Hematologische diagnostiek
Inhoudsopgave
Anatomie en fysiologie van de lymfoïde weefsels ........................................................................... 4
Beenmerg ........................................................................................................................................5
B-lymfocyt ontwikkeling ....................................................................................................................6
Regulatie eiwitten in het germinatief centrum .....................................................................................8
Cell of origin .....................................................................................................................................8
Cluster of differentation CD merkers .................................................................................................9
Rol voor de patholoog ..................................................................................................................10
Verdere investigatie? ...................................................................................................................... 10
Juiste staalname ............................................................................................................................ 11
Klassiek lichtmicroscopisch onderzoek ........................................................................................... 12
Aanvullend moleculair-genetisch onderzoek .................................................................................... 14
Biomerker detectie ......................................................................................................................... 15
Samenstelling van tumor-micromilieu bepaalt prognose .................................................................. 16
Samenvatting ................................................................................................................................. 16
Boek: ..........................................................................................................................................16
Samenvatting ..............................................................................................................................22
Reactieve processen ...................................................................................................................... 23
Tumorale processen ....................................................................................................................... 23
Lymfeklier ...................................................................................................................................... 24
Folliculaire hyperplasie ...............................................................................................................25
Casus ............................................................................................................................................ 27
kenmerken ..................................................................................................................................... 27
Paracorticale hyperplasie ............................................................................................................29
Samenstelling van paracortex ......................................................................................................... 30
Diffuse paracorticale hyperplasie .................................................................................................... 33
Casus ............................................................................................................................................ 34
, Nodulair: Dermatopatische lymfadeniti ........................................................................................... 35
Sinus hyperplasie ........................................................................................................................37
Granulomateuze lymfadenitis ......................................................................................................39
niet-suppuratieve necrotiserend granoloma .................................................................................... 40
Suppuratieve necrotiserende granuloma ......................................................................................... 42
Niet-necrotiserende granulomateuze lymfadenitis ........................................................................... 43
Samenvatting ..............................................................................................................................44
Lymfomen ...................................................................................................................................45
merkers ......................................................................................................................................... 46
Anatomische sites .......................................................................................................................... 48
Etiologie ......................................................................................................................................... 48
Lymfoom diagnostiek ..................................................................................................................... 49
Hodgkin lymfoom ........................................................................................................................49
Rol van EBV bij hodgkin ................................................................................................................... 50
types ............................................................................................................................................. 50
Genetica ........................................................................................................................................ 50
behandeling ................................................................................................................................... 51
Non-Hodgkin lymfoom .................................................................................................................51
Localisatie ..................................................................................................................................... 52
Diagnose ....................................................................................................................................... 52
Klein cellig lymfoom ....................................................................................................................53
casus............................................................................................................................................. 53
Folliculair lymfoom ......................................................................................................................... 53
Casus 2 ......................................................................................................................................... 55
Extranodale marginale zone lymfoom / MALT ................................................................................... 56
Casus 4 ......................................................................................................................................... 57
Mantel cellymfoom ......................................................................................................................... 58
Behandeling ................................................................................................................................... 58
Side note ....................................................................................................................................... 59
Grootcellige lymfomen ................................................................................................................59
Casus 1 ......................................................................................................................................... 59
, DLBCL ........................................................................................................................................... 60
Casus 2 ......................................................................................................................................... 61
Burkitt lymfoom .............................................................................................................................. 62
High grade b-cel lymfoom ............................................................................................................... 62
EBV gerelateerde lymfomen ............................................................................................................ 63
Behandeling agressief B-cel lymfoom .............................................................................................. 63
T/ Nk-cel non hodgkin lymfomen ..................................................................................................64
Diagnose ....................................................................................................................................... 64
Casus 1 ......................................................................................................................................... 65
Perifeer t-cel lymfoom, NOS ............................................................................................................ 65
Casus 2 ......................................................................................................................................... 66
Angio-immunoblastisch T-cel lymfoom ............................................................................................ 66
Casus 3 ......................................................................................................................................... 67
Anaplastisch grootcellig lymfoom ALCL ........................................................................................... 68
Casus 4 ......................................................................................................................................... 68
Mycosis fungoides .......................................................................................................................... 69
Casus 6 ......................................................................................................................................... 69
Samenvatting ................................................................................................................................. 70
, Rol van de hematopatholoog in de diagnostiek van hematologische aandoeningen
-bloed
-beenmerg
-lymfoïde weefsels
Anatomie en fysiologie van de lymfoïde weefsels
-primair
-secundair
Alle lymfocyten vinden hun oorsprong in het beenmerg
Ontstaan in beenmerg -> secundaire lymfoïde organen (malt, milt, lymfeklieren)
Mucosa geassocieerde lymfeklierweefsel: platen van peyer
Elk epitheel dat langdurig onder inflammatie staat -> lymfocyten aantrekken
Chronisch blijven? -> vorming van MALT (= acquired)
Bv langdurige helicobacter gastritis -> wand vorming van lymfoïd weefsel -> kan MALT lymfoom geven
Langdurige inflammatie:
-trigger
-auto-immuunziekte
=> elke plaats kan omvormen tot maligne process
