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Non- Hodgkins Lymphoma. r isk factor. Elderly Men Predisposed: primary and secondary immunodeficiency states HIV infection Undergone organ transplantation With inherited immune deficiencies Sicca syndromes. etiology. Infectious agents HTLV-1 : adult T cell lymphoma
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risk factor • Elderly • Men • Predisposed: primary and secondary immunodeficiency states • HIV infection • Undergone organ transplantation • With inherited immune deficiencies • Sicca syndromes
etiology • Infectious agents • HTLV-1: adult T cell lymphoma • EBV: Burkitt’s lymphoma, primary CNS lymphoma, extranodal nasal T/NK cell lymphoma, aggressive non-Hodgkin’s lymphoma • HIV: aggressive B cell non-Hodgkin’s lymphoma • H. pylori: gastric MALT lymphoma • Borrelia sp.: skin MALT lymphoma • Chlamydophiliapsittaci: eyes MALT lymphoma • C. jejuni: small intestine MALT lymphoma • Hepatitis C virus: lymphoplasmacytic lymphoma • Human herpes virus 8: primary effusion lymphoma, multicentricCastleman’s disease
etiology • Chemical exposures • Exposure to agriculture chemicals increase incidence of non-Hodgkins lymphoma • Medical treatment • Patients treated for Hodgkin’s disease
immunology • Majority are of B cell in origin • Stage of differentiation does not predict the natural history • Immunologic cell surface phenotype of more primitive cells are less aggressive and more amenable to curative therapy • Apparent stage of differentiation does not reflect the stage at which the genetic lesions that gave rise to the malignancy developed
Cell surface phenotyping is to aid in the differential diagnosis of lymphoid tumors that appear similar by light microscopy • Malignancies of lymphoid cells are associated with recurring genetic abnormalities and can be identified at variety of levels: • Gross chromosomal change • Rearrangement of specific genes • Overexpression, underexpression, mutation of specific oncogenes
Gene profiling • simultaneous assessment of expression of thousand genes • Identify new genes with pathologic importance, patterns of gene expression with diagnostic/prognostic significance, new therapeutic targets