIOTERAPIE
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SCHEME DE POLICHIMIOTERAPIE
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EFECTE SECUNDARE ALE
TRATAMENTULUI IN LH
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EFECTE SECUNDARE ALE
TRATAMENTULUI IN LH
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MALIGNITATI SECUNDARE DUPA
TRATAMENT CT SI/SAU RT IN LH
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LIMFOAMELE NONHODGKIN (LNH)
• DEFINITIE
Grup heterogen de limfoproliferari maligne cu origine in limfocitele B sau T
• EPIDEMIOLOGIE
1,6-17,1/100000/an barbati
0,7-11,7/100000/an femei
• ETIOLOGIE
Necunoscuta
Factori de risc:
Genetic
De mediu
Imunosupresie
Virusi
Agenti mutageni
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FACTORI DE RISC
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FACTORI DE RISC
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FACTORI DE RISC
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Criterii de clasificare histologica:
- tipul celular – celula mica ( centrocit)
- celula mare ( centroblast)
- modelul infiltrarii – nodular
- difuz
- analiza imunohistochimica
- analiza genetica
LIMFOAMELE MALIGNE –NON
HODGKIN CLASIFICARE
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TABLOU CLINIC
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EXAMEN CLINIC
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EXAMEN PARACLINIC
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EXAMEN PARACLINIC
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STADIALIZARE ANN ARBOR 1971
modificata 1989
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FACTORI DE PROGNOSTIC NEGATIV
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TRATAMENT
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TRATAMENT
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TRATAMENT
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TRATAMENT exemple:
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TRATAMENT