Gamze Dal Dilek @gmz_dl

🩸Major WHO Categories of Lymphoid Neoplasms 🩸 Memory pneumonic🧠 "🌃Starry-sky burps (macrophages eat debris), MYC t(8;14) = sugar rush, Ki67=100%, fastest growing toddler ever!" 1. Core Principles of Classification -Integrated Diagnosis: Combines Morphology (architecture), Immunophenotype (Flow/IHC), Genetics(FISH/NGS), and Clinical Context. -Arbitrary Boundaries: The distinction between "leukemia" (blood/marrow) and "lymphoma" (tissue/node) is often fluid (e.g., CLL/SLL). ->Major WHO Categories of Lymphoid Neoplasms 1. Precursor lymphoid neoplasmsExample: B-ALL 2. Mature B-cell neoplasms (most common) 3. Mature T/NK-cell neoplasms 4. Hodgkin lymphoma 5. Rare mixed entitiesExample: Mediastinal gray-zone lymphoma 2. Mature B-Cell Neoplasms: Key Entities ##🌿Follicular Lymphoma (FL) ~25% of lymphomas ->🧬: t(14;18) involving BCL2 and IGH. This causes BCL2 overexpression, which prevents apoptosis. ->Phenotype: CD10+, BCL6+, CD19/CD20+, BCL2+. ->Clinical: 🐢Indolent but can transform into DLBCL. ->Neoplastic germinal center B cells with Follicular growth pattern ## Mantle Cell Lymphoma (MCL) : ~6%🛡️ ->🧬: t(11;14) involving CyclinD1 (CCND1). Drives the G1 → S cell cycle transition. ->Morphology: Small-medium monomorphic lymphocytes ->Phenotype: CD5+, CyclinD1+, SOX11+. (CD10−), CD19/CD20 ->Prognosis 📈: Ki−67 index is the primary driver (>30% is aggressive). ## Marginal Zone Lymphoma (MALT)  ~7%🍕 ->Etiology: 🦠Driven by chronic inflammation (e.g., H. pylori in the stomach, Sjögren’s in salivary glands). ->🧬: t(11;18); presence usually predicts failure to respond to H. pylori antibiotics. ->Sites: Salivary glands, Stomach (most common), Thyroid, Lung ->Pathogenesis: Chronic antigen stimulation ex: H. Pylori, Hashimoto thyroiditis, Sjogren syndrome ->Pathologic hallmark🔬: Lymphoepithelial lesions 🥊 3. Diffuse Large B-Cell Lymphoma (DLBCL) ->The most common NHL, now classified by Cell of Origin (COO): ->GCB Subtype: Derived from germinal centers 🏰. Better prognosis. ->ABC Subtype: ⚡"Activated" post-germinal center cells (B-Cells). Worse prognosis; driven by NF−κB. ->High-Grade "Double-Hit" Lymphoma: Defined by MYC plus BCL2 (and/or BCL6) rearrangements via FISH. Extremely aggressive; poor response to standard R-CHOP use R-EPOCH ->Double-Expressor (DE): 🖼️ Protein only by IHC. ⚠️ Intermediate prognosis Hans Algorithm (IHC): Uses CD10, BCL6, and MUM1 to approximate COO.. Algorithm: 1️⃣ CD10+ → GCB 2️⃣ CD10− + MUM1+ → non-GCB 3️⃣ CD10− + MUM1− + BCL6+ → GCB Otherwise → non-GCB Important DLBCL Variants ->Double-Hit Lymphoma ->Genetics: MYC + BCL2 rearrangements ->Very aggressive. Often treated with R-EPOCH rather than R-CHOP. ->Double-Expressor Lymphoma ->Protein overexpression: MYC, BCL2, Detected by IHC, not genetics. ->Prognosis: Intermediate Treatment BTK inhibitors → ABC EZH2 inhibitors → GCB Other Important Subtypes ->Primary mediastinal large B-cell lymphoma- Young women, large mediastinal mass, Pathways involved: JAK-STAT, NF-κB, PD-L1 overexpression. Important because:→ responds to PD-1 inhibitors -> Primary CNS lymphoma -> Intravascular large B-cell lymphoma ->T-cell/histiocyte-rich DLBCL 🌌 4. Burkitt Lymphoma ->Morphology: "Starry-sky" pattern (tingible body macrophages)(Macrophages = stars; Tumor = sky) ->🧬 : t(8;14) involving MYC. ->Phenotype: Ki−67≈100% (Fastest growing) ->Variants: Endemic (EBV+, jaw), Sporadic (Abdominal), and Immunodeficiency-associated (HIV)🎗️. 🤺 5. T-Cell and NK-Cell Neoplasms Less common but very heterogeneous. 1️⃣ Leukemic/disseminated 2️⃣ Extranodal 3️⃣ Cutaneous 4️⃣ Nodal 1. Peripheral T-Cell Lymphoma (PTCL-NOS)-Common nodal TCL: Divided into GATA3 (poor prognosis) and TBX21 (better prognosis) subtypes. 2. Angioimmunoblastic T-Cell Lymphoma (AITL) ->(TFH origin)🔍 CD10+, PD−1+. Associated with TET2/DNMT3A mutations. 🧬 Patients at risk for B-cell lymphoma/MDS/AML ->Morphology: Vascular proliferation, clear cytoplasm T cells with pin back ground ->Multi-step Model: Often starts with clonal hematopoiesis mutations (TET2, DNMT3A,IDH2) in stem cells, differentiation to TFH (RHOA)Mutation—> Lymphoma development 3. Anaplastic Large Cell Lymphoma (ALCL)🐎 ->"Hallmark" cells (Horseshoe nuclei) ->ALK-Positive: Mostly young patients; t(2;5) NPM1−ALK; excellent prognosis. CD30 +, ->ALK-Negative: Older patients; prognosis depends on genetics, Morphology similar to ALK+ but ALK negative (DUSP22 = good; Triple neg-intermediate, TP63 = poor). ->Primary cutaneous ALCL : Larger tumors >1.5cm, persistent lesions ->Breast Implant-Associated (BIA-ALCL): Occurs in the capsule/seroma around textured implants; CD30+, ALK−, late serum around the implant. #InstaMed #TwitterMD #XMed #ReelMedEd #PathReel #OncoReel #HemeReel #Lymphoma @ASH_hematology @ASHClinicalNews @JCO_ASCO @BloodJournal @NEJM @LancetHaematol @NatureMedicine @VJHemOnc @HemOncToday @TargetedOnc @OncLive @TheLancet @mpnvoice @oncodaily @realbowtiedoc @IMG_Oncologists @OncoAlert @ASCOPost @LymphomaHub @SocietyofHemOnc @OncBrothers @ASCOPost 🩸🩸

