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       HOW-TO      

.  This is a tutorial about lymphomas: non-Hodgkin lymphomas, Hodgkin lymphomas, and plasma cell dyscrasias. These three entities make up the three large supersections on the Table of Contents, and each supersection is subdivided into several main pages or sections. The emphasis is on how these lymphomas are diagnosed and what the important morphological and biological distinctions are among them. Text and copious color illustrations are supplied, as well as hyperlinks between associated sections.
        The tutorial is designed to be useful to pathologists, treating clinicians, and health professionals who care for patients with lymphomas. Residents, health professions students, and lay people will also find here the answers to many lymphoma-related questions.
         The objectives of this course are to gain a useful understanding of various aspects of non-Hodgkin lymphomas, Hodgkin lymphomas, and plasma cell dyscrasias. Upon completion of this tutorial, readers should be able to:
  1. Discuss the epidemiology of lymphomas.
  2. Explain the behavior and prognosis of different kinds of lymphomas, including some of the biological mechanisms underlying their evolution.
  3. Classify lymphomas according to the currently up-to-date WHO Classification.
  4. Enumerate the techniques used to diagnose lymphomas in the laboratory, including immunoperoxidase staining, flow cytometry, and cytogenetics.
  5. Identify the morpohological distinctions between lymphomas, including what each individual type looks like and what features characterize larger classes of lymphomas such as follicular lymphomas or T-cell lymphomas.
  6. Differentiate between supergroups of lymphomas, such as non-Hodgkin versus Hodgkin, low-grade versus high-grade, T-cell versus B-cell.
  7. Distinguish among benign and malignant lymphoid proliferations, such as lymphomas versus reactive adenopathies, or mulitple myeloma versus monoclonal gammopathies of uncertain significance.
        The section on non-Hodgkin lymphomas (the largest) tackles first B-cell and then T-cell lymphomas. The B-cell lymphomas are considered as they are named in the WHO Classification. For conceptual purposes they are grouped as follows:
  • Low-grade lymphomas with diffuse growth: small lymphocytic lymphoma/chronic lymphocytic leukemia, lymphoplasmacytic lymphoma, marginal zone lymphoma.
  • Mantle cell lymphoma: a diffuse lymphoma with relatively mature-appearing, medium-sized cells that is aggressive in behavior.
  • Follicular lymphomas: lymphomas with a follicular growth pattern.
  • Diffuse large cell lymphomas: a broad class of lymphomas with a diffuse growth pattern and aggressive morphological and clinical features.
  • High grade lymphomas: lymphoblastic lymphoma and Burkitt lymphoma.
How to Live, What to Do:  You can study the tutorial as a whole or peruse one of subtopics. Probably the best way to do either is to view each main page as a unit, jumping back and forth between the main page and its associated illustrative pages (indicated as links within the main page). Most of the links within each main page take you to subpages stuffed with photomicrographs. When you're done with a main page, you can jump to the succeeding one by clicking on the Next link.
        Occasionally links will take you elsewhere, such as to other main pages in the tutorial or to other hematopathology web sites with relevant material. Remember, any time you leave a main page or section, returning is as simple as clicking on your browser's Back button. Also, each main page contains links to the previous and next ones; if you get lost, the Table of Contents can redirect you to your target.
        The less linear-minded may choose to careen around the site more randomly, like bees buzzing from bloom to bloom to skim off the nectar.

Navigation:  Each of the main sections or pages is listed in the Table of Contents. Navigational aids are located on each of these main section pages toward the top of the blue band at the left of the page and also at the bottom of the page. Using these aids, the reader can click to jump either to the Table of Contents, the next section, or the previous one. Thus a tireless reader could traverse the entire tutorial in order without ever having to return to the Table of Contents.
        Each section or page also contains links to pages with additional illustrations. If you visit one of these illustrative pages, you should use the Back button of your web browser to return to the main section page you just left. On each illustrative page, you will also find links to the Table of Contents.

         Whatever your degree of medical sophistication, I hope you find something useful here. And enjoy the photomicrographs--they are the soul of the tutorial.

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Copyright © 2006 David Weissmann. All rights reserved.