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1496 Part XI: Malignant Lymphoid Diseases Chapter 90: Classification of Malignant Lymphoid Disorders 1497

TABLE 90–1. Classification of Lymphoma and Lymphoid Leukemia by World Health Organization (Continued)
Neoplasm Morphology Phenotype* Genotype †
B-cell lymphoma Confluent, diffuse, sheet- In contrast to HL, CD45+. Positive for Poorly characterized
unclassifiable, features like growth of pleomor- CD30 and CD15
intermediate between phic cells within a fibrotic
DLBCL and classical stroma. Pleomorphic cells
Hodgkin lymphoma resembling HL R-S–like cells
(HL) and lacunar cells. Necrosis
frequent
Plasma Cell Neoplasms
Monoclonal gammop- Marrow infiltrate with M-protein <30 g/L, marrow <10% Abnormal cytogenetics rarely
athy of undetermined mature plasma cells com- plasma cells, no end-organ damage. encountered in MGUS. FISH studies
significance (MGUS) prising 1–9% of cellularity CD138+. Often difficult to demon- involving IgH occur in ~50% of cases:
strate LC restriction because of small t(11;14), t(4;14). Del13q. Hyper-
numbers of plasma cells diploidy 40%
Plasma cell myeloma Myeloma plasma cells seen sIg+, CD5-, CD10-, CD19-, CD20-, IgR, commonly with complex karyo-
in marrow arranged in CD38+(bright), CD45+/-, CD56+, types and or t(6;14)(p25;q32) involv-
interstitial clusters CD117+(bright), CD138+(bright) ing MUM1. t(11;14) seen in 15–25%
cases
Extraosseous Plasma cells in extraos- Same as plasma cell myeloma Same as above
plasmacytoma seous organs must be
distinguished from other
lymphoproliferative disor-
ders (i.e., MALT type)
Solitary plasmacytoma Plasma cells Same as plasma cell myeloma Same as above
of bone
Monoclonal immuno- Prominent organ (kidney LCDD is κ light chain predominant. HCDD with VλVI overrepresentation.
globulin deposition most common, occasion- HCDD shows λ chain predominance. LCDD with VκIV variable region
disease ally liver, heart, nerve, Marrow may show abnormal κ/λ ratio
blood vessels involved)
deposits of nonamyloid,
nonfibrillary, amorphous
eosinophilic material that
does not stain with congo
red. Heavy chain (HCDD)
and light chain (LCDD)
Hodgkin Lymphoma (Hl)
Nodular lymphocyte pre- “Popcorn cells” with nuclei BCL6+, CD19+, CD20+, CD22+, IgR, with high-level expression of
dominant HL resembling those of CD45+, CD79a+, CD15-, and rarely BCL6
(Chap. 97) centroblasts CD30+/-, Bob1+, Oct2+, PAX5+
Classic Hl (Chap. 97)
Nodular sclerosis HL R-S cells and lacunar cells R-S cells typically are CD15+, R-S cells generally express PAX5 and
dispersed in reactive lym- CD20-/+, CD30+, CD45-, CD79a-, MUM1, variable expression of BCL6,
phoid nodules PAX5+(dim) and have IgR without functional Ig
Lymphocyte-rich HL Few R-S cells with occa- Same as above Same as above
sional “popcorn” appear-
ance dispersed in lymphoid
nodules
Mixed cellularity HL R-S cells dispersed among R-S cells typically are CD15+, R-S cells generally express PAX5 and
plasma cells, epithelioid CD20-/+, CD30+, CD45-, CD79a- MUM1, variable expression of BCL6,
histiocytes, eosinophils, and have IgR without functional Ig
and T cells
Lymphocyte-depleted HL Prominent numbers of R-S Same as above Same as above
cells with effacement of the
nodal structure
(Continued)

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