The Milan System for Reporting Salivary Gland Cytopathology #cyto_pathology #pathology

Diffuse gliomas - basic facts for residents #whocnstumors #makesurgipatheasy

@glinglerimek Thans a lot 💕 @glinglerimek

One of the highlights of my thesis process 📌new article

✅ Updated, evidence-based reporting standard aligned with WHO 5th ed and AJCC/UICC 8th ed ✅ Defines core vs non-core elements to support accurate staging and uniform reporting of testicular GCTs #openaccess @IntSocUropath @ICCRCancer @Histo_Journal 🔗 onlinelibrary.wiley.com/doi/10.1111/hi…

Histopathology @Histo_Journal

8 months ago

Second edition ICCR dataset for testicular germ cell tumours: a reporting guide for histopathological diagnosis of orchiectomy specimens - Bremmer - 2026 - Histopathology - Wiley Online Library #gupath @daniel_berney #ICCR #openaccess onlinelibrary.wiley.com/doi/10.1111/hi…

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Molecular pathology of testicular germ cell tumours: an update for practicing pathologists - Fichtner - 2026 - Histopathology - Wiley Online Library #openaccess #gupath onlinelibrary.wiley.com/doi/10.1111/hi…

Prostate cancer: Gleason grading (Basic facts for residents)

Hope you all had a wonderful Thanksgiving. What would you call this melanocytic lesion in a 25 year old lady on her forehead? #dermpath p16 is preserved. @SGottesmanMD @kis_lorand @HoustonArsenal @glinglerimek @DrGeeONE @Dr_Jukic @et565 @david_terrano

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HYPERCHROMIC RBCs Hyperchromia = increased cellular Hb concentration (correlates with reduced central pallor on smear). It is seen in several types of poikilocytes (see graphic). If enough RBCs are affected, e.g., in HS or HbCC, it may increase the MCHC.

Recall DOG1-, CD117-, CD34+, perineurial markers neg, S100 etc. neg PDGFRa mutated! cKIT not mutated c.2524_2525delinsAT (p.D842I) Now what do you think?

Dan Graham @DanGrahamMD

a year ago

50s F submucosal gastric mass. Dx/workup? #GIpath #BSTpath #PathTwitter #PathX

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Gastric carcinomas with enteroblastic differentiation have been food for thought for Dr. Vikram Deshpande for some time. Track back through the references in this commentary to explore the topic nicely. J Clin Pathol. 2024 Aug 16;77(9):605-607. PMID: 38538071.

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Burası Saraçhane! x.com/i/broadcasts/1…

T Cell LPDs Hopefully this chart will make your life Easier😀 #hematology #meded #medtwitter #medicine #blooducation

@Dermpathl Thank you🙃 @Dermpathl

Mimics of lymph nodal metastasis #pathtwitter #pathmemes

@Kardiyoloji_ 159

Features of epithelial dysplasia

Low-grade fetal lung adenocarcinoma DOES NOT show: A) Squamous morules B) Subnuclear clearing C) Membranous β-catenin #pulmpath #pathtwitter #pathresidents 📽️🙏@YasmeenButtMD youtu.be/a0kEOMG_qdQ?t=…