Inhoudsopgave
Anatomie en fysiologie van de lymfoïde weefsels ........................................................................... 4
Beenmerg ........................................................................................................................................5
B-lymfocyt ontwikkeling ....................................................................................................................6
Regulatie eiwitten in het germinatief centrum .....................................................................................8
Cell of origin .....................................................................................................................................8
Cluster of differentation CD merkers .................................................................................................9
Rol voor de patholoog ..................................................................................................................10
Verdere investigatie? ...................................................................................................................... 10
Juiste staalname ............................................................................................................................ 11
Klassiek lichtmicroscopisch onderzoek ........................................................................................... 12
Aanvullend moleculair-genetisch onderzoek .................................................................................... 14
Biomerker detectie ......................................................................................................................... 15
Samenstelling van tumor-micromilieu bepaalt prognose .................................................................. 16
Samenvatting ................................................................................................................................. 16
Boek: ..........................................................................................................................................16
Samenvatting ..............................................................................................................................22
Reactieve processen ...................................................................................................................... 23
Tumorale processen ....................................................................................................................... 23
Lymfeklier ...................................................................................................................................... 24
Folliculaire hyperplasie ...............................................................................................................25
Casus ............................................................................................................................................ 27
kenmerken ..................................................................................................................................... 27
Paracorticale hyperplasie ............................................................................................................29
Samenstelling van paracortex ......................................................................................................... 30
Diffuse paracorticale hyperplasie .................................................................................................... 33
Casus ............................................................................................................................................ 34
, Nodulair: Dermatopatische lymfadeniti ........................................................................................... 35
Sinus hyperplasie ........................................................................................................................37
Granulomateuze lymfadenitis ......................................................................................................39
niet-suppuratieve necrotiserend granoloma .................................................................................... 40
Suppuratieve necrotiserende granuloma ......................................................................................... 42
Niet-necrotiserende granulomateuze lymfadenitis ........................................................................... 43
Samenvatting ..............................................................................................................................44
Lymfomen ...................................................................................................................................45
merkers ......................................................................................................................................... 46
Anatomische sites .......................................................................................................................... 48
Etiologie ......................................................................................................................................... 48
Lymfoom diagnostiek ..................................................................................................................... 49
Hodgkin lymfoom ........................................................................................................................49
Rol van EBV bij hodgkin ................................................................................................................... 50
types ............................................................................................................................................. 50
Genetica ........................................................................................................................................ 50
behandeling ................................................................................................................................... 51
Non-Hodgkin lymfoom .................................................................................................................51
Localisatie ..................................................................................................................................... 52
Diagnose ....................................................................................................................................... 52
Klein cellig lymfoom ....................................................................................................................53
casus............................................................................................................................................. 53
Folliculair lymfoom ......................................................................................................................... 53
Casus 2 ......................................................................................................................................... 55
Extranodale marginale zone lymfoom / MALT ................................................................................... 56
Casus 4 ......................................................................................................................................... 57
Mantel cellymfoom ......................................................................................................................... 58
Behandeling ................................................................................................................................... 58
Side note ....................................................................................................................................... 59
Grootcellige lymfomen ................................................................................................................59
Casus 1 ......................................................................................................................................... 59
, DLBCL ........................................................................................................................................... 60
Casus 2 ......................................................................................................................................... 61
Burkitt lymfoom .............................................................................................................................. 62
High grade b-cel lymfoom ............................................................................................................... 62
EBV gerelateerde lymfomen ............................................................................................................ 63
Behandeling agressief B-cel lymfoom .............................................................................................. 63
T/ Nk-cel non hodgkin lymfomen ..................................................................................................64
Diagnose ....................................................................................................................................... 64
Casus 1 ......................................................................................................................................... 65
Perifeer t-cel lymfoom, NOS ............................................................................................................ 65
Casus 2 ......................................................................................................................................... 66
Angio-immunoblastisch T-cel lymfoom ............................................................................................ 66
Casus 3 ......................................................................................................................................... 67
Anaplastisch grootcellig lymfoom ALCL ........................................................................................... 68
Casus 4 ......................................................................................................................................... 68
Mycosis fungoides .......................................................................................................................... 69
Casus 6 ......................................................................................................................................... 69
Samenvatting ................................................................................................................................. 70
, Rol van de hematopatholoog in de diagnostiek van hematologische aandoeningen
-bloed
-beenmerg
-lymfoïde weefsels
Anatomie en fysiologie van de lymfoïde weefsels
-primair
-secundair
Alle lymfocyten vinden hun oorsprong in het beenmerg
Ontstaan in beenmerg -> secundaire lymfoïde organen (malt, milt, lymfeklieren)
Mucosa geassocieerde lymfeklierweefsel: platen van peyer
Elk epitheel dat langdurig onder inflammatie staat -> lymfocyten aantrekken
Chronisch blijven? -> vorming van MALT (= acquired)
Bv langdurige helicobacter gastritis -> wand vorming van lymfoïd weefsel -> kan MALT lymfoom geven
Langdurige inflammatie:
-trigger
-auto-immuunziekte
=> elke plaats kan omvormen tot maligne process
