case2 - Case 2A: Lymphoma Boone Morgane, Grine Lynda,...

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Case 2A: Lymphoma Boone Morgane, Grine Lynda, Rogiers Brecht and Titeca Kevin October 20, 2009
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A 54-year-old male is diagnosed with a lymphoma. In the neoplastic cells a t(14;18)(q32;q21) is noted. What are the signs and symptoms of lymphoma? How is lymphoma diagnosed? What is the meaning of the t(14;18)(q32;q21)? t(14;18)(q32;q21): diagnostic tools How should he be treated? What is his prognosis?
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Lymphoma Neoplastic proliferations of lymphocytes arising as discrete tissue masses
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Signs and symptoms of lymphoma c Swollen lymph nodes c Sudden and unexpected weight loss c Fever c Night sweats c Fatigue c Lower back pain due to pressure of lymph nodes c Itchy skin, rashes and lesions can be a sign of lymphoma (esp. cutaneous lymphoma)
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Lymphoma Diagnosis
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Lymphoma Diagnosis Grading and staging to determine therapy: imaging studies (PET, MRI, CT) blood tests bone marrow tests surgical and physical examination cytogenetic analysis (translocation)
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Lymphoma diagnosis (2)
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t(14;18)(q32;q21) Translocation of band 3 sub-band 2, q-arm of chr 14 to 18q21 Most commonly: t(14;18)(q32;q21)( IgH/BCL2) OE of BCL-2 by Ig heavy chain enhancer Most common translocation in B-cell lymphoma’s: 14 18 c 85% of follicular lymphoma’s c 30% of diffuse large B-cell lymphoma’s c rarely others! t(14;18)(q32;q21)( IgH/MALT1 ) OE of MALT1 Rare: only in 3% of MALT-lymphoma’s IgH BCL2
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Why so common in B-cell lymphoma’s? Inherent genomic instability of B-cells V(D)J recombination Class switching t(14;18)(q32;q21) (2) Somatic hypermutation Translocation mostly occurs in pre-B cell stage
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t(14;18)(q32;q21) (3): consequences Stamatopoulos et al, Immunol. Today 2000, 21(6):298-305
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case2 - Case 2A: Lymphoma Boone Morgane, Grine Lynda,...

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